Department of Orthopaedic Oncology, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
Clin Orthop Relat Res. 2012 Dec;470(12):3577-86. doi: 10.1007/s11999-012-2455-8. Epub 2012 Jul 3.
After resecting tumors confined to one femoral condyle, a unicondylar osteoarticular allograft can be used for reconstruction without sacrificing the uninvolved condyle. However, unicondylar osteoarticular allografts have been associated with a high rate of joint degeneration. We describe a unicondylar osteoallograft prosthesis composite reconstruction replacing only one side of the joint to reduce compartment degeneration and avoid contamination of the tibia, but the survival, function, and complications of a unicondylar osteoallograft prosthesis composite are unclear.
We located a bone resection plane intraoperatively as planned before surgery using a computer-assisted navigation system. The tumor then was removed en bloc and the unicondylar defect filled with a size-matched allogeneic unicondyle. The allograft cartilage was removed. Thereafter, the condyle of the femoral component was resurfaced with a unicompartmental knee prosthesis to form a unicondylar osteoallograft prosthesis composite, however the tibia was left undisturbed. Navigation allowed precise apposition between the unicondylar osteoallograft prosthesis composite and host bone to ensure mechanical alignment and congruency of the joint surface before fixation with a plate.
We retrospectively reviewed 12 patients who underwent unicondylar osteoallograft prosthesis composite reconstructions after unicondylar resection for tumors. One patient died from tumor-related causes without unicondylar osteoallograft prosthesis composite failure after 18 months. We observed the survival rate of unicondylar osteoallograft prosthesis composite reconstruction and related complications. Function and radiographs also were documented according to the Musculoskeletal Tumor Society (MSTS) functional scoring system and the International Society of Limb Salvage radiographic scoring system. The minimum followup was 8 months (median, 37 months; range, 8-65 months).
At last followup, 10 of the 12 unicondylar osteoallograft prosthesis composite reconstructions were still in place. Three reconstructions failed owing to two local recurrences (both treated with amputation) and there was one infection (treated with revision and maintenance of the implant at last followup). The average MSTS functional score at last followup was 27 points and the radiographic score 91%.
Our observations suggest unicondylar osteoallograft prosthesis composite reconstruction might be a reliable technique with relatively few major complications and at least short-term maintenance of the tibial cartilage.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
在切除局限于股骨髁的肿瘤后，可以使用单髁骨关节同种异体移植物进行重建，而无需牺牲未受累的髁。然而，单髁骨关节同种异体移植物与较高的关节退变率有关。我们描述了一种单髁骨关节同种异体移植物假体复合重建，仅重建关节的一侧，以减少间室退变并避免胫骨污染，但单髁骨关节同种异体移植物假体的存活率、功能和并发症尚不清楚。
我们使用计算机辅助导航系统在术前按计划定位术中的骨切除平面。然后整块切除肿瘤，并将单髁缺损填充匹配大小的同种异体单髁。切除同种异体软骨。此后，股骨部件的髁用单髁膝关节假体表面置换，形成单髁骨关节同种异体移植物假体复合，而胫骨保持不变。导航允许单髁骨关节同种异体移植物假体复合与宿主骨之间精确贴合，以确保在固定钢板之前关节表面的机械对线和一致性。
我们回顾性分析了 12 例因肿瘤行单髁切除后行单髁骨关节同种异体移植物假体复合重建的患者。1 例患者因肿瘤相关原因死亡，18 个月后单髁骨关节同种异体移植物假体复合无失败。我们观察了单髁骨关节同种异体移植物假体复合重建的存活率和相关并发症。根据肌肉骨骼肿瘤学会（MSTS）功能评分系统和国际肢体挽救协会放射评分系统，还记录了功能和影像学结果。最低随访时间为 8 个月（中位数，37 个月；范围，8-65 个月）。
最后随访时，12 例单髁骨关节同种异体移植物假体复合中有 10 例仍在位。3 例重建失败，原因是 2 例局部复发（均行截肢），1 例感染（最后随访时行翻修并保留植入物）。最后随访时的平均 MSTS 功能评分为 27 分，影像学评分为 91%。
我们的观察结果表明，单髁骨关节同种异体移植物假体复合重建可能是一种可靠的技术，其主要并发症相对较少，至少在短期内能维持胫骨软骨。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
