Sewell M D, Hanna S A, McGrath A, Aston W J S, Blunn G W, Pollock R C, Skinner J A, Cannon S R, Briggs T W R
Sarcoma Unit, London Bone and Soft Tissue Tumour Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
J Bone Joint Surg Br. 2011 Aug;93(8):1111-7. doi: 10.1302/0301-620X.93B8.25750.
The best method of reconstruction after resection of malignant tumours of the tibial diaphysis is unknown. In the absence of any long-term studies analysing the results of intercalary endoprosthetic replacement, we present a retrospective review of 18 patients who underwent limb salvage using a tibial diaphyseal endoprosthetic replacement following excision of a malignant bone tumour. There were ten men and eight women with a mean age of 42.5 years (16 to 76). Mean follow-up was 58.5 months (20 to 141) for all patients and 69.3 months (20 to 141) for the 12 patients still alive. Cumulative patient survival was 59% (95% confidence interval (CI) 32 to 84) at five years. Implant survival was 63% (95% CI 35 to 90) at ten years. Four patients required revision to a proximal tibial replacement at a mean follow-up of 29 months (10 to 54). Complications included metastases in five patients, aseptic loosening in four, peri-prosthetic fracture in two, infection in one and local recurrence in one. The mean Musculoskeletal Tumor Society score and the mean Toronto Extremity Salvage Score were 23 (17 to 28) and 74% (53 to 91), respectively. Although rates of complication and revision were high, custom-made tibial diaphyseal replacement following resection of malignant bone tumours enables early return to function and provides an attractive alternative to other surgical options, without apparent compromise of patient survival.
胫骨骨干恶性肿瘤切除术后的最佳重建方法尚不清楚。由于缺乏分析节段性内置假体置换结果的长期研究，我们对18例恶性骨肿瘤切除后采用胫骨骨干内置假体置换进行保肢治疗的患者进行了回顾性研究。其中男性10例，女性8例，平均年龄42.5岁（16至76岁）。所有患者的平均随访时间为58.5个月（20至141个月），12例存活患者的平均随访时间为69.3个月（20至141个月）。5年时患者累积生存率为59%（95%置信区间（CI）32至84）。10年时植入物生存率为63%（95%CI 35至90）。4例患者在平均随访29个月（10至54个月）时需要翻修为近端胫骨置换。并发症包括5例发生转移、4例无菌性松动、2例假体周围骨折、1例感染和1例局部复发。肌肉骨骼肿瘤学会平均评分和多伦多肢体挽救平均评分分别为23分（17至28分）和74%（53至91%）。虽然并发症和翻修率较高，但恶性骨肿瘤切除后定制的胫骨骨干置换能够使患者早期恢复功能，并为其他手术选择提供了有吸引力的替代方案，且对患者生存率无明显影响。
