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Extendable Endoprostheses in Skeletally Immature Patients: A Study of 124 Children Surviving More Than 10 Years After Resection of Bone Sarcomas.

骨骼发育不成熟患者的可伸展内假体: 一项对 124 例骨肉瘤切除术后存活 10 年以上儿童的研究。

  • 影响因子:3.57
  • DOI:10.2106/JBJS.19.00621
  • 作者列表:"Tsuda Y","Tsoi K","Stevenson JD","Fujiwara T","Tillman R","Abudu A
  • 发表时间:2020-01-15
Abstract

BACKGROUND:Extendable endoprostheses are used to reconstruct segmental defects following resection of bone sarcomas in skeletally immature patients. However, there remains a paucity of studies with regard to long-term outcomes. METHODS:We retrospectively reviewed 124 skeletally immature children who underwent an extendable endoprosthetic replacement and survived more than 10 years after the surgical procedures. Anatomical sites included the distal part of the femur (n = 66), the proximal part of the femur (n = 13), the proximal part of the tibia (n = 29), and the proximal part of the humerus (n = 16). Complications and implant survival were classified according to the modified Henderson criteria. RESULTS:The mean follow-up was 24 years (range, 10 to 36 years). The mean age at the time of the extendable endoprosthetic replacement was 9 years (range, 2 to 16 years). All patients had reached skeletal maturity at the last follow-up. The 10-year endoprosthetic failure-free survival rate was 28%. A total of 243 complications occurred in 90% of patients; these complications were most frequently related to soft-tissue problems (27% of complications). The incidence of and cumulative survival with respect to each failure mode varied between anatomical sites. Soft-tissue failures occurred most frequently in the proximal part of the femur (77%; p = 0.003), and the distal part of the femur was the most frequent site of aseptic loosening (52%; p = 0.014) and structural failure (55%; p = 0.001). Excluding lengthening procedures, 105 patients (85%) underwent an additional surgical procedure, with a mean of 2.7 surgical procedures per patient (range, 0 to 7 surgical procedures per patient). The mean limb-length discrepancy at the final follow-up was 1 cm (range, 0 to 9 cm). Limb salvage was achieved in 113 patients (91%). The mean Musculoskeletal Tumor Society functional score (the percentage of a total score of 30 points) was 82% (range, 40% to 100%) in 115 patients with available data at the last follow-up. CONCLUSIONS:Extendable endoprostheses are associated with a high complication rate and a need for additional surgical procedures over time. Despite this, successful limb salvage with reasonable function and small limb-length discrepancy is achievable in the long term. Our study provides benchmark data for individual anatomical sites for further improvements of outcomes. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景: 在骨骼不成熟的患者中,可伸展的内假体用于重建切除骨肉瘤后的节段性缺损。然而,关于长期结果的研究仍然很少。 方法: 我们回顾性分析了 124 例骨骼发育不成熟的儿童,他们接受了可延长的假体置换,术后存活超过 10 年。解剖部位包括股骨远端 (n = 66) 、股骨近端 (n = 13) 、胫骨近端 (n = 29) 、和肱骨近端 (n = 16)。根据改良的Henderson标准对并发症和植入物存活率进行分类。 结果: 平均随访 24 年 (10 ~ 36 年)。可伸展型内假体置换术时的平均年龄为 9 岁 (范围 2-16 岁)。所有患者在末次随访时均达到骨骼成熟度。10 年假体内无衰竭生存率为 28%。243 的患者共发生 90% 次并发症; 这些并发症最常与软组织问题有关 (占并发症的 27%)。解剖部位之间每种失败模式的发生率和累积生存率各不相同。软组织衰竭最常见于股骨近端 (77%; p = 0.003),股骨远端是无菌性松动最常见的部位 (52%; p = 0.014) 和结构失效 (55%; p = 0.001)。不包括延长手术,105 例患者 (85%) 接受了额外的手术,平均每例患者 2.7 次手术 (范围,每例患者 0 至 7 次手术)。最终随访时平均肢体长度差异为 1厘米 (范围 0-9厘米)。保肢治疗 113 例 (91%)。在最后一次随访时有数据的 82% 例患者中,平均肌肉骨骼肿瘤协会功能评分 (占总分 30 分的百分比) 为 40% (范围,100% ~ 115)。 结论: 随着时间的推移,可伸展的内假体具有较高的并发症发生率和需要额外的外科手术。尽管如此,从长远来看,具有合理功能和小肢体长度差异的成功保肢是可以实现的。我们的研究为进一步改善结局提供了个体解剖部位的基准数据。 证据级别: 治疗性IV级。有关证据级别的完整描述,请参见作者说明。

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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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