Spiegelberg B G I, Sewell M D, Aston W J S, Blunn G W, Pollock R, Cannon S R, Briggs T W R
The Royal National Orthopaedic Hospital, Middlesex, UK.
J Bone Joint Surg Br. 2009 Oct;91(10):1373-7. doi: 10.1302/0301-620X.91B10.22076.
This paper describes the preliminary results of a proximal tibial endoprosthesis which spares the knee joint and enables retention of the natural articulation by replacing part of the tibial metaphysis and diaphysis. In eight patients who had a primary malignant bone tumour of the proximal tibia, the distal stem, which had a hydroxyapatite-coated collar to improve fixation, was cemented into the medullary canal. The proximal end had hydroxyapatite-coated extracortical plates which were secured to the remaining proximal tibial metaphysis using cortical screws. The mean age of the patients at operation was 28.9 years (8 to 43) and the mean follow-up was for 35 months (4 to 48). The mean Musculoskeletal Tumour Society score was 79% (57% to 90%), the mean Oxford Knee score was 40 points of 48 (36 to 46) and the mean knee flexion was 112 degrees (100 degrees to 120 degrees). In one patient, revision to a below-knee amputation through the prosthesis was required because of recurrence of the tumour. Another patient sustained a periprosthetic fracture which healed with a painful malunion. This was revised to a further endoprosthesis which replaced the knee. In the remaining six patients the prosthesis allowed preservation of the knee joint with good function and no early evidence of loosening. Further follow-up is required to assess the longevity of these prostheses.
本文描述了一种保留膝关节的胫骨近端假体的初步结果，该假体通过替换部分胫骨干骺端和骨干，能够保留自然关节。在8例患有胫骨近端原发性恶性骨肿瘤的患者中，具有羟基磷灰石涂层套环以改善固定的远端柄被骨水泥固定于髓腔内。近端有羟基磷灰石涂层的皮质外板，使用皮质螺钉固定于剩余的胫骨近端干骺端。患者手术时的平均年龄为28.9岁（8至43岁），平均随访时间为35个月（4至48个月）。肌肉骨骼肿瘤学会平均评分为79%（57%至90%），牛津膝关节平均评分为48分中的40分（36至46分），膝关节平均屈曲度为112度（100度至120度）。1例患者因肿瘤复发，需要通过假体进行膝下截肢翻修手术。另1例患者发生假体周围骨折，愈合后出现疼痛性畸形愈合。对此进行翻修，更换为另一种替代膝关节的假体。其余6例患者的假体使膝关节得以保留，功能良好，且无早期松动迹象。需要进一步随访以评估这些假体的使用寿命。
