Kakimoto Takuya, Matsumine Akihiko, Asanuma Kunihiro, Matsubara Takao, Nakamura Tomoki, Sudo Akihiro
Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan.
Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka-shimoaizuki 23-3, Eiheiji, Fukui 910-1193, Japan.
SICOT J. 2019;5:23. doi: 10.1051/sicotj/2019020. Epub 2019 Jun 28.
Reconstruction using a total femur prosthesis (TFP) remains a challenging procedure in musculoskeletal tumor surgery. The purpose of this study was to show the clinical outcomes of total femur replacement (TFR) in our institute.
Nine patients underwent reconstruction with a TFP after the wide resection of malignant bone and soft-tissue tumors of the femur between January 2003 and April 2014. The mean age of the patients at the time of TFR was 47.5 years, and the mean follow-up period was 52.9 months. The histological diagnoses were as follows: bone sarcoma (n = 4), soft-tissue sarcoma invading the femoral bones (n = 4), and metastatic bone tumor (n = 1).
The oncological outcomes were as follows: three patients achieved continuous disease free, two patients were alive with disease, and four patients died from disease. The 3- and 5-year overall survival rates were 88.9% and 55.6%, respectively. The rate of the overall survival in patients with primary bone tumors (100% at 5 years) was significantly better than that in patients with primary soft tissue sarcomas (0% at 5 years) (p = 0.015). A deep infection occurred postoperatively in one patient, but the patient was successfully treated with surgical debridement and revision surgery. There were no patients who showed dislocation or aseptic loosening. The mean Musculo-Skeletal Tumor Society functional score was 58.5% (46.7-80.0), with scores of 65.5% in patients with a primary bone tumor and 50.8% in those with a primary soft-tissue sarcoma.
In the present study, the patients who underwent TFR due to bone invasion by soft tissue sarcoma had a worse prognosis than the bone sarcoma patients.
使用全股骨假体（TFP）进行重建在肌肉骨骼肿瘤手术中仍然是一项具有挑战性的手术。本研究的目的是展示我院全股骨置换（TFR）的临床结果。
2003年1月至2014年4月期间，9例患者在股骨恶性骨和软组织肿瘤广泛切除后接受了TFP重建。TFR时患者的平均年龄为47.5岁，平均随访期为52.9个月。组织学诊断如下：骨肉瘤（n = 4）、侵犯股骨的软组织肉瘤（n = 4）和转移性骨肿瘤（n = 1）。
肿瘤学结果如下：3例患者实现持续无病生存，2例患者带瘤生存，4例患者死于疾病。3年和5年总生存率分别为88.9%和55.6%。原发性骨肿瘤患者的总生存率（5年时为100%）明显优于原发性软组织肉瘤患者（5年时为0%）（p = 0.015）。1例患者术后发生深部感染，但通过手术清创和翻修手术成功治疗。没有患者出现脱位或无菌性松动。肌肉骨骼肿瘤学会功能评分平均为58.5%（46.7 - 80.0），原发性骨肿瘤患者的评分为65.5%，原发性软组织肉瘤患者的评分为50.8%。
在本研究中，因软组织肉瘤侵犯骨骼而接受TFR的患者预后比骨肉瘤患者差。
