Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Università Cattolica Del Sacro Cuore, Rome, Italy.
BMC Musculoskelet Disord. 2022 Sep 6;22(Suppl 2):1068. doi: 10.1186/s12891-022-05726-7.
Hip megaprostheses are a long known reconstructive method in the treatment of proximal femur metastases. The use of cemented or uncemented stems is still matter of debate. The aim of this study to compare cemented and uncemented megaprostheses on functional outcomes and complications, in order to establish the role of cementation.
We retrospectively analysed 51 metastatic patients with proximal femur metastases treated with endoprosthetic reconstruction by megaprostheses, 25 with cementless stems and 26 with cemented ones with different megaprosthetic implants. The primary endpoint was MSTS score, and the secondary endpoint was to state the incidence of surgical and clinical complications in the two groups. An un-paired T test was used to compare anthropometric, anamnestic data, and MSTS. Chi-square test was performed for evaluation of complication in the two group. Multiple linear regression was used to match the functional outcomes and complications' incidence in the population study. Logistic regression was performed to analyse the odds ratio of different parameters and their role in the incidence of complications.
The mean follow-up was 50.1 months (+ 12.5). In thirty case right side was involved. No statistical differences were noticed between Group A and B regard the age, gender, active fracture/impending fracture. Comparing the MSTS results within the two groups at last follow-up, the score cemented group was higher than cementless one (17.9 + 7.8 vs 24.2 + 5.3; statistical significance p = 0.001). Regarding surgical complications a logistic regression was performed to analyse the odds ratio of age, cementation and length of resection; cementation confirm and odds ratio of 11 times in the incidence of surgical complications.
Cementation seems to be more liable to complications onset, while improves functional score in metastatic patients compared to uncemented megaprostheses. More studies have to be conducted in order to create a protocol and establish criteria to use cemented or uncemented stems in a frail population like metastatic patients.
髋关节假体是治疗股骨近端转移瘤的一种长期应用的重建方法。骨水泥固定和非骨水泥固定假体的使用仍存在争议。本研究旨在比较骨水泥固定和非骨水泥固定假体在功能结果和并发症方面的差异，以确定骨水泥固定的作用。
我们回顾性分析了 51 例股骨近端转移瘤患者，采用假体重建治疗，其中 25 例采用非骨水泥固定假体，26 例采用骨水泥固定假体，使用不同的假体。主要终点是 MSTS 评分，次要终点是报告两组手术和临床并发症的发生率。采用配对 T 检验比较两组的人体测量学、病史资料和 MSTS 评分。采用卡方检验评估两组并发症的发生率。采用多元线性回归匹配人群研究中的功能结果和并发症发生率。采用 logistic 回归分析不同参数的比值比及其在并发症发生率中的作用。
平均随访时间为 50.1±12.5 个月。在 30 例病例中，右侧受累。A 组和 B 组在年龄、性别、活动骨折/骨折风险方面无统计学差异。比较两组末次随访时的 MSTS 结果，骨水泥固定组评分高于非骨水泥固定组（17.9±7.8 比 24.2±5.3；统计学意义 p=0.001）。关于手术并发症，进行了 logistic 回归分析以分析年龄、骨水泥固定和切除长度的比值比；骨水泥固定的比值比为 11 倍，与手术并发症的发生相关。
与非骨水泥固定假体相比，骨水泥固定假体更容易发生并发症，但可提高转移性患者的功能评分。需要进一步开展研究，制定方案，为转移性患者等脆弱人群确定使用骨水泥固定或非骨水泥固定假体的标准。
