Andreani Lorenzo, Ipponi Edoardo, Falcinelli Federico, Barderi Sara, Vannucci Lorenzo, Campo Francesco Rosario, D'Arienzo Antonio, Parchi Paolo Domenico
Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy.
Department of Rehabilitation and Physical Therapy, University of Pisa, 56126 Pisa, Italy.
Healthcare (Basel). 2023 Nov 19;11(22):2984. doi: 10.3390/healthcare11222984.
Megaprostheses are the most used reconstructive approach for patients who have undergone massive resection of their distal femurs due to bone tumors. Although the literature about their outcomes has flourished in recent decades, to date, a consensus on rehabilitative treatment is yet to be established. In this study, we report on our experience with our latest standardized rehabilitation program, evaluating our results in a mid-to-long-term scenario.
We evaluated the functional results of all our oncologic patients treated between 2016 and 2022 who could follow our standardized post-operative rehabilitative approach, consisting of progressive knee mobilization and early weight-bearing.
Sixteen cases were included in our study. The average duration of the patients' hospitalization was 12.2 days. A standing position was reached on average 4.1 days after surgery, while assisted walking was started 4.5 days after surgery. After a mean post-operative follow-up of 46.7 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggest that the sooner patients could achieve a standing position (R = -0.609; = 0.012) and start walking (R = -0.623; = 0.010), the better their final functional outcomes regarding their MSTS scores.
Rehabilitation should be considered a pivotal factor in decreeing the success of distal femur megaprosthetic implants in long-surviving oncologic patients. Correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximizing the post-operative functional outcomes of these patients.
对于因骨肿瘤而接受股骨远端大块切除的患者，巨型假体是最常用的重建方法。尽管近几十年来关于其治疗效果的文献大量涌现，但迄今为止，关于康复治疗仍未达成共识。在本研究中，我们报告了我们最新标准化康复计划的经验，并在中长期情况下评估了我们的结果。
我们评估了2016年至2022年间接受治疗的所有肿瘤患者的功能结果，这些患者能够遵循我们标准化的术后康复方法，包括逐步进行膝关节活动和早期负重。
我们的研究纳入了16例病例。患者的平均住院时间为12.2天。术后平均4.1天达到站立位，术后4.5天开始辅助行走。术后平均随访46.7个月后，我们患者的平均肌肉骨骼肿瘤学会（MSTS）评分为23.2（10 - 30）。我们的数据表明，患者越早达到站立位（R = -0.609；P = 0.012）并开始行走（R = -0.623；P = 0.010），其最终的MSTS评分功能结果就越好。
在决定长期存活的肿瘤患者股骨远端巨型假体植入成功方面，康复应被视为一个关键因素。正确的康复，侧重于早期活动和逐步负重，对于最大化这些患者的术后功能结果至关重要。
