Daher Mohammad, Fares Mohamad Y, Gill Steve S, Boufadel Peter, Jensen Andrew R, Eward William C, Khan Adam Z, Horneff John G, Abboud Joseph A
Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson Medical Center, Philadelphia, PA, USA.
Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Clin Shoulder Elb. 2025 Jul 28;28(3):298-305. doi: 10.5397/cise.2025.00388.
Allograft prosthetic composite (APC) and megaprosthesis (MP) have both been used to reconstruct the proximal humerus after its resection due to primary or secondary tumors. However, varied results have been reported in the literature with no consensus on which reconstruction has better overall outcomes.
PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through September 2024. The compared outcomes consisted of adverse events, patient-reported outcomes measures, and range of motion. Ten studies and 400 patients were included, with 115 in the APC group and 285 in the MP group.
The APC group had a higher rate of reoperations (odds ratio, 2.50; 95% CI, 1.40-4.45; P=0.002) than did the MP group over an average follow-up of 7.0 years. However, better postoperative flexion (mean difference, 10.11; 95% CI, 5.33-14.90; P<0.001) and Musculoskeletal Tumor Society scores (mean difference, 3.73; 95% CI, 1.37- 6.08; P=0.002) were seen in the APC group.
The present study shows a lower rate of revision with the use of MP but better functional outcomes and forward flexion with APC as the surgical option for proximal humerus reconstruction. Level of evidence: III.
同种异体移植假体复合物（APC）和巨型假体（MP）均已用于因原发性或继发性肿瘤切除后近端肱骨的重建。然而，文献报道的结果各不相同，对于哪种重建方式总体效果更好尚无共识。
检索截至2024年9月的PubMed、Cochrane和谷歌学术（第1 - 20页）。比较的结果包括不良事件、患者报告的结局指标和活动范围。纳入了10项研究和400例患者，其中APC组115例，MP组285例。
在平均7.0年的随访中，APC组的再次手术率（优势比，2.50；95%可信区间，1.40 - 4.45；P = 0.002）高于MP组。然而，APC组术后屈曲度更好（平均差异，10.11；95%可信区间，5.33 - 14.90；P < 0.001），肌肉骨骼肿瘤学会评分也更高（平均差异，3.73；95%可信区间，1.37 - 6.08；P = 0.002）。
本研究表明，作为近端肱骨重建的手术选择，使用MP的翻修率较低，但使用APC的功能结局和前屈效果更好。证据级别：III级。
