Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine/Orthopedics Research Institute of Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine, No.1511, Jianghong Road, Hangzhou, 310000, China.
Int Orthop. 2019 Feb;43(2):475-482. doi: 10.1007/s00264-018-3939-2. Epub 2018 Apr 27.
The aims of our study are (1) to explore the risk factors of mechanical failure (MF), (2) to figure out an index to evaluate this risk, and (3) to select an optimal reconstruction strategy to reduce this risk.
We retrospectively reviewed 104 patients from Dec. 2008 to Mar. 2016, undergone extensive knee curettages in our institution. Radiographs and post-operative interviews were used to classified cases of MF. Relative factors (age, tumor location, the invaded area, etc.) were also collected and analyzed by SPSS software.
Thick subchondral bony layer (p = 0.006) and combined grafting of the cement and bone (p = 0.006) had lower risk of mechanical failure. Mechanical failure appeared to happen in the femur (p = 0.012) more easily. The ROC curve (AUC = 0.722) reveals that less post-operative bony layer (≤ 3.3 mm) is more likely to cause mechanical failure. The Kaplan-Meier survival curve showing increased survival in those patients after a combination grafting surgery (HR, 3.799; p = 0.006).
Based on our study results, combined grafting of the cement and bone reduced the risk of mechanical failure in the knee due to the thin subchondral bone layer (SCB), especially in the femur.
我们研究的目的是：(1) 探讨机械故障 (MF) 的危险因素，(2) 找到评估这种风险的指标，(3) 选择最佳的重建策略以降低这种风险。
我们回顾性分析了 2008 年 12 月至 2016 年 3 月在我院行广泛膝关节刮除术的 104 例患者。使用影像学检查和术后随访来对 MF 病例进行分类。使用 SPSS 软件收集并分析了相对因素（年龄、肿瘤位置、受侵面积等）。
厚的软骨下骨层（p=0.006）和骨水泥与骨联合移植（p=0.006）发生机械故障的风险较低。机械故障似乎更容易发生在股骨（p=0.012）。ROC 曲线（AUC=0.722）表明，术后骨层较薄（≤3.3mm）更可能导致机械故障。Kaplan-Meier 生存曲线显示，联合移植术后患者的生存率增加（HR，3.799；p=0.006）。
根据我们的研究结果，骨水泥与骨联合移植减少了由于软骨下骨层（SCB）较薄（尤其是股骨）引起的膝关节机械故障的风险。
