Outcome After Reconstruction of the Proximal Humerus for Tumor Resection: A Systematic Review

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• 作者：Teun Teunis MD (1)
  Sjoerd P. F. T. Nota MD (1)
  Francis J. Hornicek MD ; PhD (1) (2)
  Joseph H. Schwab MD ; MS (1) (3)
  Santiago A. Lozano-Calderón MD ; PhD (1)
  
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2014
• 出版时间：July 2014
• 年：2014
• 卷：472
• 期：7
• 页码：2245-2253
• 全文大小：
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• 作者单位：Teun Teunis MD (1)
  Sjoerd P. F. T. Nota MD (1)
  Francis J. Hornicek MD, PhD (1) (2)
  Joseph H. Schwab MD, MS (1) (3)
  Santiago A. Lozano-Calderón MD, PhD (1)
  
  1. Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital–Harvard Medical School, Room 3.946, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA
  2. Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital–Harvard Medical School, Boston, MA, USA
  3. Spine Surgery Service, Massachusetts General Hospital–Harvard Medical School, Boston, MA, USA
  
• ISSN：1528-1132

文摘

Background Tumors of the appendicular skeleton commonly affect the proximal humerus, but there is no consensus regarding the best reconstructive technique after proximal humerus resection for tumors of the shoulder. Questions/purposes We wished to perform a systematic review to determine which surgical reconstruction offers the (1) best functional outcome as measured by the Musculoskeletal Tumor Society (MSTS) score, (2) longest construct survival, and (3) lowest complication rate after proximal humerus resection for malignant or aggressive benign tumors of the shoulder. Methods We searched the literature up to June 1, 2013, from MEDLINE, EMBASE, and the Cochrane Library. Only studies reporting results in English, Dutch, or German and with followups of 80% or more of the patients at a minimum of 2?years were included. Twenty-nine studies with 693 patients met our criteria, seven studies (24%) were level of evidence III and the remainder were level IV. Studies reported on reconstruction with prostheses (n?=?17), osteoarticular allografts (n?=?10), and allograft-prosthesis composites (n?=?11). Owing to substantial heterogeneity and bias, we narratively report our results. Results Functional scores in prosthesis studies ranged from 61% to 77% (10 studies, 141 patients), from 50% to 78% (eight studies, 84 patients) in osteoarticular graft studies, and from 57% to 91% (10 studies, 141 patients) in allograft-prosthesis composite studies. Implant survival ranged from 0.38 to 1.0 in the prosthesis group (341 patients), 0.33 to 1.0 in the osteoarticular allograft group (143 patients), and 0.33 to 1.0 in allograft-prosthesis group (132 patients). Overall complications per patient varied between 0.045 and 0.85 in the prosthesis group, 0 and 1.5 in the osteoarticular graft group, and 0.19 and 0.79 in the prosthesis-composite graft group. We observed a higher fracture rate for osteoarticular allografts, but other specific complication rates were similar. Conclusions Owing to the limitations of our systematic review, we found that allograft-prosthesis composites and prostheses seem to have similar functional outcome and survival rates, and both seem to avoid fractures that are observed with osteoarticular allografts. Further collaboration in the field of surgical oncology, using randomized controlled trials, is required to establish the superiority of any particular treatment.