骨干骨段的串联重建：采用节段性假体和游离腓骨瓣

Tandem Reconstruction of the Femoral Diaphysis Using an Intercalary Prosthesis and a Fibular Free Flap.

机构信息

Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY.

Orthopaedic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY.

出版信息

J Bone Joint Surg Am. 2024 Mar 6;106(5):425-434. doi: 10.2106/JBJS.23.00211. Epub 2023 Dec 21.

DOI:10.2106/JBJS.23.00211

PMID:38127807

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10932824/

Abstract

BACKGROUND

Femoral diaphyseal reconstructions with metal prostheses have mediocre results because of high mechanical forces that result in eventual implant failure. Biological alternatives require prolonged restrictions on weight-bearing and have high rates of infection, nonunion, and fracture. A novel method of utilizing a vascularized fibula in combination with an intercalary prosthesis was developed to complement the immediate stability of the prosthesis with the long-term biological fixation of a vascularized fibular graft.

METHODS

A prospectively maintained database was retrospectively reviewed to identify patients who underwent reconstruction of an oncological intercalary femoral defect using an intercalary prosthesis and an inline fibular free flap (FFF). They were compared with patients who underwent femoral reconstruction using an intercalary allograft and an FFF.

RESULTS

Femoral reconstruction with an intercalary metal prosthesis and an FFF was performed in 8 patients, and reconstruction with an allograft and an FFF was performed in 16 patients. The mean follow-up was 5.3 years and 8.5 years, respectively (p = 0.02). In the bioprosthetic group, radiographic union of the fibula occurred in 7 (88%) of 8 patients, whereas in the allograft group, 13 (81%) of 16 patients had allograft union (p = 1.00) and all 16 patients had fibular union (p = 0.33). The mean time to fibular union in the bioprosthetic group was 9.0 months, whereas in the allograft group, the mean time to allograft union was 15.3 months (p = 0.03) and the mean time to fibular union was 12.5 months (p = 0.42). Unrestricted weight-bearing occurred at a mean of 3.7 months in the prosthesis group and 16.5 months in the allograft group (p < 0.01). Complications were observed in 2 (25%) of 8 patients in the prosthesis group and in 13 (81%) of 16 patients in the allograft group (p = 0.02). Neither chemotherapy nor radiation affected fibular or allograft union rates. Musculoskeletal Tumor Society scores did not differ significantly between the groups (mean, 26 versus 28; p = 0.10).

CONCLUSIONS

Bioprosthetic intercalary femoral reconstruction with a metal prosthesis and an FFF resulted in earlier weight-bearing, a shorter time to union, fewer operations needed for union, and lower complication rates than reconstruction with an allograft and an FFF.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

由于股骨骨干重建后假体承受的机械力较高，最终导致假体失效，因此使用金属假体进行股骨骨干重建的效果并不理想。生物替代品需要长时间限制负重，并且感染、骨不连和骨折的发生率较高。为了弥补假体即刻稳定性的不足，同时发挥带血管腓骨移植物的长期生物固定作用，我们开发了一种利用带血管腓骨的新型方法，将其与节段性假体结合使用。

方法

对前瞻性保存的数据库进行回顾性分析，以确定使用节段性假体和腓骨游离皮瓣（FFF）行骨肿瘤节段性股骨缺损重建的患者，并与使用同种异体移植物和 FFF 行股骨重建的患者进行比较。

结果

8 例患者采用金属假体和 FFF 行股骨重建，16 例患者采用同种异体移植物和 FFF 行股骨重建。平均随访时间分别为 5.3 年和 8.5 年（p = 0.02）。在生物假体组中，8 例患者中有 7 例（88%）腓骨影像学愈合，而在同种异体组中，16 例患者中有 13 例（81%）同种异体骨愈合（p = 1.00），16 例患者均有腓骨愈合（p = 0.33）。生物假体组腓骨愈合的平均时间为 9.0 个月，同种异体组同种异体骨愈合的平均时间为 15.3 个月（p = 0.03），腓骨愈合的平均时间为 12.5 个月（p = 0.42）。在假体组中，患者平均在 3.7 个月时可不受限制地负重，而在同种异体组中，患者平均在 16.5 个月时可不受限制地负重（p < 0.01）。假体组有 2 例（25%）患者和同种异体组有 13 例（81%）患者发生并发症（p = 0.02）。化疗和放疗均未影响腓骨或同种异体骨愈合率。两组间肌肉骨骼肿瘤学会（Musculoskeletal Tumor Society，MSTS）评分无显著差异（平均，26 分比 28 分；p = 0.10）。