Calori G M, Colombo M, Malagoli E, Mazzola S, Bucci M, Mazza E
C.O.R., Reparative Orthopaedic Surgery Department, Orthopaedic Institute G. Pini, University of Milan, Italy.
C.O.R., Reparative Orthopaedic Surgery Department, Orthopaedic Institute G. Pini, University of Milan, Italy.
Injury. 2014 Dec;45 Suppl 6:S105-10. doi: 10.1016/j.injury.2014.10.032. Epub 2014 Nov 18.
The recent evolution of prosthesis technology has enabled the surgeon to replace entire limbs. These special prostheses, or megaprostheses, were developed for the treatment of severe oncological bone loss; however, the indications and applications of these devices have expanded to other orthopaedic and trauma situations. For some years, surgeons have been implanting megaprostheses in non-oncological conditions, such as acute trauma in severe bone loss and poor bone quality; post-traumatic failures, both aseptic and septic (represented by complex non-unions and critical size bone defects); major bone loss in prosthetic revision, both aseptic and septic; periprosthetic fractures with component mobilisation and poor bone stock condition. The purpose of this study was to evaluate retrospectively the complications during and after the implantation of megaprosthesis of the lower limb in post-traumatic and prosthetic bone loss, and to propose tips about how to avoid and manage such complications.
All the complications and difficulties we have encountered during or after the implantation of megaprosthesis in non-oncology patients were evaluated retrospectively. A total of 72 patients were treated with large resection mono-and bi-articular prostheses between January 2008 and January 2014.
The main critical problems found in the study were: restoration of the correct length and rotation of the limb; reconstruction of the knee extensor mechanism; trochanteric reconstruction; stability/dislocation of the implant; mobility/range of motion (ROM) of the implant; skin cover; sepsis, and bone quality.
Megaprosthesis in severe bone loss can be considered as an available solution for the orthopaedic surgeon in extreme, appropriately selected cases. This type of complex surgery must be performed in specialised centres where knowledge and technologies are present. Patients with severe bone loss should not be treated in the same way as oncology patients because life expectancy is definitely longer; therefore, the surgical technique and the system implantation must be extremely rigorous to ensure longevity of the prosthesis. The characteristics of the bone and soft tissue conditions in these patients are very different from those presented by oncology patients, which creates critical problems that the surgeon should be able to manage to avoid serious complications.
近年来假肢技术的发展使外科医生能够替换整个肢体。这些特殊的假肢，即巨型假肢，最初是为治疗严重的肿瘤性骨缺损而开发的；然而，这些装置的适应症和应用范围已扩展到其他骨科和创伤情况。多年来，外科医生一直在非肿瘤性疾病中植入巨型假肢，例如严重骨丢失和骨质量差的急性创伤；无菌性和感染性创伤后失败（以复杂的骨不连和临界尺寸骨缺损为代表）；无菌性和感染性假体翻修中的严重骨丢失；伴有假体松动和骨量不佳的假体周围骨折。本研究的目的是回顾性评估创伤后和假体骨丢失患者下肢巨型假肢植入期间及之后的并发症，并提出有关如何避免和处理此类并发症的建议。
我们回顾性评估了在非肿瘤患者中植入巨型假肢期间及之后遇到的所有并发症和困难。2008年1月至2014年1月期间，共有72例患者接受了大切除单关节和双关节假体治疗。
该研究中发现的主要关键问题有：肢体正确长度和旋转的恢复；膝关节伸肌机制的重建；转子重建；植入物的稳定性/脱位；植入物的活动度/活动范围（ROM）；皮肤覆盖；感染，以及骨质量。
在极端且经过适当选择的病例中，对于严重骨丢失患者，巨型假肢可被视为骨科医生的一种可行解决方案。这类复杂手术必须在具备相关知识和技术的专业中心进行。严重骨丢失患者的治疗方式不应与肿瘤患者相同，因为其预期寿命肯定更长；因此，手术技术和系统植入必须极其严格，以确保假体的使用寿命。这些患者的骨骼和软组织状况特征与肿瘤患者非常不同，这会产生一些关键问题，外科医生应能够处理这些问题以避免严重并发症。
