Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?
Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?
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DOI：
10.1007/s11999.0000000000000125
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发表时间：
2018-05
影响因子：
4.2
通讯作者：
Windhager R
中科院分区：
文献类型：
--
作者：
Sevelda F;Waldstein W;Panotopoulos J;Kaider A;Funovics PT;Windhager R
大多数转移到股骨的骨病变可以不通过手术或微创髓内钉治疗。在罕见的股骨广泛转移性疾病患者中，全股骨置换术可能是截肢术的唯一手术替代方案;然而，对这种方法知之甚少。在高度选择的一小组股骨转移癌患者中，我们问：（1）这种治疗后患者的生存率如何？(2)无全因翻修和截肢的植入物存活率是多少，与这种治疗相关的并发症是什么？(3)患者在全股骨置换术后实现了哪些功能结局？1986年至2016年期间，11名患者（3名男性，8名女性）平均年龄为64岁（范围：41 - 78岁），接受了全股骨置换术;无患者失访。最常见的原发病是乳腺癌。总的来说，在此期间，我们的手术适应症是广泛的转移性疾病，无法进行内固定或单独的股骨近端或远端置换，预期寿命超过6个月。在此期间，我们对该手术的禁忌症是预期寿命小于6个月。通过Kaplan-Meier分析评估患者生存率;通过竞争风险分析评估无翻修手术和截肢的植入物生存率。术前和术后6 - 12周测定功能，肌肉骨骼肿瘤协会（MSTS）评分标准化为100分量表，评分越高表示功能越好，来自纵向维护的机构数据库。11例患者在术后中位5个月（范围，1 - 31个月）死亡。1年无翻修率和肢体存活率分别为82%（95% CI，51%-98%）和91%（95% CI，61%-99%）。再手术原因为髋关节脱位、感染和局部复发各1例。后两种并发症导致两名患者截肢。中位MSTS评分为32（范围，13 - 57）。尽管试图选择预期寿命更长的患者，但11例患者中有8例在术后6个月死亡，另外2例患者在术后8个月和17个月截肢。尽管我们尽最大努力为我们认为至少能活6个月的患者施行全股骨置换术，但本系列中大多数接受全股骨置换术的患者在死亡时仍未从手术中恢复。基于此，我们认为，大多数股骨广泛转移性疾病的患者应提供姑息治疗，而不是主要的重建。IV级，治疗性研究
The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The latter two complications resulted in amputation in two patients. The median MSTS score was 32 (range, 13-57). Despite attempts to select patients who might have anticipated greater life expectancy, eight of 11 patients died by 6 months after surgery, and an additional two patients had undergone an amputation at 8 and at 17 months postoperatively. Most patients undergoing total femur replacement in this series did not recover from the procedure by the time they died, despite our best attempts to perform the procedure in patients whom we thought would live at least 6 months. Based on this, we believe that most patients with extensive metastatic disease to the femur should be offered palliative care, rather than major reconstruction. Level IV, therapeutic study
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影响因子：
3.2
作者：
Liu T;Zhang X;Zhang Q;Zhang X;Guo X
通讯作者：
Guo X
DOI：
10.1097/01.blo.0000059580.08469.3e
发表时间：
2003-04-01
影响因子：
4.2
作者：
Jung, ST;Ghert, MA;Scully, SP
通讯作者：
Scully, SP
DOI：
10.1302/0301-620x.87b5.16021
发表时间：
2005-05-01
影响因子：
--
作者：
Bauer, HCF
通讯作者：
Bauer, HCF
DOI：
10.1097/01.blo.0000093849.72468.82
发表时间：
2003-10-01
影响因子：
4.2
作者：
Ward, WG;Holsenbeck, S;Howe, D
通讯作者：
Howe, D
影响因子：
2.7
作者：
Arvinius, Camilla;Cebrian Parra, Juan Luis;Lopez-Duran Stern, Luis
通讯作者：
Lopez-Duran Stern, Luis