Di Martino Alberto, Martinelli Nicolò, Loppini Mattia, Piccioli Andrea, Denaro Vincenzo
Department of Orthopaedics and Trauma Surgery, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy.
Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy.
Injury. 2017 Oct;48 Suppl 3:S48-S54. doi: 10.1016/S0020-1383(17)30658-7.
Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction?
A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines.
At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement.
Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
股骨近端转移瘤通常通过肿瘤切除并用假体进行重建，或通过骨固定术进行手术治疗。然而，关于最合适的手术治疗方法仍存在争议。我们提出了以下问题：（1）接受内固定治疗的患者手术翻修频率是否高于接受假体置换重建的患者？（2）接受内固定治疗的患者发生不需要手术的并发症的频率是否高于接受假体置换重建的患者？
对比较这两种手术方法的手术翻修率和并发症发生率的研究进行系统评价。根据STROBE指南，10项研究共纳入1107例患者，其中3项研究方法学质量高，3项中等，4项质量低。
目前，假体脱位是股骨近端假体置换患者中最常见的并发症，而内固定组再次手术的主要原因是内固定松动。假体置换组再次干预的时间为3至11.6个月，内固定组为7.8至22.3个月。非手术并发症（主要是脱位和感染）在接受假体置换手术的患者中更常见。
在这些患者的手术治疗决策过程中，应考虑植入物相关并发症和手术相关发病率。这些数据可以改善医患沟通，并指导关于患者手术生存和并发症的进一步研究。
