n = 216
n = 89
n = 79
infezioni 15 (6,9%) 11 (12,4%) 7 (8,8%) lesioni nervose 25 (11,6%) 4 (4,5%) 7 (8,8%) mob. asettiche 20 (9,3%) 5 (5,6%) 0 instabilità 0 0 19 (24%) riassorbimento 3 (1,4%) 12 (13,5%) 4 (5%) pseudoartrosi 0 10 (11,2%) 15 (19%) altro 10 (4,6%) 3 (3,4%) 2 (2,5%) totale 73 (33,8%) 45 (50,6%) 54 (68,4%)7. CONCLUSIONI
La ricostruzione dei gravi difetti ossei nella regione del gomito rappresenta una situazione difficile da affrontare per il chirurgo ortopedico. Le tecniche chirurgiche a disposizione sono molteplici, tra cui troviamo l’artrodesi, le protesi di primo impianto, le megaprotesi, gli innesti protesizzati e i trapianti osteoarticolari.
La scarsa incidenza di complicanze, i buoni risultati funzionali, oncologici, estetici e emozionali, rendono ad oggi le protesi modulari e le custom made la migliore scelta chirurgica, sia in pazienti con neoplasie di varia natura che in caso di fallimento di altre tecniche ricostruttive. Probabilmente, il miglior campo di utilizzo è rappresentato dai soggetti con lesioni metastatiche in cui si sono già realizzate fratture patologiche oppure che sono prossime a realizzarsi a causa della massiccia perdita di tessuto osseo sano. In generale comunque possiamo dire che l’impianto di protesi è preferibile in pazienti più anziani e con scarse richieste funzionali, con possibile resezione completa di tendini e muscoli, in quanto l’intervento chirurgico è più sicuro e meno complesso. Tutte le ricostruzioni biologiche invece hanno risultati migliori in pazienti giovani e con richieste funzionali maggiori, poiché nella maggior parte dei casi si riescono a preservare sia le strutture muscolari che i legamenti. Questo permette di ottenere buoni livelli di stabilità e un’adeguata mobilità articolare.
Indipendentemente dal tipo di ricostruzione è fondamentale la collaborazione con il chirurgo plastico per garantire la corretta copertura dei tessuti molli; suture non ottimali possono esporre il paziente a infezioni che possono pregiudicare l’esito dell’intervento.
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