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Umkehrplastik im operativen Behandlungsplan der primär malignen Knochentumoren

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Zusammenfassung

Durch die Einführung einer multimodalen Therapie mit Chemo- und evtl. Strahlentherapie bei malignen Knochentumoren konnte die Langzeitüberlebensrate deutlich gesteigert werden. Heute überleben bis zu 80% der Patienten mit einem Ewing- oder Osteosarkom. Daher kommt der Funktion der betroffenen Extremität und der Lebensqualität des Patienten nach der Tumorresektion eine entscheidende Bedeutung zu.

Die Umkehrplastik, die 1974 von Salzer in die Tumorchirurgie eingeführt und von Winkelmann modifziert wurde, ersparte vor der Ära der Tumorendoprothetik vielen Patienten die Amputation. Aber auch im Zeitalter des Extremitätenerhalts (limb salvage) muss die Umkehrplastik hinsichtlich der Funktionalität und der Akzeptanz den Vergleich mit der Endoprothetik nicht scheuen. Insbesondere bei Tumoren mit ausgedehnter Weichteilkomponente, des proximalen oder gesamten Femurs und der proximalen Tibia und bei Patienten unterhalb des 10. Lebensjahres ist die Umkehrplastik eine ernstzunehmende Alternative. Des Weiteren kann sie nach misslungenem Extremitätenerhalt (Infektion, mehrfache Prothesenwechsel) den Patienten vor einer Amputation bewahren.

Abstract

Long-term survival of patients with a malignant bone tumor increased with a combined therapeutic approach using chemotherapy and possibly radiation therapy. Today up to 80% of patients with an osteosarcoma or Ewing's sarcoma survive. Therefore, it is important that the functional outcome and the quality of life are good after resection of the tumor.

Before the era of endoprosthetic devices, rotationplasty, which was introduced in 1974 by Salzer for surgery of malignant bone tumors and modified by Winkelmann, protected many patients from an amputation. Although many authors favor limb-saving procedures today, rotationplasty obtained excellent functional and psychosocial results. Rotationplasty can be recommended in tumors with a large soft tissue component, in tumors located in the proximal femur and proximal tibia, and in children under 10 years of age. Furthermore, rotationplasty can be used in patients in whom a limb-salvage procedure failed because of infection or repeated changes of the endoprosthesis.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemeine Orthopädie, Westfälische Wilhelms-Universität, Münster

    J. Hardes, C. Gebert, W. Winkelmann & G. Gosheger

  2. Orthopädische Klinik, Klinikum, Ingolstadt

    A. Hillmann

  3. Klinik und Poliklinik für Allgemeine Orthopädie, Westfälische Wilhelms-Universität, Albert-Schweitzer-Straße 33, 48129, Münster

    J. Hardes

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  1. J. Hardes
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  2. C. Gebert
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  3. A. Hillmann
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  4. W. Winkelmann
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  5. G. Gosheger
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Correspondence to J. Hardes.

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Hardes, J., Gebert, C., Hillmann, A. et al. Umkehrplastik im operativen Behandlungsplan der primär malignen Knochentumoren. Orthopäde 32, 965–970 (2003). https://doi.org/10.1007/s00132-003-0550-y

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