肿瘤切除术后下肢重建中大型假体的生存率如何？
What was the survival of megaprostheses in lower limb reconstructions after tumor resections?
作者信息
Capanna Rodolfo, Scoccianti Guido, Frenos Filippo, Vilardi Antonio, Beltrami Giovanni, Campanacci Domenico Andrea
机构信息
Department of Orthopaedic Oncology, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 3, 50134, Firenze, Italy.
出版信息
Clin Orthop Relat Res. 2015 Mar;473(3):820-30. doi: 10.1007/s11999-014-3736-1.
BACKGROUND
Prosthetic replacement is the most commonly used option for reconstruction of osteoarticular bone loss resulting from bone neoplasm resection or prosthetic failure. Starting in late 2001, we began exclusively using a single system for large-segment osteoarticular reconstruction after tumor resection; to our knowledge, there are no published series from one center evaluating the use of this implant.
QUESTIONS/PURPOSES: We investigated the following issues: (1) What is the overall survival, excluding local tumor recurrence, for these endoprostheses used for tumor reconstructions of the lower extremities (knee and hip)? (2) What types of failure were observed in these reconstructions? (3) Do the survival and complications vary according to site of implant?
METHODS
Between September 2001 and March 2012, we exclusively used this implant for tumor reconstructions. During that time, 278 patients underwent tumor reconstructions of the hip or knee, of whom 200 (72%) were available at a minimum 2 years followup. Seventy-eight patients were excluded from the study for insufficient followup as a result of early death (42) or loss at followup (36). The reconstruction types were the following: proximal femur (69 cases), distal femur (87), proximal tibia (32), and total knee (12). Failures were classified according to the Henderson classification. Nine patients among those with followup shorter than 2 years had presented one or more failures and they were included in our analysis but separately evaluated.
RESULTS
Overall survival (no further surgical procedures of any type after primary surgery), excluding Type 5 failure (tumor recurrence), was 75.9% at 5 years and 66.2% at 10 years. Seventy-one failures occurred in 58 implants (29%). Mechanical failures accounted for 59.2% and nonmechanical failures for 40.8%. The first causes of failure of the implants were the result of soft tissue failure in 6%, aseptic loosening in 3%, structural failure in 7%, infection in 8.5%, and tumor recurrence in 4.5% of the whole series. Nine implants sustained two or more failures. Overall incidence of infection was 9.5%. No statistically significant differences were observed according to anatomical site.
CONCLUSIONS
Like in the case with many such complex oncologic reconstructions, the failure rate at short- to midterm in this group was over 20%. Comparative trials are called for to ascertain whether one implant is superior to another. Infection and structural failure were the most frequent modes of failure in our experience.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
背景
假体置换是因骨肿瘤切除或假体失败导致骨与关节骨缺损重建最常用的方法。从2001年末开始，我们在肿瘤切除后大段骨与关节重建中仅使用单一系统；据我们所知，尚无来自一个中心评估该植入物使用情况的系列报道。
问题/目的：我们研究了以下问题：（1）用于下肢（膝和髋）肿瘤重建的这些假体，排除局部肿瘤复发后的总生存率是多少？（2）这些重建中观察到哪些类型的失败？（3）生存率和并发症是否因植入部位而异？
方法
2001年9月至2012年3月期间，我们在肿瘤重建中仅使用该植入物。在此期间，278例患者接受了髋或膝关节肿瘤重建，其中200例（72%）至少随访了2年。78例患者因早期死亡（42例）或随访失访（36例）而随访不足被排除在研究之外。重建类型如下：股骨近端（69例）、股骨远端（87例）、胫骨近端（32例）和全膝关节（12例）。失败情况根据亨德森分类法进行分类。随访时间短于2年的9例患者出现了一次或多次失败，他们被纳入我们的分析，但单独评估。
结果
排除5型失败（肿瘤复发）后，初次手术后无任何类型进一步手术的总生存率在5年时为75.9%，在10年时为66.2%。58个植入物（29%）出现了71次失败。机械性失败占59.2%，非机械性失败占40.8%。植入物失败的首要原因在整个系列中，软组织失败占6%，无菌性松动占3%，结构性失败占7%，感染占8.5%，肿瘤复发占4.5%。9个植入物出现了两次或更多次失败。感染的总发生率为9.5%。根据解剖部位未观察到统计学上的显著差异。
结论
与许多此类复杂的肿瘤重建情况一样，该组患者短期至中期的失败率超过20%。需要进行对比试验以确定一种植入物是否优于另一种。根据我们的经验，感染和结构性失败是最常见的失败模式。
证据水平
IV级，治疗性研究。有关证据水平的完整描述，请参阅作者须知。
Zotero 插件