Yilmaz Müjgan, Sørensen Michala S, Saebye Casper, Baad-Hansen Thomas, Petersen Michael M
Department of Orthopedic Surgery, Musculoskeletal Tumor Section, Rigshospitalet Blegdamsvej, University of Copenhagen, Copenhagen, Denmark.
Department of Orthopedics, Tumor Section, Aarhus University Hospital, Aarhus, Denmark.
J Surg Oncol. 2019 Aug;120(2):183-192. doi: 10.1002/jso.25490. Epub 2019 May 1.
We investigated implant revision, implant failure, and amputation risk after limb-sparing bone tumor surgery using the Global Modular Replacement System (GMRS) tumor prosthesis in patients suffering from bone sarcomas (BS), giant cell tumors (GCT), or metastatic bone disease (MBD).
A retrospective study of a nationwide consecutive cohort (n = 119, 47 [12-81] years, M/F = 65/54) having limb-sparing surgery and reconstruction using the GMRS tumor prosthesis due to bone tumors (BS/GCT/MBD = 70/8/41) from 2005 to 2013. Anatomical locations were as followed: distal femur (n = 49), proximal femur (n = 41), proximal tibia (n = 26), or total femur (n = 3). Kaplan-Meier survival analysis and competing risk analysis with death as a competing risk were used for statistical analysis.
For BS and GCT patients, 5-year patient survival was 72% (95% confidence interval [CI]: 59-85%) and for MBD 33% (95% CI: 19-48%). Thirty-two patients underwent revision surgery (5-year revision incidence 14%; 95% CI: 8-21%). Twelve patients had revision of bone-anchored parts (implant failure) with a 5-year revision incidence 6% (95% CI: 2-10%). Ten amputations were performed due to local relapse (n = 9) or recurrent infections (n = 1) with a 5-year incidence of amputation: 8% (95% CI: 3-13%).
We identified a low risk of revision and amputation when using the GMRS tumor prosthesis for limb-sparing bone tumor.
我们对骨肉瘤（BS）、骨巨细胞瘤（GCT）或转移性骨病（MBD）患者使用全球模块化置换系统（GMRS）肿瘤假体进行保肢骨肿瘤手术后的植入物翻修、植入物失败和截肢风险进行了调查。
对2005年至2013年因骨肿瘤（BS/GCT/MBD = 70/8/41）使用GMRS肿瘤假体进行保肢手术和重建的全国连续性队列（n = 119，47 [12 - 81]岁，男/女 = 65/54）进行回顾性研究。解剖部位如下：股骨远端（n = 49）、股骨近端（n = 41）、胫骨近端（n = 26）或全股骨（n = 3）。采用Kaplan-Meier生存分析和以死亡作为竞争风险的竞争风险分析进行统计分析。
对于BS和GCT患者，5年患者生存率为72%（95%置信区间[CI]：59 - 85%），对于MBD患者为33%（95% CI：19 - 48%）。32例患者接受了翻修手术（5年翻修发生率14%；95% CI：8 - 21%）。12例患者对骨锚定部件进行了翻修（植入物失败），5年翻修发生率为6%（95% CI：2 - 10%）。因局部复发（n = 9）或反复感染（n = 1）进行了10次截肢，5年截肢发生率为8%（95% CI：3 - 13%）。
我们发现使用GMRS肿瘤假体进行保肢骨肿瘤手术时翻修和截肢风险较低。
