McGrath Anthony, Sewell Mathew D, Hanna Sammy A, Pollock Robin C, Skinner John A, Cannon Stephen R, Briggs Timothy W R
London Bone and Soft Tissue Tumour Service, The Royal National Orthopaedic Hospital, Stanmore, U.K.
Acta Orthop Belg. 2011 Apr;77(2):171-9.
The optimal reconstructive method following segmental resection of malignant tumours in the humeral diaphysis is unknown as there are no prospective long-term studies comparing biologic with endoprosthetic reconstruction. This is a retrospective review of 13 patients who, between 1995 and 2010, had undergone limb salvage at our institution using a custom-made humeral diaphyseal endoprosthetic replacement following excision of malignant bone disease. There were 9 males and 4 females with a mean age of 35 years at the time of surgery (range: 10 to 78). Mean follow-up was 56.8 months (range: 5 to 148). Cumulative patient survival was 75% at 10 years. Implant survival, with removal of the endoprosthesis or part of it for any reason as an end point, was 47% at 10 years. Seven patients required revision (54%). Complications included metastases in four, aseptic loosening in four, peri-prosthetic fracture in two and local recurrence in two. Mean MSTS and TESS scores were 23 (18 to 27) and 67% (52-80) respectively. Custom-made humeral diaphyseal replacement following resection of malignant bone tumours provided functional results superior to amputation, without an obvious compromise in patient survival. There was a relatively high revision rate for aseptic loosening and peri-prosthetic fracture and patients should be counselled about this preoperatively.
由于尚无前瞻性长期研究对生物重建与假体置换重建进行比较，因此肱骨干恶性肿瘤节段切除后的最佳重建方法尚不清楚。本文回顾性分析了1995年至2010年间在我院接受肢体挽救手术的13例患者，这些患者在切除恶性骨病后采用定制的肱骨干假体置换。其中男性9例，女性4例，手术时平均年龄35岁（范围：10至78岁）。平均随访时间为56.8个月（范围：5至148个月）。10年时患者累积生存率为75%。以因任何原因取出假体或其一部分作为终点，10年时假体生存率为47%。7例患者需要翻修（54%）。并发症包括4例转移、4例无菌性松动、2例假体周围骨折和2例局部复发。平均MSTS和TESS评分分别为23（18至27）和67%（52 - 80）。切除恶性骨肿瘤后定制肱骨干置换提供了优于截肢的功能结果，且患者生存率无明显降低。无菌性松动和假体周围骨折的翻修率相对较高，术前应向患者说明这一点。
