保留自身关节的定制型假体与新轴心式膝关节假体在股骨远端骨肉瘤保肢治疗中的应用效果比较

目的:对比分析保留自身关节的定制型假体和新轴心式膝关节假体在股骨远端骨肉瘤保肢治疗中的临床疗效。方法:回顾性队列研究。纳入2012年8月—2019年3月上海市第六人民医院股骨远端骨肉瘤患者32例，其中男22例、女10例，年龄8～73(22.1±15.9)岁。本组32例新辅助化疗均有效，均行股骨远端瘤段切除假体重建术治疗...

Comparison of curative effect in native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients with distal femoral osteosarcoma

Objective To compare the clinical effectiveness of native joint-preserving custom-made prosthesis and newly designed pivoted knee prothesis in treatment of patients diagnosed with distal femoral osteosarcoma.Methods A retrospective cohort study was performed on 32 patients diagnosed with femoral osteosarcoma and who underwent bone tumor resection and reconstruction with man-made prosthesis between January 2012 to December 2019. Radiography showed good response in neoadjuvant chemotherapy. Based on the constructive procedure, 12 cases were included in the native joint-preserving custom-made prosthesis group and 20 cases in the newly pivoted knee prosthesis groups. Post-operative Musculoskeletal Tumor Society score (MSTS) and Hospital for Special Surgery (HSS) score were compared at 12 months after surgery, and the rates of tumor recurrence were compared between two groups. Postoperative complications and difference of length of lower limb in children below 15 years old were observed.Results The MSTS scores after 12 months were (26.6±2.6) points and (22.6±1.8) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. The HSS scores were (90.1±4.1) points and (70.4±5.1) points in native joint-preserving custom-made prosthesis and newly pivoted knee prosthesis groups, respectively. There were significantly statistical differences between two groups(t=5.019, 11.375, all P values＜0.05). The rate of tumor recurrence was 2/12 in native joint-preserving custom-made prosthesis group and 15%(3/20) in newly pivoted knee prosthesis group with no statistically significant difference (P=0.620). The fracture of the stem of prosthesis occurred in one case, and wound healing was delayed in one case in the native joint-preserving custom-made prosthesis group. Loose prothesis in two cases and delayed wound healing in one case were observed in the newly pivoted knee prosthesis group. No postoperative limb length beyond 20 mm was recorded in children below 15 years old more than 24 months after surgery.Conclusions Compared with the newly designed pivoted knee prosthesis custom-made prosthesis that aims to preserve the joint, based on strict surgical indications and the good response of neoadjuvant chemotherapy, the construction of native joint-preserving custom-made prosthesis is a safe and effective option for preserving joint function although it failed to reduce postoperative unequal length of lower limbs in children below 15 years old with growing up.