多孔钽髋臼植入物与哈林顿重建治疗髋臼转移瘤的比较。
Comparison of Porous Tantalum Acetabular Implants and Harrington Reconstruction for Metastatic Disease of the Acetabulum.
机构信息
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
出版信息
J Bone Joint Surg Am. 2020 Jul 15;102(14):1239-1247. doi: 10.2106/JBJS.19.01189.
BACKGROUND
The periacetabular region is a common location for metastatic disease. Although large lytic acetabular defects are commonly treated with a hip arthroplasty with a cemented component according to a Harrington-style reconstruction, the use of highly porous uncemented tantalum acetabular components has been described. Currently, there are no direct comparisons of these reconstructive techniques. The purpose of this study was to compare the outcomes of the Harrington technique and tantalum acetabular component reconstruction for periacetabular metastases.
METHODS
From 2 tertiary sarcoma centers, we retrospectively reviewed 115 patients (70 female and 45 male) with an acetabular metastatic defect who had been treated between 2002 and 2015 with a total hip arthroplasty using either the cemented Harrington technique (78 patients) or a tantalum acetabular reconstruction (37 patients). The mean patient age was 61 years, and the most common Eastern Cooperative Oncology Group status was 3 (39 patients). The mean follow-up for surviving patients was 4 years.
RESULTS
An additional surgical procedure was performed in 24 patients (21%). Harrington-style reconstructions were more likely to require a reoperation compared with tantalum reconstructions (hazard ratio [HR], 4.59; p = 0.003). The acetabular component was revised in 13 patients (11%); 5 patients (4%) underwent revisions that were due to loosening of the acetabular component. The 10-year cumulative incidence of revision of the acetabular component for loosening was 9.6% in the Harrington group and 0% in the tantalum group (p = 0.09). The mean Harris hip score significantly improved following reconstruction (31 to 67 points; p < 0.001), with no significant difference (p = 0.29) between groups.
CONCLUSIONS
In patients with periacetabular metastatic disease treated with total hip arthroplasty, an acetabular reconstruction strategy utilizing highly porous tantalum acetabular components and augments successfully provided patients with a more durable construct with fewer complications compared with the cemented Harrington-style technique.
LEVELS OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
髋臼周围区域是转移瘤的常见部位。尽管根据哈林顿（Harrington）式重建采用带水泥固定组件的髋关节置换术可治疗大的髋臼溶骨性缺损，但也有使用多孔非骨水泥钽髋臼组件的报道。目前，尚无这些重建技术的直接比较。本研究旨在比较哈林顿技术和多孔非骨水泥钽髋臼组件重建治疗髋臼周围转移瘤的疗效。
方法
我们回顾性分析了 2002 年至 2015 年间在 2 家三级肉瘤中心接受髋关节置换术治疗髋臼转移瘤缺损的 115 例患者（70 例女性，45 例男性）的临床资料，其中 78 例患者采用带水泥固定的哈林顿技术（哈林顿组），37 例患者采用多孔非骨水泥钽髋臼组件重建（钽组）。患者的平均年龄为 61 岁，最常见的东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）体能状态为 3 分（39 例）。对存活患者的平均随访时间为 4 年。
结果
24 例（21%）患者接受了额外的手术。与钽组相比，哈林顿组更可能需要再次手术（风险比[HR]，4.59；p=0.003）。髋臼组件翻修 13 例（11%），其中 5 例（4%）因髋臼组件松动而翻修。哈林顿组髋臼组件松动翻修的 10 年累积发生率为 9.6%，钽组为 0%（p=0.09）。重建后，患者的 Harris 髋关节评分显著提高（由 31 分提高至 67 分；p<0.001），但两组间差异无统计学意义（p=0.29）。
结论
在接受全髋关节置换术治疗髋臼周围转移瘤的患者中，与带水泥固定的哈林顿式技术相比，采用多孔非骨水泥钽髋臼组件和加强物的髋臼重建策略可提供更耐用的结构，且并发症更少。
证据等级
治疗性研究，III 级。具体分级请参考作者须知。
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