You Qi, Lu Minxun, Min Li, Zhang Yuqi, Wang Jie, Wang Yitian, Zheng Chuanxi, Zhou Yong, Tu Chongqi
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Front Bioeng Biotechnol. 2022 Feb 28;10:795485. doi: 10.3389/fbioe.2022.795485. eCollection 2022.
Hemiarthroplasty is widely used for proximal femoral reconstruction after tumor resection. However, complications of hemiarthroplasty include infection, hip dislocation, and acetabular wear. This study aimed to: (1) evaluate the reliability and validity of a customized cementless intercalary endoprosthesis (CCIE) with an intra-neck curved stem (INCS) to reconstruct femoral diaphyseal defects with an ultrashort proximal femur (UPF); (2) assess the lower extremity function after reconstruction with this endoprosthesis; and (3) identify the postoperative complications associated with the use of this endoprosthesis. Between October 2015 and May 2019, 13 patients underwent reconstruction with a CCIE with an INCS. The distance from the center of the femoral head to the midline of the body and the apex of the acetabulum was measured preoperatively. Additionally, the distance from the tip of the INCS to the midline of the body and the apex of the acetabulum was measured postoperatively. The femoral neck-shaft angle was also measured pre- and postoperatively. After an average follow-up duration of 46 months, the radiological outcomes of the CCIE with an INCS were analyzed. Function was evaluated with the Musculoskeletal Tumor Society (MSTS) score. Pain was measured using a paper visual analog scale (VAS) pre- and postoperatively, and complications were recorded. Compared with our preoperative design, we found no significant difference in the postoperative distance from the tip of the INCS to the body midline ( = 0.187) and the apex of the acetabulum ( = 0.159), or in the postoperative femoral neck-shaft angle ( = 0.793). Thus, the INCS positions were deemed accurate. The average MSTS score was 26 (range: 24-28), and the VAS score was significantly decreased postoperatively compared with preoperatively (). No patients developed aseptic loosening, infection, periprosthetic fracture, or prosthetic fracture as of the last follow-up. The CCIE with an INCS was a valid and reliable method for reconstructing femoral diaphyseal defects with a UPF following malignant tumor resection. Postoperative lower extremity function was acceptable, with an appropriate individualized rehabilitation program, and the incidence of complications was low.
半髋关节置换术广泛应用于肿瘤切除术后的股骨近端重建。然而，半髋关节置换术的并发症包括感染、髋关节脱位和髋臼磨损。本研究旨在：（1）评估一种定制的带颈内弯柄（INCS）的非骨水泥型间隔内置假体（CCIE）用于重建股骨骨干缺损合并超短股骨近端（UPF）的可靠性和有效性；（2）评估使用该假体重建后的下肢功能；（3）确定使用该假体术后的并发症。2015年10月至2019年5月期间，13例患者接受了带INCS的CCIE重建手术。术前测量股骨头中心到身体中线和髋臼顶点的距离。此外，术后测量INCS尖端到身体中线和髋臼顶点的距离。术前和术后还测量了股骨颈干角。平均随访46个月后，分析了带INCS的CCIE的影像学结果。使用肌肉骨骼肿瘤学会（MSTS）评分评估功能。术前和术后使用纸质视觉模拟量表（VAS）测量疼痛，并记录并发症。与我们的术前设计相比，我们发现术后INCS尖端到身体中线的距离（ = 0.187）和到髋臼顶点的距离（ = 0.159），以及术后股骨颈干角（ = 0.793）均无显著差异。因此，INCS的位置被认为是准确的。平均MSTS评分为26分（范围：24 - 28分），术后VAS评分与术前相比显著降低（）。截至最后一次随访，没有患者出现无菌性松动、感染、假体周围骨折或假体骨折。带INCS的CCIE是恶性肿瘤切除术后重建合并UPF的股骨骨干缺损的一种有效且可靠的方法。术后下肢功能在适当的个体化康复计划下是可以接受的，并且并发症发生率较低。
