Kashyap Nishant, Runu Ritesh, Ahmed Wasim, Kumar Indrajeet, Subash Abhijeet
Orthopaedics, Indira Gandhi Institute of Medical Sciences, Patna, Patna, IND.
Cureus. 2022 Sep 8;14(9):e28959. doi: 10.7759/cureus.28959. eCollection 2022 Sep.
Background The method known as "limb salvage surgery" (LSS) aids in the removal of extremity tumours, and reconstruction is completed with satisfactory oncologic, functional, and cosmetic outcomes. Oncologic clearance is given first priority, followed by functional outcomes. Worldwide, the trend has already shifted away from amputations and toward limb salvage surgery for eligible patients due to efficient chemotherapy regimens, improved imaging techniques, precise administration of enhanced radiation, better reconstructive choices, and developments in bio-engineering. The purpose of the present study was to determine the clinicopathological characteristics, surgical techniques, functional outcome, and prognostic factors of limb salvage surgery performed using mega prosthesis in primary malignant or benign resectable tumours. Methods Our retrospective cohort study was carried out over a period of two years and included 28 patients who received care for bone tumours. The data gathered comprised the demographic profile, clinical characteristics, histological characteristics, treatments given, functional results, and survival. LSS was performed on all patients by orthopaedics oncologists trained in the surgical oncology department. Following surgery, during the first two years, patients were examined at every three-month interval, then every six months until the fifth year, and then once a year after that. The Kaplan-Meier method was utilized to determine the median follow-up and recurrence-free survival (RFS). Results In our study, the mean age of study subjects was 30.0±10.9 years. Almost all of the subjects included in the study had lower limb bone tumours (96.4%). The most common site for the tumour was the distal femur (57.1%) followed by the proximal femur (32.2%). The most common type of benign tumour was giant cell tumour (GCT) (53.6%), including recurrences of giant cell tumour (GCT), and among malignant tumours, osteosarcoma was the most common (25.0%). The mean surgical resection of bone in limb salvage surgery was 125.2±24.2 mm. The most common post-operative complication was leg length discrepancy (LLD) among 25.0% of subjects, which was managed by shoe raise. The overall mean musculoskeletal tumour society (MTSS) score after LSS was 25.0±4.3. Using the Kaplan-Meier method analysis, we found that relapse-free survival was 83.7% among enrolled subjects at a median follow-up period of 80 months. Conclusion It can be difficult to surgically treat patients who have malignant bone tumours. In limb-sparing surgery for bone tumours, the modular segmental-replacement system prosthesis that we preferred produced satisfactory results in terms of tumour control and limb function. To get good long-term results, the case selection must be appropriate.
背景 “保肢手术”（LSS）这一方法有助于切除肢体肿瘤，并且重建手术完成后可获得令人满意的肿瘤学、功能和美容效果。肿瘤学切缘是首要考虑因素，其次是功能效果。在全球范围内，由于有效的化疗方案、改进的成像技术、精确的强化放疗、更好的重建选择以及生物工程学的发展，对于符合条件的患者，趋势已从截肢转向保肢手术。本研究的目的是确定使用巨型假体对原发性恶性或良性可切除肿瘤进行保肢手术的临床病理特征、手术技术、功能结果和预后因素。
方法 我们进行了一项为期两年的回顾性队列研究，纳入了28例接受骨肿瘤治疗的患者。收集的数据包括人口统计学资料、临床特征、组织学特征、给予的治疗、功能结果和生存情况。所有患者均由在外科肿瘤学部门接受培训的骨科肿瘤学家进行保肢手术。术后，在头两年，每三个月对患者进行一次检查，然后每六个月检查一次直至第五年，之后每年检查一次。采用Kaplan-Meier方法确定中位随访时间和无复发生存期（RFS）。
结果 在我们的研究中，研究对象的平均年龄为30.0±10.9岁。几乎所有纳入研究的对象都患有下肢骨肿瘤（96.4%）。肿瘤最常见的部位是股骨远端（57.1%），其次是股骨近端（32.2%）。最常见的良性肿瘤类型是骨巨细胞瘤（GCT）（53.6%），包括骨巨细胞瘤的复发，在恶性肿瘤中，骨肉瘤最为常见（25.0%）。保肢手术中骨的平均手术切除长度为125.2±24.2毫米。最常见的术后并发症是25.0%的研究对象出现下肢长度不等（LLD），通过垫高鞋子进行处理。保肢手术后肌肉骨骼肿瘤协会（MTSS）的总体平均评分为25.0±4.3。使用Kaplan-Meier方法分析，我们发现在中位随访期80个月时，纳入研究的对象无复发生存率为83.7%。
结论 对患有恶性骨肿瘤的患者进行手术治疗可能具有挑战性。在骨肿瘤的保肢手术中，我们首选的模块化节段置换系统假体在肿瘤控制和肢体功能方面产生了令人满意的结果。为了获得良好的长期效果，病例选择必须恰当。
