Bahamonde Luis, Zecchetto Pierluca
Department of Orthopedics and Traumatology, University of Chile, Santiago, Chile.
Ann Jt. 2022 Nov 18;8:1. doi: 10.21037/aoj-20-104. eCollection 2023.
Modular oncologic megaprosthesis is the standard method for reconstruction after resection of tumors of the proximal femur. These implants have been utilized for either primary tumors or metastatic disease of bone and multiple myeloma. Fixation is based on either cemented or cementless stems, and a collar supporting the body of the prosthesis. For those patients with advanced disease and/or limited life span, a judicious approach should balance the functional expectations, prognosis, and the issue of cost of the surgical procedure and the implant that is selected.
Based on the principles of distal fixation of tapered stems, the authors have utilized implants originally designed for hip revision surgery to reconstruct the proximal femur in 19 patients, after resection because of metastases, multiple myeloma and some aggressive primary tumors. The essentials of the technique consist of distal fixation in the remaining isthmus of the femur by means of tapered stems, impacted in such a way to achieve solid primary fixation, balanced with accurate leg length restoration. Proximally, the implant remains devoid of bone coverage.
In this retrospective study, proper distal fixation, leaving the proximal part of the implant uncovered with bone, has resulted in good functional results in mid-term follow-up of patients. Primary fixation has led to secondary bone ongrowth and remodeling, providing secondary fixation. Complications such as instability, loosening and infection are comparable with those associated to the traditional management with mega prosthesis.
The utilization of tapered stems for distal fixation after proximal femoral resections has shown reliable results after mid-term follow-up. The method might be considered as a cost-effective alternative for selected patients.
模块化肿瘤型大假体是股骨近端肿瘤切除术后重建的标准方法。这些植入物已用于原发性肿瘤或骨转移性疾病及多发性骨髓瘤。固定方式基于骨水泥型或非骨水泥型柄，以及支撑假体主体的颈环。对于那些患有晚期疾病和/或预期寿命有限的患者，明智的方法应在功能期望、预后以及手术和所选植入物的成本问题之间取得平衡。
基于锥形柄远端固定的原则，作者利用最初设计用于髋关节翻修手术的植入物，对19例因转移瘤、多发性骨髓瘤和一些侵袭性原发性肿瘤而切除术后的患者进行股骨近端重建。该技术的要点包括通过锥形柄在股骨剩余峡部进行远端固定，以实现牢固的一期固定，并通过准确恢复肢体长度来平衡。近端，植入物保持无骨覆盖。
在这项回顾性研究中，适当的远端固定，使植入物近端无骨覆盖，在患者中期随访中取得了良好的功能结果。一期固定导致了二期骨长入和重塑，提供了二期固定。诸如不稳定、松动和感染等并发症与传统大假体治疗相关的并发症相当。
股骨近端切除术后使用锥形柄进行远端固定在中期随访后显示出可靠的结果。该方法可被视为某些特定患者具有成本效益的替代方案。
