Fraser Ewen, Spence Stephanie, Farhan-Alanie Omer M, Doonan James, Mahendra Ashish, Gupta Sanjay
Ninewells Hospital, Dundee, UK.
Royal Alexandra Hospital, Paisley, Scotland.
Bone Jt Open. 2024 Dec 8;5(12):1092-1100. doi: 10.1302/2633-1462.512.BJO-2024-0095.R1.
Limb salvage surgery (LSS) is the primary treatment option for primary bone malignancy. It involves the removal of bone and tissue, followed by reconstruction with endoprosthetic replacements (EPRs) to prevent amputation. Trabecular metal (TM) collars have been developed to encourage bone ingrowth (osseointegration (OI)) into EPRs. The primary aim of this study was to assess whether OI occurs when TM collars are used in EPRs for tumour.
A total of 124 patients from July 2010 to August 2021 who underwent an EPR for tumour under the West of Scotland orthopaedic oncology team were identified. Overall, 81 patients (65%) met the inclusion criteria, and two consultants independently analyzed radiographs at three and 12 months, as well as the last radiograph, using a modified version of the Stanford Radiological Assessment System.
OI of the TM collar occurred in approximately 65% of patients at last radiograph. The percentage of patients with OI at three months (65.4%) reflected the 12-month (65%) and long-term (64.4%) follow-up. The median amount of OI across all radiographs was one at all three timepoints, with only five cases (11.1%) showing OI in all four zones at last radiograph. Radiolucency at the bone:collar junction was present in 23 cases (28.4%) at three months, but only four (6.7%) showed progression of this at 12 months. The interobserver reliability was found to be highly reliable in all parameters (p < 0.001).
OI occurs in approximately 65% of TM collars, and is similar at three months, 12 months, and last radiograph. The extent of OI at the bone:collar junction was found to have decreased at longer-term follow-up. Furthermore, radiolucency at the bone-collar impact junction does occur in some patients but only a low number will show radiolucency progression at longer-term follow-up.
保肢手术（LSS）是原发性骨恶性肿瘤的主要治疗选择。该手术包括切除骨骼和组织，随后用内置假体置换物（EPR）进行重建以防止截肢。已开发出小梁金属（TM）环以促进骨长入（骨整合（OI））到EPR中。本研究的主要目的是评估在用于肿瘤的EPR中使用TM环时是否会发生骨整合。
确定了2010年7月至2021年8月期间在苏格兰西部骨科肿瘤团队接受肿瘤EPR手术的124例患者。总体而言，81例患者（65%）符合纳入标准，两名顾问使用改良版的斯坦福放射学评估系统独立分析了三个月、十二个月时的X光片以及最后一张X光片。
在最后一张X光片时，约65%的患者出现TM环的骨整合。三个月时骨整合患者的百分比（65.4%）与十二个月（65%）和长期（64.4%）随访结果相符。在所有三个时间点，所有X光片上骨整合的中位数均为1，在最后一张X光片时，只有5例（11.1%）在所有四个区域均出现骨整合。三个月时，23例（28.4%）患者在骨与环的交界处出现射线可透性，但在十二个月时只有4例（6.7%）显示其有进展。发现所有参数的观察者间可靠性都非常高（p < 0.001）。
约65%的TM环会发生骨整合，在三个月、十二个月和最后一张X光片时情况相似。发现在长期随访中，骨与环交界处的骨整合程度有所降低。此外，一些患者在骨-环撞击交界处确实会出现射线可透性，但只有少数患者在长期随访中会出现射线可透性进展。
