Nongdamba Hawaibam, Bondarde Parshwanath, Danish V, Maheshwari Vikas, Karn Rahul, Olkha Vikas, Dhingra Mohit, Vathulya Madhubhari
Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India.
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India.
J Orthop. 2023 Dec 2;49:123-127. doi: 10.1016/j.jor.2023.11.069. eCollection 2024 Mar.
Medical advancements in musculoskeletal oncology has significantly reduced the mortality rate associated with limb-sparing surgery, making it comparable to amputation. The use of modular megaprosthesis for sarcoma treatment has now become a standard practice. However, these non-biological implants are not without their complications.
A retrospective cohort study was conducted on all patients who underwent wide resection of locally aggressive and malignant bone tumors, followed by reconstruction with megaprosthesis between January 2018 and January 2023 at tertiary care hospital. Patients were evaluated based on oncological outcomes, functional outcomes, and complications with a minimum follow-up period of 6 months.
The study included a total of 30 patients, comprising 16 males and 14 females, with a mean age of 33.6 ± 15.6 years. They all underwent wide resection and reconstruction with megaprosthesis. Diagnosis among the patients included 19 cases of giant cell tumors, 5 cases of osteosarcomas, 2 cases of metastatic bone tumors, and 1 case each of chondrosarcoma, malignant fibrous histiocytoma, multiple myeloma, and chondromyxoid fibroma. These tumors were predominantly located in the distal femur (15 patients) and proximal tibia (12 patients). The average follow-up period was 33 ± 21 months, resulting in an average final Musculoskeletal Tumor Society (MSTS) score of 81 % ± 9 %. Complications were observed in 21 patients, with infection being the most common, specifically Type 4 (10 patients, 37 %), followed by Type 1 (4 patients, 13 %) and Type 3 (4 patients, 13 %). Two patients (7 %) experienced Type 5 complications, while three succumbed to their illnesses. Additionally, two patients required amputation, one due to local recurrence and the other due to a deep-seated infection.
Megaprosthesis is a viable reconstruction option following wide resection of bone tumors. Infection remains the most common issue, and cost poses a significant challenge.
肌肉骨骼肿瘤学的医学进步显著降低了与保肢手术相关的死亡率，使其与截肢相当。使用模块化大假体治疗肉瘤现已成为一种标准做法。然而，这些非生物植入物并非没有并发症。
对2018年1月至2023年1月在三级护理医院接受局部侵袭性和恶性骨肿瘤广泛切除并随后用大假体重建的所有患者进行了一项回顾性队列研究。基于肿瘤学结果、功能结果和并发症对患者进行评估，最短随访期为6个月。
该研究共纳入30例患者，其中男性16例，女性14例，平均年龄33.6±15.6岁。他们均接受了广泛切除并用大假体进行重建。患者的诊断包括19例骨巨细胞瘤、5例骨肉瘤、2例转移性骨肿瘤，以及软骨肉瘤、恶性纤维组织细胞瘤、多发性骨髓瘤和软骨黏液样纤维瘤各1例。这些肿瘤主要位于股骨远端（15例患者）和胫骨近端（12例患者）。平均随访期为33±21个月，最终肌肉骨骼肿瘤学会（MSTS）平均评分为81%±9%。21例患者出现并发症，感染最为常见，特别是4型（10例患者，37%），其次是1型（4例患者，13%）和3型（4例患者，13%）。2例患者（7%）出现5型并发症，3例患者因病死亡。此外，2例患者需要截肢，1例因局部复发，另1例因深部感染。
大假体是骨肿瘤广泛切除后可行的重建选择。感染仍然是最常见的问题，成本构成重大挑战。
