Modular Tumor Resection Prosthesis in Osteosarcoma Treatment

Özet

Amaç: Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan olguların değerlendirilmesi amaçlandı. Gereç ve Yöntem: Kliniğimizde 2000 ile 2012 yılları arasında Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan ve yeterli takipleri olan 14 olgu değerlendirildi. Olgular cinsiyet, yaş, yön, tümör yerleşimi, takip süresi, tedavi başarısı, komplikasyon, nüks ve sağkalım açısından incelendi. Elde edilen veriler SPSS 15.0 programına aktarılarak analiz edildi. Verilerin normal dağılıma uygunluğu Shapiro-Wilk testi ile değerlendirildi. Bulgular: 14 olgunun 8'i erkek, 6'sı kadın ve ortalama yaş 21.9±7.02 idi. Osteosarkom 9 (%64.3) hastada femur distalinde, 5 (%35.7) hastada tibia proksimalinde, 5 hastada sağ ve 9 hastada sol alt ekstremitede idi. Ortalama takip süresi 33 ay idi. Ortalama MSTS skoru 81.9 hesaplandı, 11 hastada (%78.6) mükemmel, 3 hastada (%21.4) yetersiz sonuç elde edildi. Komplikasyon olarak 3 olguda aseptik gevşeme, 2 olguda peroneal sinir felci, 2 olguda cilt nekrozu, 2 olguda periprostatik kırık, 1 olguda protez enfeksiyonu ve 1 olguda lokal nüks gözlendi. Peroneal sinir felci olan 2 olgu dısında komplikasyonlar sorunsuz iyileşti. Lokal nüks gelişen hasta akciğer metastazı nedeniyle kaybedildi. Tartışma: Osteosarkomun tümör rezeksiyon protezi ile tedavisi, uzun dönemde protezin sağkalımını etkileyecek olan olası komplikasyonlar nedeniyle kullanımında soru işareti yaratmaktadır. Ancak stabilite, erken yük verme ve osteosentez kaygısından uzak olması nedeniyle avantajlı ve amputasyona kıyasla psikolojik olarak yüz güldürücüdür.

Abstract

Aim: The aim of the study is to evaluate the cases who underwent tumor resection prosthesis due to osteosarcoma. Material and Method: 14 cases who underwent tumor resection prosthesis due to osteosarcoma in our clinic between 2000 and 2012 and who had sufficient follow-ups were evaluated. The cases were examined in terms of gender, age, direction, tumor location, follow-up time, success of the treatment, complication, recurrence, and survival. The data obtained were transferred to the SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with the ShapiroWilk test. Results: 8 of the 14 cases were male, 6 were female, and the average age of the cases was 21.9±7.02. Osteosarcoma was in the distal femur in 9 (64.3%) of the patients, in the proximal tibia in 5 (35.7%) of the patients, in the right lower extremity in 5 of the patients, and in the left lower extremity in 9 of the patients. Average follow-up time was 33 months (3-144 months range). Average MSTS score was found as 81.9 (53-96 range), perfect results were taken in 11 (78.6%) patients while insufficient results were taken in 3 (21.4%) patients. As for complications, aseptic softening was observed in 3 cases, peroneal nerve paralysis was observed in 2 cases, skin necrosis was observed in 2 cases, periprostatic fracture was observed in 2 cases, prosthesis infection was observed in 1 case, and local recurrence was observed in 1 case. Except for the two cases with peroneal nerve paralysis, cases with complications recovered without any problems. The patient who developed local recurrence was lost due to lung metastasis. Discussion: Treatment of osteosarcoma through tumor resection prosthesis raises question marks due to possible complications that can affect the survival of the prosthesis in the long term. However, this treatment method is favorable in terms of stability, early load efficiency, and causing less anxiety than osteosynthesis; it is also psychologically more pleasing than amputation.