Kamiński Paweł, Szmyd Jakub, Ambroży Jarosław, Jaworski Jerzy Mirosław, Frańczuk Bogusław
Cracow Centre of Rehabilitation and Orthopaedics, Kraków, Poland.
Andrzej Frycz Modrzewski Krakow University, Faculty of Health and Medical Science, Kraków, Poland.
Ortop Traumatol Rehabil. 2017 Apr 12;19(2):145-156. doi: 10.5604/15093492.1238002.
The introduction of resection prostheses paved the way for the development of limb-sparing surgery in patients with primary or metastatic bone tumours. After some time, the developing possibilities of treatment of extensive bone defects allowed for the use of resection prostheses as an emergency procedure in patients undergoing revision surgery due to hip implant loosening. The aim of this paper is to compare treatment outcomes in patients receiving the Modular Universal Tumour and Revision System (MUTARS) resection prosthesis during arthroplasty performed for different indications: treatment of a tumour metastasis and revision surgery in cases of implant loosening.
A total of 34 MUTARS femoral resection prostheses were implanted in 34 patients at the Cracow Centre of Rehabilitation and Orthopaedics between December 2008 and January 2016. The procedure was indicated due to the presence of a tumour metastasis (in 13 cases) or due to implant loosening that required revision arthroplasty with a resection prosthesis (in 21 cases). Femoral bone defects were classified according to Paprosky and Katthagen in all operated patients. Clinical assessment was conducted with the modified Harris Hip Score before the surgery and at one year after the procedure. In addition, pain intensity was assessed with a Visual Analogue Scale (VAS).
No statistically significant differences were observed between the groups with respect to the length of the femoral bone resected, perioperative blood loss and the number of packed red blood cell (PRBC) units required. A statistically significant difference was found in duration of the surgery and hospital stay, which were longer in the revision arthroplasty group. No statistically significant differences were observed between the groups in the post-operative HHS scores and pain assessment in the VAS scale. The revision arthroplasty group showed significantly more dislocations (8 vs. 2) and cases of surgical site infection.
1.The use of the MUTARS modular resection prosthesis allows for fast clinical improvement that meets the patient's expectations both in oncological treatment and in revision arthroplasty. 2. The extent of bone resection, procedure duration and perioperative blood loss associated with the surgical placement of a resection prosthesis are similar in oncological treatment and in revision arthroplasty. 3. The use of a resection prosthesis in revision arthroplasty is associated with a high risk of implant dislocation.
切除假体的引入为原发性或转移性骨肿瘤患者保肢手术的发展铺平了道路。一段时间后，随着广泛骨缺损治疗方法的不断发展，切除假体开始被用作因髋关节植入物松动而接受翻修手术患者的紧急治疗手段。本文旨在比较在不同适应证的关节成形术中使用模块化通用肿瘤与翻修系统（MUTARS）切除假体的患者的治疗效果：肿瘤转移的治疗以及植入物松动情况下的翻修手术。
2008年12月至2016年1月期间，在克拉科夫康复与矫形中心，共为34例患者植入了34个MUTARS股骨切除假体。手术适应证为存在肿瘤转移（13例）或因植入物松动需要使用切除假体进行翻修关节成形术（21例）。对所有手术患者的股骨骨缺损按照Paprosky和Katthagen方法进行分类。术前及术后1年采用改良Harris髋关节评分进行临床评估。此外，使用视觉模拟量表（VAS）评估疼痛强度。
两组在切除的股骨长度、围手术期失血量及所需浓缩红细胞（PRBC）单位数量方面未观察到统计学显著差异。在手术时长和住院时间方面发现有统计学显著差异，翻修关节成形术组的时间更长。两组在术后HHS评分及VAS量表疼痛评估方面未观察到统计学显著差异。翻修关节成形术组出现明显更多的脱位病例（8例对2例）及手术部位感染病例。
