Jin Qing-Lin, Su Hao-Bin, Du Shao-Hua, Hou Chang-He, Lu Ming, Dai Shuang-Wu, Lei Zi-Xiong, Chen Wei, Li Hao-Miao
Department of Musculoskeletal Oncology, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Front Oncol. 2024 Feb 12;14:1328703. doi: 10.3389/fonc.2024.1328703. eCollection 2024.
Periprosthetic fracture (PPF) is one of the severe complications in patients with osteosarcoma and carries the risk of limb loss. This study describes the characteristics, treatment strategies, and outcomes of this complication.
Patients were consecutively included who were treated at our institution between 2016 and 2020 with a PPF of distal femur. The treatment strategies included two types: 1) open reduction and internal fixation with plates and screws and 2) replacement with long-stem endoprosthesis and reinforcement with wire rope if necessary.
A total of 11 patients (mean age 12.2 years (9-14)) were included, and the mean follow-up period was 36.5 (21-54) months. Most fractures were caused by direct or indirect trauma (n = 8), and others (n = 3) underwent PPF without obvious cause. The first type of treatment was performed on four patients, and the second type was performed on seven patients. The mean Musculoskeletal Tumor Society (MSTS) score was 20 (17-23). All patients recovered from the complication, and limb preservation could be achieved.
PPF is a big challenge for musculoskeletal oncologists, particularly in younger patients. Additionally, PPF poses a challenge for orthopedic surgeons, as limb preservation should be an important goal. Hence, internal fixation with plates and endoprosthetic replacement are optional treatment strategies based on fracture type and patient needs.
假体周围骨折（PPF）是骨肉瘤患者的严重并发症之一，存在肢体缺失风险。本研究描述了该并发症的特征、治疗策略及结果。
连续纳入2016年至2020年在我院接受治疗的股骨远端PPF患者。治疗策略包括两种类型：1）钢板螺钉切开复位内固定；2）必要时采用长柄假体置换并用钢丝绳加强。
共纳入11例患者（平均年龄12.2岁（9 - 14岁）），平均随访期为36.5（21 - 54）个月。多数骨折由直接或间接创伤引起（n = 8），其他（n = 3）患者无明显原因发生PPF。4例患者采用第一种治疗方式，7例患者采用第二种治疗方式。肌肉骨骼肿瘤学会（MSTS）平均评分为20（17 - 23）。所有患者均从并发症中康复，可实现保肢。
PPF对肌肉骨骼肿瘤学家来说是一项重大挑战，尤其是在年轻患者中。此外，PPF对骨科医生也构成挑战，因为保肢应是一个重要目标。因此，根据骨折类型和患者需求，钢板内固定和假体置换是可选的治疗策略。
