Orthopaedic Institute, G. Pini, University of Milan, Italy.
Orthopaedic Institute, G. Pini, University of Milan, Italy.
Injury. 2014 Feb;45(2):388-93. doi: 10.1016/j.injury.2013.09.015. Epub 2013 Sep 21.
The development of new megaprosthesis for the treatment of large bone defects provides important options to orthopaedic oncologic surgeons for the replacement of skeletal segments, such as the long bones of the upper and lower limbs and the relative joints. We implanted megaprosthesis using either a one-step or two-step technique depending on the patient's condition. The aim of this study was to evaluate retrospectively both clinical and radiological outcomes in patients who underwent lower limb megaprosthesis implant.
A total of 32 patients were treated with mono- and bi-articular megaprosthesis subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients was about 18 months (range 3 months to 5 years). Clinical and serial radiographic evaluations were conducted using standard methods (X-ray at 45 days, 3, 6, 12, 18 and 24 months) and blood parameters of inflammation were monitored for at least 2 months.
Although the mean length of follow-up was only 18 months, the first patients to enter the study were monitored for 5 years and showed encouraging clinical results, with good articulation of the segments, no somato-sensory or motor deficit and acceptable functional recovery. During surgery and, more importantly, in pre-operative planning, much attention should be given to the evaluation of the extensor apparatus, preserving it and, when necessary, reinforcing it with tendon substitutes.
Megaprosthesis in extreme cases of severe bone loss and prosthetic failure is a potential solution for the orthopaedic surgeon. In oncological surgery, the opportunity to restore functionality to the patient (although not ad integrum) is important for both the patient and the surgeon. The high mortality associated with cancer precludes long-term patient follow-up; therefore, there is a lack of certainty about the survival of this type of prosthesis and any medium- to long-term complications that may occur. Nevertheless, patients should be considered as an oncologic patient, not because of the disease, but because of the limited therapeutic options available.
Megaprosthesis provides a valuable opportunity to restore functionality to patients with highly disabling diseases.
为治疗大骨缺损而开发的新型假体为矫形骨肿瘤外科医生提供了重要的选择，可用于置换肢体长骨和相关关节等骨骼节段。我们根据患者的情况，采用一步或两步技术植入假体。本研究旨在回顾性评估下肢假体植入患者的临床和影像学结果。
共对 32 例患者进行了单关节和双关节假体治疗，分为以下几类：股骨近端、股骨远端、胫骨近端和全股骨。患者的平均随访时间约为 18 个月（3 个月至 5 年）。采用标准方法（术后 45 天、3、6、12、18 和 24 个月时行 X 线检查）进行临床和连续影像学评估，并监测炎症血液参数至少 2 个月。
虽然平均随访时间仅为 18 个月，但最早进入研究的患者已随访 5 年，结果令人鼓舞，节段关节良好，无躯体感觉或运动缺陷，功能恢复可接受。在手术中，更重要的是在术前规划中，应非常重视对伸肌装置的评估，保存伸肌装置，并在必要时用肌腱替代品进行加强。
在严重骨质流失和假体失败的极端情况下，假体是矫形外科医生的潜在解决方案。在肿瘤外科中，为患者恢复功能的机会（尽管不是完全恢复）对患者和外科医生都很重要。癌症相关的高死亡率排除了对患者的长期随访；因此，这种假体的存活率以及可能出现的任何中至长期并发症都存在不确定性。然而，应将患者视为肿瘤患者，不是因为疾病，而是因为可用的治疗选择有限。
假体为患有高度致残性疾病的患者提供了恢复功能的宝贵机会。
