Casadei R, De Paolis M, Drago G, Romagnoli C, Donati D
Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
Orthop Traumatol Surg Res. 2016 Jun;102(4):459-65. doi: 10.1016/j.otsr.2015.12.026. Epub 2016 Apr 12.
Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses.
Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control.
Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17.
At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%) radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%) partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean of 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%).
Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms.
Therapeutic.
IV, retrospective study.
假体可用于原发性和转移性病变的肘关节重建。几位作者报告了他们使用不同类型植入物的经验，但未涉及模块化假体。
使用肘关节假体进行保肢手术在获得良好功能结果和可靠的局部肿瘤控制方面是有效的。
对1990年至2012年在里佐利研究所接受治疗的47例肘关节肿瘤患者进行评估。其中原发性肿瘤30例（64%），骨肿瘤24例，软组织肉瘤6例，骨转移瘤17例。25例患者采用模块化假体进行肘关节重建，22例采用标准假体。30例为一期重建，17例为二期重建。
在最后一次随访时，15例（32%）患者死于疾病（DOD），平均随访35个月；12例（25%）患者带瘤生存（AWD），平均随访29个月；19例（40%）患者无疾病证据（NED），平均随访80个月。早期并发症与意外的神经损伤有关，12例患者（25%）出现这种情况：5例患者的功能缺损在平均6个月后恢复；其他患者未恢复或仅部分恢复。2例植入物（4%）发生感染：1例采用抗生素治疗，另1例需要翻修植入物。1例出现骨水泥挤出的植入物进行了翻修。3例患者（6%）的X线片显示假体柄周围有透亮晕（肱骨2例，尺骨1例）；由于患者在每次随访时均完全无症状，未采取任何措施。3例患者（6%）的X线片显示同种异体骨部分吸收，但在最后一次随访时保持不变，无疼痛或功能障碍。观察到7例局部复发（15%），平均发生在术后16个月；5例通过切除和/或放疗治疗，2例通过截肢治疗。MEPS和MSTS的平均功能评分分别为84%和22/30（73%）。
肘关节假体在原发性肿瘤中的功能优于转移性肿瘤。肿瘤切除后进行肘关节假体重建对于原发性和继发性骨肿瘤都是一种可行的选择。
治疗性研究。
IV级，回顾性研究。
