全球模块化置换系统肿瘤假体用于骨科肿瘤疾病保肢骨切除术后重建的长期结果：一项全国队列研究的结果

Long-term results of the Global Modular Replacement System tumor prosthesis for reconstruction after limb-sparing bone resections in orthopedic oncologic conditions: Results from a national cohort.

作者信息

Yilmaz Müjgan, Sørensen Michala S, Saebye Casper, Baad-Hansen Thomas, Petersen Michael M

机构信息

Department of Orthopedic Surgery, Musculoskeletal Tumor Section, Rigshospitalet Blegdamsvej, University of Copenhagen, Copenhagen, Denmark.

Department of Orthopedics, Tumor Section, Aarhus University Hospital, Aarhus, Denmark.

出版信息

J Surg Oncol. 2019 Aug;120(2):183-192. doi: 10.1002/jso.25490. Epub 2019 May 1.

DOI:10.1002/jso.25490

PMID:31042011

Abstract

BACKGROUND AND OBJECTIVES

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).

MATERIAL AND METHODS

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.

RESULTS

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%).

CONCLUSIONS

We identified a low risk of revision and amputation when using the GMRS tumor prosthesis for limb-sparing bone tumor.

摘要

背景与目的

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。

材料与方法

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。

结果

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%）。