Brzeszczyński Filip Fryderyk, Karpiński Michał, Brzeszczyński Marcel Aleksander, Bończak Oktawiusz, Hamilton David F
Department of Trauma, Orthopaedics and Musculoskeletal Oncology, Copernicus Memorial Hospital, 93-513 Lodz, Poland.
The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB24 3FX, UK.
Cancers (Basel). 2025 Sep 9;17(18):2951. doi: 10.3390/cancers17182951.
BACKGROUND/OBJECTIVES: Bone reconstruction using megaprostheses is increasingly performed following bone tumour resections, including sarcomas, to enhance patient outcomes and quality of life. However, this is a complex patient group, and there is little consensus as to postoperative rehabilitation and associated outcomes.
A systematic search was conducted in MEDLINE and EMBASE databases according to the Implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidelines. Studies describing rehabilitation protocols and functional outcomes following bone tumour resection and modular oncologic megaprosthesis reconstruction were included. All papers were individually assessed for methodological quality using the Joanna Briggs Institute (JBI) critical appraisal tool.
The search generated 105 records, 28 underwent full-text review, and 13 studies were included. Available data reflect 371 patients with a mean age of 49.17 (S.D. 21.40) years and a mean postoperative follow-up of 41.88 (S.D. 32.88) months. Surgical indications were documented as sarcomas in 9 studies, and tumour metastasis to the bone in 10 studies. Rehabilitation protocols were reported in 5 studies following proximal humerus resection with a mean dislocation rate of 14.5% (S.D. 5.26). All protocols advised brace immobilisation for a period ranging between 10 days and 6 months. Superior Constant-Murley shoulder score was reported in patients with early active isometric exercises at 6 weeks. Six studies reported proximal femur prosthesis rehabilitation and functional outcomes, with a mean dislocation rate of 10% (S.D. 9.82). Enhanced outcomes were reported in studies employing early mobilisation. Two studies assessed distal femur prosthesis; both studies reported similar protocols with full weight bearing 3 weeks following surgery. The methodological quality of the studies varied, but was overall modest, with 10/13 studies meeting at least 50% of JBI reporting criteria.
The existing literature on rehabilitation and outcomes in orthopaedic oncology patients following arthroplasty with megaprosthesis is limited, with rehabilitative protocols variably described. However, it seems that early active mobilisation does not increase the risk of joint dislocations or infections.
背景/目的：在包括肉瘤在内的骨肿瘤切除术后，使用大型假体进行骨重建的操作日益增多，以改善患者的治疗效果和生活质量。然而，这是一个复杂的患者群体，对于术后康复及相关结果几乎没有共识。
根据运动、康复、运动医学和体育科学领域实施系统评价和荟萃分析的首选报告项目（PERSiST）指南，在MEDLINE和EMBASE数据库中进行了系统检索。纳入了描述骨肿瘤切除和模块化肿瘤假体重建后康复方案及功能结果的研究。使用乔安娜·布里格斯研究所（JBI）批判性评价工具对所有论文的方法学质量进行单独评估。
检索共产生105条记录，28篇进行了全文审查，13项研究被纳入。现有数据反映了371例患者，平均年龄49.17（标准差21.40）岁，术后平均随访41.88（标准差32.88）个月。9项研究记录手术指征为肉瘤，10项研究为肿瘤骨转移。5项研究报告了肱骨近端切除术后的康复方案，平均脱位率为14.5%（标准差5.26）。所有方案均建议使用支具固定10天至6个月。6周时早期进行主动等长运动的患者Constant-Murley肩关节评分更高。6项研究报告了股骨近端假体的康复及功能结果，平均脱位率为10%（标准差9.82）。采用早期活动的研究报告了更好的结果。2项研究评估了股骨远端假体；两项研究均报告了相似的方案，术后3周完全负重。研究的方法学质量各不相同，但总体一般，13项研究中有10项至少符合JBI报告标准的50%。
关于骨肿瘤患者使用大型假体置换术后康复及结果的现有文献有限，康复方案描述不一。然而，早期主动活动似乎不会增加关节脱位或感染的风险。
