膝关节周围原发性肿瘤的人工关节置换术:来自北京大学的经验
Endoprosthetic replacement for primary tumours around the knee: experience from Peking University.
作者信息
Guo W, Ji T, Yang R, Tang X, Yang Y
机构信息
Musculoskeletal Tumor Centre, People's Hospital, Peking University, 11# Xizhimen Nan Road, Xicheng District, Beijing, 100044, China.
出版信息
J Bone Joint Surg Br. 2008 Aug;90(8):1084-9. doi: 10.1302/0301-620X.90B8.20240.
In developing countries locally-made low-cost prostheses are mainly used in limb-salvage surgery to alleviate the economic burden. We retrospectively collected data on 104 patients treated by limb-salvage surgery between July 1997 and July 2005. We used a locally-designed and fabricated stainless-steel endoprosthesis in each case. Oncological and functional outcomes were evaluated at a mean follow-up of 47 months (12 to 118). A total of 73 patients (70.2%) were free from disease, nine (8.7%) were alive with disease, 19 (18.2%) had died from their disease and three (2.9%) from unrelated causes. According to the Musculoskeletal Tumor Society scoring system, the mean functional score was 76.3% (SD 17.8). The five-year survival for the implant was 70.5%. There were nine cases (8.7%) of infection, seven early and two late, seven (6.7%) of breakage of the prosthesis, three (2.9%) of aseptic loosening and two (1.9%) of failure of the polyethylene bushing. Multivariate analysis showed that a proximal tibial prosthesis and a resection length of 14 cm or more were significant negative prognostic factors. Our survival rates and Musculoskeletal Tumor Society functional scores are similar to those reported in the literature. Although longer follow-up is needed to confirm our results, we believe that a low-cost custom-made endoprosthesis is a cost-effective and reliable reconstructive option for limb salvage in developing countries.
在发展中国家,本地制造的低成本假体主要用于保肢手术,以减轻经济负担。我们回顾性收集了1997年7月至2005年7月期间接受保肢手术治疗的104例患者的数据。每例患者均使用了本地设计和制造的不锈钢内置假体。在平均随访47个月(12至118个月)时评估肿瘤学和功能结果。共有73例患者(70.2%)无疾病,9例(8.7%)带瘤生存,19例(18.2%)死于疾病,3例(2.9%)死于无关原因。根据肌肉骨骼肿瘤学会评分系统,平均功能评分为76.3%(标准差17.8)。植入物的五年生存率为70.5%。有9例(8.7%)感染,7例早期感染和2例晚期感染,7例(6.7%)假体断裂,3例(2.9%)无菌性松动,2例(1.9%)聚乙烯衬套失效。多因素分析表明,胫骨近端假体和切除长度14 cm或更长是显著的负面预后因素。我们的生存率和肌肉骨骼肿瘤学会功能评分与文献报道的相似。尽管需要更长时间的随访来证实我们的结果,但我们认为低成本定制内置假体是发展中国家保肢的一种经济有效且可靠的重建选择。