Complications and survival after surgical treatment of 214 metastatic lesions of the humerus
Complications and survival after surgical treatment of 214 metastatic lesions of the humerus
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DOI：
10.1016/j.jse.2011.06.019
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发表时间：
2012-08-01
影响因子：
3
通讯作者：
Weiss, Rudiger J.
中科院分区：
文献类型：
--
作者：
Wedin, Rikard;Hansen, Bjarne H.;Weiss, Rudiger J.
背景：肱骨是第二个最常见的长骨部位的转移性骨疾病。我们报告的并发症，失败的危险因素，和生存的一个大系列的患者进行骨转移的humerus.Materials和方法：这项研究是基于208例手术治疗的214肱骨转移性病变。采用髓内钉固定148例，内假体35例，钢板固定21例，其他方法10例。结果：手术年龄29-87岁，中位年龄67岁。乳腺癌是31%的原发肿瘤。手术重建的总失败率为9%。肱骨近端的再手术率为7%，骨干为8%，骨远端为33%。在涉及内假体的36例手术中，2例失败（6%），而178例骨接合器械中有18例失败（10%）。在接骨组中，髓内钉失败率为7%，钢板固定失败率为22%。多因素考克斯回归分析显示，前列腺癌与术后失败风险增加相关（风险比，7; P < 0.033）。术后1年的累积生存率为40%（95%可信区间[CI] 34-47），2年为21%（95%可信区间，15-26），3年为16%（95%可信区间，12-19）。结论：我们选择的方法是骨水泥型半假体用于病理性肱骨近端骨折，交锁髓内钉用于骨干病变。肱骨远端的病理性骨折并不常见，并且有很高的再手术率。证据等级：IV级，病例系列，治疗研究。(C)2012年《肩肘外科杂志》董事会。
Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus.Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10.Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years.Conclusions: Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate.Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.