微创与非侵入式系统在全股骨假体延长中的比较。

Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses.

机构信息

Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK.

出版信息

Bone Joint J. 2018 Dec;100-B(12):1640-1646. doi: 10.1302/0301-620X.100B12.BJJ-2018-0135.R1.

DOI:10.1302/0301-620X.100B12.BJJ-2018-0135.R1

PMID:30499323

Abstract

AIMS

The aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.

PATIENTS AND METHODS

A total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.

RESULTS

The overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).

CONCLUSION

The survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

摘要

目的

本研究旨在描述、分析和比较微创（MI）和非微创（NI）全股骨延长假体的生存率、功能结果和并发症。

患者和方法

1991 年至 2016 年期间共植入 24 例全股骨延长假体，其中 11 例为 MI，13 例为 NI。记录了患者的特征、并发症和功能结果。共有 10 名女性和 10 名男性患者，手术时的平均年龄为 11 岁（2 岁至 41 岁）。平均随访时间为 13.2 年（7 个月至 29.25 年）。进行了生存分析，并根据改良 Henderson 系统对失败进行了分类。

结果

MI 假体的 5 年、10 年和 20 年总体假体存活率分别为 79%，NI 假体的 5 年存活率为 84%，10 年存活率为 70%。在最终随访时，13 例假体无需进一步手术。总体并发症发生率为 46%。MI 和 NI 假体的平均无翻修假体存活率分别为 59 个月和 49 个月。两种假体的总体假体存活率、无翻修存活率或并发症分布无统计学差异。两组感染率也相似（9%对 7%；p = 0.902）。MI 假体的肢体长度差异率为 54%，NI 假体的肢体长度差异率为 23%。在接受 MI 假体治疗的患者中，膝关节活动范围（0°至 62°对 0°至 83°；p = 0.047）较小，延长后膝关节屈曲挛缩的平均缓解时间（3.3 个月对 1.07 个月；p < 0.001）较长，肌肉骨骼肿瘤学会（MSTS）评分（24.7 对 27；p = 0.295）较低。