铰链膝关节重建假体在股骨远端或胫骨近端肿瘤切除术后的生存和并发症：161 例回顾性研究。

Survival and complications in hinged knee reconstruction prostheses after distal femoral or proximal tibial tumor resection: A retrospective study of 161 cases.

机构信息

Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine, Université de Tours, Centre-Val de Loire, Hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.

出版信息

Orthop Traumatol Surg Res. 2020 May;106(3):403-407. doi: 10.1016/j.otsr.2019.11.027. Epub 2020 Apr 8.

DOI:10.1016/j.otsr.2019.11.027

PMID:32276844

Abstract

INTRODUCTION

Hinged knee megaprostheses are mainly used for reconstruction after tumor resection. They may incur complications, but this has not been assessed in the French literature, except in small series at short follow-up. We therefore conducted a large-scale nationwide multicenter retrospective study with a minimum 5 years' follow-up. The objectives were (1) to compare survival between distal femoral and proximal tibial reconstruction prostheses, and (2) to analyze complications and failure.

HYPOTHESIS

Distal femoral hinged reconstruction prostheses show longer survival with fewer complications than proximal tibial prostheses.

MATERIAL AND METHODS

One hundred sixty-one patients were included: 118 in the distal femoral group, and 43 in the proximal tibial group. Tumors were mostly osteosarcomas (90 cases) or chondrosarcomas (31 cases). Mean age was 37 years (range, 12-86 years). Complications were assessed on the Henderson classification. Failure was defined by prosthesis anchor exchange or amputation.

RESULTS

At a mean 9 years' follow-up (range, 5-23 years), implant survival was longer in the distal femoral group: 5- and 10-year survival, 84% [95% CI, 75-89] and 70% [95% CI, 59-79] versus 74% [95% CI, 69-85] and 43% [95% CI, 23-61] (p=0.02). Revision surgery for complications mainly concerned aseptic loosening (19%, 30 cases) or deep infection (16%, 25 cases) and more often involved the proximal tibia (65% vs. 43%, 28 vs. 51 cases; OR 2.4 [95% CI, 1.2-5.1]; p=0.02).

DISCUSSION

Hinged knee reconstruction prosthesis is a solution in tumoral pathology, but with a high risk of complications (loosening and infection) and a higher failure rate in the proximal tibial reconstruction prosthesis.

LEVEL OF EVIDENCE

IV, case series.

摘要

简介

铰链式膝关节假体主要用于肿瘤切除后的重建。它们可能会引发并发症，但这在法国文献中尚未得到评估，除了在随访时间较短的小系列中有所报道。因此，我们进行了一项大规模的全国多中心回顾性研究，随访时间至少为 5 年。目的是：(1) 比较股骨远端和胫骨近端重建假体的生存率；(2) 分析并发症和失败原因。

假设

铰链式膝关节重建假体的生存率高于胫骨近端假体，且并发症更少。

材料与方法

共纳入 161 例患者：118 例股骨远端组，43 例胫骨近端组。肿瘤主要为骨肉瘤（90 例）或软骨肉瘤（31 例）。平均年龄为 37 岁（范围：12-86 岁）。并发症评估采用 Henderson 分级。假体固定物更换或截肢定义为失败。

结果

平均随访 9 年（范围：5-23 年），股骨远端组的假体生存率更长：5 年和 10 年生存率分别为 84%[95%可信区间（CI）：75%-89%]和 70%[95% CI：59%-79%]，而胫骨近端组分别为 74%[95% CI：69%-85%]和 43%[95% CI：23%-61%]（p=0.02）。并发症的翻修手术主要涉及无菌性松动（19%，30 例）或深部感染（16%，25 例），且更常发生于胫骨近端（65%比 43%，28 例比 51 例；比值比（OR）：2.4[95% CI：1.2-5.1]；p=0.02）。