You Qi, Lu Minxun, Min Li, Zhang Yuqi, Luo Yi, Zhou Yong, Tu Chongqi
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Sichuan Model Worker and Craftsman Talent Innovation Resaerch Studio, China.
Front Surg. 2022 Sep 22;9:991168. doi: 10.3389/fsurg.2022.991168. eCollection 2022.
Short metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary findings and experiences associated with an intra-neck curved stem (INCS) reconstructive approach, with a particular focus on mechanical stability.
From March 2013 to August 2016, 11 total patients underwent reconstructive procedures using a customized cemented femoral endoprosthesis (CCFE) with an INCS. Measurements of femoral neck-shaft angle values were made before and after this procedure. Radiological outcomes associated with this treatment strategy over an average 63-month follow-up period were additionally assessed. Functionality was assessed based upon Musculoskeletal Tumor Society (MSTS) scores, while a visual analog scale (VAS) was used to rate pre- and postoperative pain, and any complications were noted.
Relative to the preoperative design, no significant differences in femoral neck-shaft angle were observed after this reconstructive procedure ( = 0.410). Postoperatively, the tip of the stem was primarily positioned within the middle third of the femoral head in both lateral and posterior-anterior radiographic, supporting the accuracy of INCS positioning. The average MSTS score for these patients was 25 (range: 21-28), and VAS scores were significantly reduced after surgery ( < 0.0001). One patient exhibited local disease recurrence and ultimately succumbed to lung metastases, while two patients exhibited aseptic loosening. None of the treated patients exhibited complications such as infections, periprosthetic fractures, or prosthetic fractures as of most recent follow-up.
CCFE with an INCS represents a viable approach to massive femoral diaphyseal defect with short proximal femur repair, as patients can achieve good functional outcomes and early weight-bearing with proper individualized rehabilitative interventions, all while exhibiting low rates of procedure-related complications.
广泛的股骨远端肿瘤切除术后残留的短干骺端节段难以处理，因为残留的短节段可能不足以容纳标准长度的髓内骨水泥柄。本研究旨在详细阐述与颈内弯柄（INCS）重建方法相关的初步研究结果和经验，特别关注机械稳定性。
2013年3月至2016年8月，11例患者接受了使用定制骨水泥型股骨假体（CCFE）和INCS的重建手术。在此手术前后测量股骨颈干角值。此外，评估了在平均63个月的随访期内与该治疗策略相关的放射学结果。根据肌肉骨骼肿瘤学会（MSTS）评分评估功能，同时使用视觉模拟量表（VAS）对术前和术后疼痛进行评分，并记录任何并发症。
相对于术前设计，该重建手术后股骨颈干角无显著差异（=0.410）。术后，在侧位和前后位X线片中，柄的尖端主要位于股骨头的中三分之一内，支持INCS定位的准确性。这些患者的平均MSTS评分为25分（范围：21 - 28分），术后VAS评分显著降低（<0.0001）。1例患者出现局部疾病复发，最终死于肺转移，2例患者出现无菌性松动。截至最近一次随访，所有接受治疗的患者均未出现感染、假体周围骨折或假体骨折等并发症。
CCFE联合INCS是治疗股骨骨干巨大缺损合并股骨近端短小的可行方法，因为患者通过适当的个体化康复干预可以获得良好的功能结果并早期负重，同时手术相关并发症发生率较低。
