Metastatic Bone Disease: A Study of the Surgical Treatment of 166 Pathologic Humeral and Femoral Fractures
Metastatic Bone Disease: A Study of the Surgical Treatment of 166 Pathologic Humeral and Femoral Fractures
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转移性骨病：166例病理性肱骨和股骨骨折的手术治疗研究
DOI：
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发表时间：
1990
影响因子：
4.2
通讯作者：
T. Shives
中科院分区：
文献类型：
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作者：
Y. Yazawa;F. Frassica;E. Chao;D. Pritchard;F. Sim;T. Shives
对147例166处肱骨和股骨转移性病变的手术治疗进行了回顾性研究。有106名女性和41名男性，平均年龄为62岁。三分之二的患者接受完全骨折治疗，而三分之一的患者接受即将发生的骨折治疗。乳腺癌、肺癌和肾癌占原发性病变的大多数。一半的患者在手术后9个月内死亡，四分之一的患者在手术后19.1个月存活。乳腺癌患者预后最好，肺癌患者预后最差。植入物失效的概率随时间线性增加，60个月时达到33%。股骨病变的失效概率更高，60个月时为44%。股骨病变固定失败的患者的平均生存期为34.5个月，平均失效间隔为17.7个月。使用加压螺钉或钉板治疗的股骨近端病变的失败率较高（23%）。失败的常见原因包括初始固定不良、植入物选择不当和术野内疾病进展。如果可能，骨水泥加固应与固定器械一起使用。通过在螺钉螺纹周围应用骨水泥，也可以减少髋关节螺钉从头部切出引起的并发症。
A retrospective study of the surgical treatment of 166 metastatic lesions of the humerus and femur in 147 patients was performed. There were 106 women and 41 men whose average age was 62 years. Two-thirds of the patients were treated for complete fractures, while one-third were treated for impending fractures. Breast, lung, and kidney carcinoma accounted for the majority of the primary lesions. One-half of the patients died within nine months of surgery, while one-quarter were alive 19.1 months after surgery. The patients with breast cancer had the best prognosis, while the patients with lung cancer had the worst. The probability of implant failure increased linearly with time to 33% at 60 months. The probability of failure for the femoral lesions was greater, with 44% at 60 months. The average survival in the patients with failed fixation in the femoral lesions was 34.5 months with a mean interval to failure at 17.7 months. The failure rate was high (23%) in proximal femoral lesions treated with a compression screw or nail plate. Common reasons for failure included poor initial fixation, improper implant selection, and progression of disease within the operative field. Bone cement augmentation should be used with the fixation device when possible. Complications due to hip-screw cut-out from the head may also be reduced by applying bone cement around the screw threads.