Limb Salvage and Revision Arthroplasty Surgery, Mount Elizabeth Medical Center, Singapore, Singapore.
Department of Orthopaedic Surgery, National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore.
Eur J Cancer Care (Engl). 2021 Mar;30(2):e13377. doi: 10.1111/ecc.13377. Epub 2020 Dec 2.
We present data from our recently completed study that suggests that joint salvage is the key parameter in keeping the limb salvage ethos relevant.
We reviewed all patients operated on nationally over 30 years (1978 to 2008). We identified 265 survivors of which 162 were available for evaluation at the time of survey.
There were 92 males and 70 females followed an average 9.1±SD3.1 years. Average age at survey was 38±SD17 years. ANOVA for mental health and TESS degree of importance for ADL identified that all categories of joint preservation were similar to an average group of people from the population. Physical health scores were significantly better amongst joint-preserved versus joint replacement patients (p = 0.003). Nevertheless, there was no significant difference between amputees with respect to physical health scores compared to arthrodesed and joint-replaced individuals. Biological reconstructions scored significantly better than metallic segmentary reconstructions (p < 0.001). Dissatisfaction appeared to correlate best with the presence of pain following reconstruction (p < 0.001).
While our study supports the finding of amputations being as satisfactory as arthrodeses and joint replacement salvage surgery, joint salvage was superior to all other categories. Assessments of equivalence should incorporate joint salvage and materials used as evaluable parameters.
我们呈现了最近完成的研究数据，这些数据表明关节挽救是保持肢体挽救理念相关性的关键参数。
我们回顾了全国范围内 30 多年（1978 年至 2008 年）的所有手术患者。我们确定了 265 名幸存者，其中 162 名在调查时可进行评估。
92 名男性和 70 名女性，平均随访 9.1±SD3.1 年。调查时的平均年龄为 38±SD17 岁。对心理健康和 TESS 对日常生活活动重要性的方差分析表明，所有关节保存类别都与人群中平均组相似。与关节置换患者相比，关节保存患者的身体健康评分明显更好（p=0.003）。然而，与关节融合和关节置换患者相比，截肢患者的身体健康评分没有显著差异。生物重建的评分明显优于金属节段重建（p<0.001）。重建后存在疼痛与不满意似乎相关性最好（p<0.001）。
虽然我们的研究支持截肢与关节融合和关节置换挽救手术一样令人满意的发现，但关节挽救优于所有其他类别。等效性评估应将关节挽救和使用的材料作为可评估的参数纳入。
