Gonzalez Marcos R, Okay Erhan, Sodhi Alisha S, Lozano-Calderon Santiago A
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
J Shoulder Elbow Surg. 2024 May;33(5):1104-1115. doi: 10.1016/j.jse.2023.12.024. Epub 2024 Feb 14.
Distal humerus replacement (DHR) is a modular endoprosthesis mainly used for bone reconstruction after resection of primary or metastatic bone lesions. Studies on DHR failure rates and postoperative functional outcomes are scarce. We sought to assess implant survival, modes of failure, and functional outcomes in patients undergoing DHR for oncologic indications.
A systematic review of the PubMed and Embase databases was performed. PRISMA guidelines were followed for this manuscript. Our study was registered on PROSPERO (457,260). Quality appraisal of included studies was conducted using the STROBE checklist. Prosthetic failure was assessed using the Henderson classification for megaprosthetic failures. We additionally performed a retrospective review of patients treated with a DHR for oncologic indications at a large tertiary care academic center. Weighted means were calculated to pool data.
Eleven studies with a total of 162 patients met the inclusion criteria. Mean follow-up was 3.7 years (range, 1.66-8 years). Henderson type 2 failures (aseptic loosening) were the most common mode of failure, occurring in 12% of cases (range, 0%-33%). Five-year implant survival was 72% (range, 49%-93.7%). Mean postoperative Musculoskeletal Tumor Society (MSTS) score was 81.1 (range, 74-84.3). In our institutional case series, 2 out of 5 patients had DHR revision for periprosthetic fracture and aseptic loosening at 16 and 27 months after surgery, respectively.
Distal humerus replacement is a successful reconstruction strategy for tumors of the distal humerus, with high implant survival and good to excellent functional outcomes.
肱骨远端置换术（DHR）是一种模块化的内置假体，主要用于原发性或转移性骨病变切除术后的骨重建。关于DHR失败率和术后功能结局的研究较少。我们旨在评估因肿瘤适应症接受DHR治疗的患者的植入物存活率、失败模式和功能结局。
对PubMed和Embase数据库进行系统评价。本手稿遵循PRISMA指南。我们的研究已在PROSPERO（457,260）上注册。使用STROBE清单对纳入研究进行质量评估。使用亨德森（Henderson）分类法评估大型假体失败的假体失败情况。我们还对一家大型三级医疗学术中心因肿瘤适应症接受DHR治疗的患者进行了回顾性研究。计算加权平均值以汇总数据。
11项研究共162例患者符合纳入标准。平均随访时间为3.7年（范围1.66 - 8年）。亨德森2型失败（无菌性松动）是最常见的失败模式，发生率为12%（范围0% - 33%）。五年植入物存活率为72%（范围49% - 93.7%）。术后肌肉骨骼肿瘤学会（MSTS）平均评分为81.1（范围74 - 84.3）。在我们的机构病例系列中，5例患者中有2例分别在术后16个月和27个月因假体周围骨折和无菌性松动接受了DHR翻修。
肱骨远端置换术是肱骨远端肿瘤的一种成功重建策略，植入物存活率高，功能结局良好至优秀。
