在翻修关节成形术中使用定制假体柄保留关节和中间肿瘤假体。
Joint preservation in revision arthroplasty and intercalary tumour implants using custom stem solutions.
机构信息
Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, Germany.
Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.
出版信息
BMC Musculoskelet Disord. 2024 Nov 5;25(1):880. doi: 10.1186/s12891-024-07997-8.
BACKGROUND
Off-the-shelf stems offer a wide variety of fixation methods for revision arthroplasty and intercalary tumour implants. However, in extensive defects or needed resection with minimal bone stock left, solid fixation is often not feasible with these implants. Custom-made stem solutions (CSS) offer a viable alternative in these cases to achieve joint preservation.
METHODS
Between 2017 and 2024 14 patients (15 implants) were treated in a single-centre study. CSS were indicated if the remaining bone stock was deemed insufficient for normal stem fixation due to tumour resection or previous operations. Postoperative analysis was conducted to evaluate the functional outcome as well as revision rates.
RESULTS
Implantation was possible in all cases, during the follow-up of 30 (SD 18; 6-66) months revision was needed in five cases; with one aseptic loosening, one screw loosening and three PJI cases. Mean MSTS score was 24 (SD 5; 17-30).
CONCLUSION
Custom-made stem solutions show promising results in extreme cases. Especially as a preservation of the joint is possible, this treatment algorithm should be considered on a case-by-case basis.
背景
现成的干骺端髓内钉为翻修关节成形术和间插肿瘤植入物提供了广泛的固定方法。然而，在广泛的缺陷或需要切除时，剩余的骨量较少，这些植入物通常无法进行可靠的固定。在这些情况下，定制化的干骺端解决方案（Custom-made stem solutions，CSS）为实现关节保留提供了可行的替代方案。
方法
在单中心研究中，2017 年至 2024 年间，14 名患者（15 个植入物）接受了治疗。如果由于肿瘤切除或先前的手术导致剩余的骨量被认为不足以进行正常的干骺端钉固定，则需要采用 CSS。术后进行分析以评估功能结果和翻修率。
结果
所有病例均成功植入，在 30（SD 18；6-66）个月的随访中，有 5 例需要翻修，其中 1 例无菌性松动，1 例螺钉松动，3 例假体关节感染。平均 MSTS 评分为 24（SD 5；17-30）。
结论
在极端情况下，定制化的干骺端解决方案显示出有前途的结果。特别是因为可以保留关节，因此应根据具体情况考虑这种治疗方案。
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