Malawer M M, Chou L B
Washington Cancer Institute, Washington Hospital Center, Washington, D.C. 20010, USA.
J Bone Joint Surg Am. 1995 Aug;77(8):1154-65. doi: 10.2106/00004623-199508000-00003.
We evaluated the long-term clinical results and the survival of the prostheses in eighty-two patients who had had a limb-sparing procedure by means of the implantation of a large-segment prosthesis. All patients had had a high-grade bone sarcoma of the distal, middle, or proximal part of the femur; the proximal part of the humerus; the proximal part of the tibia; or the pelvis. The duration of follow-up ranged from two to twelve years (median, three and one-half years). Function was evaluated with the revised 30-point classification system of the Musculoskeletal Tumor Society. The survival of the prostheses was analyzed with regard to several variables with use of Kaplan-Meier survival estimates. Sixty-eight patients were alive at the latest follow-up evaluation. The survival rate of the prostheses was 83 per cent at five years and 67 per cent at ten years. Twelve prostheses were revised, and eleven revisions were successful. The rate of revision was highest (six of thirteen) in the patients who had had a tumor of the proximal part of the tibia. In contrast, only three (10 per cent) of the thirty-one patients who had had a tumor of the distal part of the femur and three (10 per cent) of the twenty-nine who had had a tumor of the proximal part of the humerus had a revision. Eleven patients (13 per cent) had an infection, which necessitated an amputation in six. Five patients (6 per cent) had a local recurrence, and nine patients (11 per cent), including the six already mentioned, ultimately needed an amputation. Patients who had had a tumor of the proximal part of the humerus had the highest functional scores, while those who had had a tumor of the proximal part of the tibia had the lowest scores. Large-segment prostheses were a good reconstructive option for the treatment of high-grade bone sarcomas in our patients. The rates of long-term survival of the prostheses were acceptable and the functional results were good or excellent after this form of treatment at most of the anatomical sites at which they were used.
我们评估了82例接受大段假体植入保肢手术患者的长期临床结果及假体生存率。所有患者均患有股骨远端、中段或近端、肱骨近端、胫骨近端或骨盆的高级别骨肉瘤。随访时间为2至12年（中位时间为3.5年）。采用肌肉骨骼肿瘤学会修订的30分分类系统评估功能。使用Kaplan-Meier生存估计法分析假体生存率与多个变量的关系。在最近一次随访评估时，68例患者存活。假体5年生存率为83%，10年生存率为67%。12例假体进行了翻修，11例翻修成功。胫骨近端肿瘤患者的翻修率最高（13例中有6例）。相比之下，31例股骨远端肿瘤患者中只有3例（10%）、29例肱骨近端肿瘤患者中只有3例（10%）进行了翻修。11例患者（13%）发生感染，其中6例需要截肢。5例患者（6%）出现局部复发，9例患者（1%）最终需要截肢，其中包括上述6例。肱骨近端肿瘤患者的功能评分最高，而胫骨近端肿瘤患者的功能评分最低。大段假体是治疗我们患者高级别骨肉瘤的良好重建选择。在大多数使用该假体的解剖部位，这种治疗方式后的假体长期生存率可接受，功能结果良好或优异。
