De Gori Marco, Scoccianti Guido, Frenos Filippo, Bettini Leonardo, Familiari Filippo, Gasparini Giorgio, Beltrami Giovanni, Cuomo Pierluigi, De Biase Pietro, Capanna Rodolfo
Department of Orthopaedic and Trauma Surgery, "Mater Domini" University Hospital, "Magna Graecia" University of Catanzaro, Catanzaro, Italy.
Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, University of Florence, Florence, Italy.
Biomed Res Int. 2016;2016:2606521. doi: 10.1155/2016/2606521. Epub 2016 Dec 5.
The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1-167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure ( = 0.921), nor to the reconstruction site ( = 0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions ( = 0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease.
使用模块化假体是处理肿瘤切除以及因非肿瘤性疾病（如骨折后遗症、骨关节移植失败、关节成形术翻修和假体周围骨折）导致的严重骨丢失的一种可行选择。我们试图调查87例在非肿瘤环境下接受大型假体重建的患者发生的中期并发症和失败情况。平均随访58（1 - 167）个月后，1年时总体无失败生存率为91.5%，2年时为80%，5年时为71.6%，5年和10年时为69.1%。根据初次手术时的诊断（P = 0.921）或重建部位（P = 0.402），生存率无显著差异。与单纯非肿瘤性疾病的假体重建相比，在肿瘤后环境中使用大型假体对生存率无影响（P = 0.851）。假体周围感染是主要并发症，10例（11.5%）患者发生，除1例病例外，所有病例均需进行大型假体翻修。医生在与患者讨论非肿瘤性疾病假体重建的预期结果时应考虑这些结果。
