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A 15-year follow-up of transfemoral amputees with bone-anchored transcutaneous prostheses.

骨锚式经皮假体经股截肢者的 15 年随访。

  • 影响因子:3.58
  • DOI:10.1302/0301-620X.102B1.BJJ-2019-0611.R1
  • 作者列表:"Hagberg K","Ghassemi Jahani SA","Kulbacka-Ortiz K","Thomsen P","Malchau H","Reinholdt C
  • 发表时间:2020-01-01
Abstract

AIMS:The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral transfemoral amputation (TFA) treated with a bone-anchored, transcutaneous prosthesis. METHODS:In this cohort study, all patients with a unilateral TFA treated with the Osseointegrated Prostheses for the Rehabilitation of Amputees (OPRA) implant system in Sahlgrenska University Hospital, Gothenburg, Sweden, between January 1999 and December 2017 were included. The cohort comprised 111 patients (78 male (70%)), with a mean age 45 years (17 to 70). The main reason for amputation was trauma in 75 (68%) and tumours in 23 (21%). Patients answered the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) before treatment and at two, five, seven, ten, and 15 years' follow-up. A prosthetic activity grade was assigned to each patient at each timepoint. All mechanical complications, defined as fracture, bending, or wear to any part of the implant system resulting in removal or change, were recorded. RESULTS:The Q-TFA scores at two, five, seven, and ten years showed significantly more prosthetic use, better mobility, fewer problems, and an improved global situation, compared with baseline. The survival rate of the osseointegrated implant part (the fixture) was 89% and 72% after seven and 15 years, respectively. A total of 61 patients (55%) had mechanical complications (mean 3.3 (SD 5.76)), resulting in exchange of the percutaneous implant parts. There was a positive relationship between a higher activity grade and the number of mechanical complications. CONCLUSION:Compared with before treatment, the patient-reported outcome was significantly better and remained so over time. Although osseointegration and the ability to transfer loads over a 15-year period have been demonstrated, a large number of mechanical failures in the external implant parts were found. Since these were related to higher activity, restrictions in activity and improvements to the mechanical properties of the implant system are required. Cite this article: Bone Joint J 2020;102-B(1):55-63.

摘要

目的: 本研究的目的是描述用骨锚定的经皮假体治疗单侧经股截肢 (TFA) 患者的植入物和患者报告的结果。 方法: 在这项队列研究中,所有在瑞典哥德堡Sahlgrenska大学医院接受骨整合假体治疗的单侧TFA患者接受截肢者 (OPRA) 植入系统康复,1999 年 1 月至 2017 年 12 月期间纳入。该队列包括 111 例患者 (78 例男性 (70%)),平均年龄 45 岁 (17-70)。截肢的主要原因是创伤 75 例 (68%) 和肿瘤 23 例 (21%)。患者在治疗前和随访 2 、 5 、 7 、 10 和 15 年时回答了经股截肢 (Q-TFA) 患者的问卷。在每个时间点为每位患者分配假体活动等级。记录所有机械并发症,定义为骨折、弯曲或磨损到植入物系统的任何部分导致移除或改变。 结果: 与基线相比,2 年、 5 年、 7 年和 10 年的Q-TFA评分显示假体使用显著增加,活动度更好,问题更少,全球情况改善。7 年和 15 年后,骨结合种植体部分 (固定物) 的存活率分别为 89% 和 72%。共有 61 例患者 (55%) 出现机械性并发症 (平均 3.3 (SD 5.76)),导致经皮植入部件交换。较高的活动等级与机械性并发症的数量之间存在正相关。 结论: 与治疗前相比,患者报告的结局明显更好,并且随着时间的推移保持不变。尽管已经证明了 15 年期间的骨整合和转移负荷的能力,但发现了外部植入部件的大量机械故障。由于这些与更高的活性有关,因此需要限制活性和改善植入系统的机械性能。引用本文: 骨关节J 2020;102-B(1):55-63。

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DOI:10.1177/1078155219842277
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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