Ferrara Paola E, Ariani Mariantonietta, Codazza Sefora, Aprovitola Adelaide, Polisano Daniele, Ronconi Gianpaolo
Department of Aging, Orthopedic and Rheumatological Sciences, University Polyclinic Foundation A. Gemelli IRCCS, 00100 Rome, Italy.
Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00100 Rome, Italy.
Cancers (Basel). 2024 Sep 30;16(19):3357. doi: 10.3390/cancers16193357.
The optimal management of bone tumors requires a multidisciplinary strategy to guarantee high-quality care. At specialized centers, the medical team responsible for managing patients with bone cancer comprises oncologists, surgeons, radiologists, pathologists, and rehabilitation specialists. The goal of treatment is to achieve long-term survival with minimal disability and pain. Postoperative rehabilitation is a fundamental therapeutic approach to enhance functionality and sustain the utmost quality of life following a limb-sparing surgery. Currently, megaprostheses are used for reconstructing bone defects after tumor resection, but in the literature, only a few studies have investigated rehabilitation outcomes in terms of functionality and impact on daily activities. This narrative review explores the functional and quality of life outcomes after the implantation of MUTARS prostheses in patients with lower extremity bone tumors. A comprehensive search was conducted on PubMed and Scopus using the following MESH terms: "MUTARS", "Megaprosthesis", "bone", "tumors", "metastasis", "lower limb", "rehabilitation", "outcome", and "quality of life", and 10 studies were included. The most frequent oncological pathology was found to be primitive bone tumors treated with modular prostheses. The outcome measures used were the Henderson et al. classification, Harris Hip Scale, Musculoskeletal Tumor Society score, Visual Analog Scale, Range Of Motion, Karnofsky Performance Scale, and quality of life questionnaire. MUTARS is a well-established treatment option after bone tumor resection, although it involves extensive and complex post-resection reconstruction that exposes joints and tissues to substantial mechanical stress. Proper rehabilitation after MUTARS surgery is a fundamental therapeutic step, although there is still insufficient evidence in the literature focusing on functional and rehabilitative outcomes. Therefore, more studies and guidelines are needed to define standardized rehabilitation protocols for clinical practice after orthopedic oncologic surgery.
骨肿瘤的最佳管理需要多学科策略来确保高质量护理。在专业中心，负责管理骨癌患者的医疗团队包括肿瘤学家、外科医生、放射科医生、病理学家和康复专家。治疗的目标是实现长期生存，同时使残疾和疼痛降至最低。术后康复是一种基本的治疗方法，可增强功能并在保肢手术后维持最高生活质量。目前，巨型假体用于肿瘤切除后重建骨缺损，但在文献中，只有少数研究调查了功能方面的康复结果以及对日常活动的影响。本叙述性综述探讨了下肢骨肿瘤患者植入MUTARS假体后的功能和生活质量结果。使用以下医学主题词在PubMed和Scopus上进行了全面检索：“MUTARS”、“巨型假体”、“骨”、“肿瘤”、“转移”、“下肢”、“康复”、“结果”和“生活质量”，共纳入10项研究。发现最常见的肿瘤病理是用模块化假体治疗的原发性骨肿瘤。所使用的结果测量指标包括亨德森等人的分类、哈里斯髋关节评分、肌肉骨骼肿瘤学会评分、视觉模拟量表、活动范围、卡诺夫斯基功能状态量表和生活质量问卷。MUTARS是骨肿瘤切除术后一种成熟的治疗选择，尽管它涉及广泛而复杂的切除后重建，使关节和组织承受巨大的机械应力。MUTARS手术后的适当康复是一个基本的治疗步骤，尽管文献中关于功能和康复结果的证据仍然不足。因此，需要更多的研究和指南来为骨科肿瘤手术后的临床实践定义标准化的康复方案。
