Benefits of early intramedullary nailing in femoral metastases
Benefits of early intramedullary nailing in femoral metastases
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DOI：
10.1007/s00264-013-2108-x
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发表时间：
2014-01-01
影响因子：
2.7
通讯作者：
Lopez-Duran Stern, Luis
中科院分区：
文献类型：
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作者：
Arvinius, Camilla;Cebrian Parra, Juan Luis;Lopez-Duran Stern, Luis
长骨病理性骨折是转移性疾病的常见并发症；然而，治疗这些骨折的不同手术技术的结果尚未明确定义。本研究的目的是评估股骨转移性植入物预防性和治疗性髓内钉治疗的差异。对 1995 年至 2011 年（随访 15 个月）65 例股骨转移患者（37 名女性；28 名男性）进行回顾性分析。 44 例出现病理性骨折，21 例即将发生骨折（Mirel 千分之一7）。所用的手术治疗是用铰削的长伽马钉进行髓内固定。研究的参数包括生存率、放射学和分析结果以及功能结果。预防性钉钉导致术后立即死亡的比例为 5%，而治疗性钉钉导致术后立即死亡的比例为 11.4%，并且每组均检测到一种技术并发症。在幸存的患者中，75.9%的骨折患者和100%的即将发生病变的患者术后能够行走。治疗组（范围 1-49）的平均生存时间为 11 个月，预防组（范围 1-34）的平均生存时间为 14 个月。与治疗性髓内钉相比，预防性髓内钉需要的输血率较低（1.4 浓度 vs. 3.0），活动时间较早（4.0 天 vs. 9.7 天），住院时间较短（8 天 vs. 16 天）（p < 0.05）。转移性病变的股骨髓内钉固定在临床和放射学方面均提供了令人满意的结果。转移瘤的早期治疗可以预防骨折并获得更好的效果，从而提高这些患者的生活质量。
Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants.Sixty-five patients with metastasis of the femur were analysed retrospectively (37 females; 28 males) between 1995 and 2011 (follow-up 15 months). Forty-four presented with pathological fractures and 21 impending fractures (Mirel a parts per thousand yen7). The operative treatments used were intramedullary fixation with reamed long Gamma nails. The studied parameters were survival, radiological and analytical findings, and functional outcomes.Prophylactic nailing resulted in immediate postoperative deaths in 5 % vs. 11.4 % in therapeutic, and one technical complication was detected in each group. Among the surviving patients 75.9 % of the fractures and 100 % of impending lesions were able to walk after the operation. The mean survival time was 11 months in the therapeutic (range 1-49) and 14 in the prophylactic group (1-34). The prophylactic intramedullary nails required a lower transfusion rate (1.4 concentrates vs. 3.0), mobilised earlier (day 4.0 vs. 9.7) and needed a shorter hospital stay (eight days vs. 16 days) compared to therapeutic nails (p < 0.05).Femoral intramedullary nailing of metastasic lesions provides satisfactory results both clinically and radiologically. Early treatment of the metastases prevents fractures and gives better results, improving life quality of these patients.