Clinical application of segmental prosthesis in reconstruction of diaphyseal tumors / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical value of segmental prosthesis in the repair of diaphyseal defect.Methods The clinical data and follow-up information of 40 patients who accepted segmental prosthesis reconstruction of long bone defects in limbs were collected from June 2010 to June 2017 in General Hospital of Jinan Military Commanding and Tianjin Hospital.The parameters for outcome evaluation including general information,surgical complications,Musculoskeletal Tumor Society (MSTS) functional score,survival and prostheses status were analyzed.Results Forty patients were underwent segmental prosthesis surgery,including 18 males and 22 females,with a median age of 64 years and the age range of 13-83 years.The surgery was performed on 28 cases of femur,8 cases of humerus,3 cases of tibia,and 1 cases of ulna.There were 5 cases of primary tumor,3 cases of multiple myeloma and 32 cases of metastatic tumor of bone,in which lung cancer,breast cancer,kidney cancer,liver cancer and colorectal cancer are common.Pathological fracture of surgical site occurred in 32 cases.The average osteotomy length was 93.5 mm.The shortest osteotomy was 60 mm and the longest osteotomy was 190 mm.The average operation time was 104.6 minutes.The median bleeding volume was 600 ml.The least bleeding was 200 ml and the most bleeding was 2 800 ml.The patients median survival time was 8.5 months from 3 to 79 months.The prosthesis median survival time was 8 months from 3 to 79 months.According to the Henderson tumor prosthesis complications classification,there were 3 cases of type Ⅰ including 2 cases of incision delayed healing and 1 case of radial nerve paralysis.There was 1 case of type Ⅱ with humeral prosthesis aseptic loosening.There was 1 case of type Ⅲ with angulation deformity between femoral prosthesis force line and biological force line.There were 2 cases of type Ⅴ with tumor recurrence followed by amputation.The limb function score of MSTS was 20.4±4.1 points.Except for two patients with tumor recurrence and amputation,38 patients got stable prosthesis function until the death or follow-up cut-off.The similar tendency of patients survival curve and prosthesis survival curve indicated that survival was the main factor affecting postoperative prosthesis survivorship.Although the use rate of humeral plate (4/8,50.0％) was higher than that of femoral plate (5/28,17.9％),the difference was not statistically significant (F=3.426,P=0.064).The results of statistical analysis of complications showed that the type of tumor was an independent risk factor for complications (x2=7.446,P=0.024).The postoperative complications rate of primary tumor was significantly higher than that of multiple myeloma and bone metastasis.Patients with no complications have better limb function after surgery (F=9.709,P=0.003).Multivariate linear regression analysis showed that age,tumor type,preoperative pathologic fracture,surgery,osteotomy length did not affect limb functions after operation.The longer survival time mean better limb function (t=4.228,P=0.000).Conclusion Segmental prosthesis is a reliable method for the repair of bone metastases with defects.Combined with bone plate fixation,it can effectively reduce the occurrence of prosthetic complications.