Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Int Orthop. 2011 Sep;35(9):1375-80. doi: 10.1007/s00264-010-1152-z. Epub 2010 Nov 18.
The purpose of this study was to compare the outcome, complications and survival of the three most commonly used surgical reconstructions of the proximal humerus after transarticular tumour resection. Between 1985 and 2005, 38 consecutive proximal humeral reconstructions using allograft-prosthesis composite (n = 10), osteoarticular allograft (n = 13) or a modular tumour prosthesis (n = 14) were performed in our clinic. The mean follow-up was ten years (1-25). Of these, 27 were disease free at latest follow-up (mean 16.8 years) and ten had died of disease. The endoprosthetic group presented the smallest complication rate of 21% (n =1), compared to 40% (n = 4) in the allograft-prosthesis composite and 62% (n = 8) in the osteoarticular allograft group. Only one revision was performed in the endoprosthetic group, in a case of shoulder instability. Infection after revision (n = 3), pseudoarthrosis (n = 2), fracture of the allograft (n = 3) and shoulder instability (n = 4) were the major complications of allograft use in general. Kaplan-Meier analysis showed a significantly better implant survival for the endoprosthetic group (log-rank p = 0.002). At final follow-up the Musculoskeletal Tumour Society scores were an average of 72% for the allograft-prosthetic composite (n = 7, median follow-up 17 years), 76% for the osteoarticular allograft (n = 3, 19 years) and 77% for the endoprosthetic reconstruction (n = 10, 5 years) groups. An endoprosthetic reconstruction after transarticular proximal humeral resection resulted in the lowest complication rate, highest implant survival and comparable functional results when compared to allograft-prosthesis composite and osteoarticular allograft use. We believe that the surgical approach that best preserves the abductor mechanism and provides sufficient surgical exposure for tumour resection contributed to better functional results and glenohumeral stability in the endoprosthetic group.
本研究旨在比较经关节肿瘤切除后三种最常用的肱骨近端重建术的结果、并发症和存活率。1985 年至 2005 年间，我们诊所共进行了 38 例肱骨近端重建术，其中使用同种异体-假体复合材料（n=10）、关节骨同种异体移植（n=13）或模块化肿瘤假体（n=14）。平均随访时间为 10 年（1-25 年）。其中，27 例在最新随访时无疾病（平均随访 16.8 年），10 例死于疾病。在假体组中，并发症发生率最小，为 21%（n=1），而在同种异体-假体复合材料组中为 40%（n=4），在关节骨同种异体移植组中为 62%（n=8）。在假体组中仅进行了一次翻修，用于治疗肩关节不稳定。在同种异体移植中，一般来说，翻修后的感染（n=3）、假关节（n=2）、同种异体移植骨折（n=3）和肩关节不稳定（n=4）是主要并发症。Kaplan-Meier 分析显示，假体组的植入物存活率明显更好（对数秩检验 p=0.002）。在最终随访时，同种异体-假体复合材料组的肌肉骨骼肿瘤协会评分平均为 72%（n=7，中位随访时间为 17 年），关节骨同种异体移植组为 76%（n=3，19 年），假体重建组为 77%（n=10，5 年）。与同种异体-假体复合材料和关节骨同种异体移植相比，经关节肱骨近端切除后行假体重建的并发症发生率最低、植入物存活率最高、功能结果相当。我们认为，保留外展肌机制并为肿瘤切除提供足够手术暴露的手术方法有助于假体组获得更好的功能结果和盂肱稳定性。
