Metastatic disease of the femur: Surgical treatment
Metastatic disease of the femur: Surgical treatment
复制标题
DOI：
10.1097/01.blo.0000093849.72468.82
复制
发表时间：
2003-10-01
影响因子：
4.2
通讯作者：
Howe, D
中科院分区：
文献类型：
--
作者：
Ward, WG;Holsenbeck, S;Howe, D
回顾了资深作者连续12年的一系列手术治疗股骨转移性疾病。治疗97例即将发生的病理性骨折比治疗85例已完成的病理性骨折效果更好，平均失血量更少（438毫升对636毫升），住院时间更短（7天对11天），出院回家的可能性更大（79%对56%），恢复无支撑行走的可能性更大（35%对12%）。重建型髓内钉内固定对大多数病理性股骨骨折患者（97,71%中的69例）提供了满意的疼痛缓解和功能保留，尽管其他形式的内固定（97,22%中的21例）或骨水泥关节置换术（97,7%中的7例）成功使用。完全病理性骨折更可能需要某种形式的关节置换术（85,55%中的47例），尽管重建型钉子（85,24%中的20例）和其他内固定技术（85,21%中的18例）也被使用。模块化肿瘤型关节置换术系统为两组患者提供了可行的挽救选择。在没有冲突目标或禁忌症的情况下，在骨折完成前对即将发生的病理性骨折进行内部稳定似乎是合理和适当的。
The senior author's 12-year consecutive series of surgery for metastatic disease of the femur was reviewed. Treatment of 97 impending pathologic fractures yielded better results than treatment of 85 completed pathologic fractures with less average blood loss (438 cc versus 636 cc), shorter hospital stay (7 days versus 11 days), greater likelihood of discharge to home as opposed to an extended care facility (79% versus 56%) and greater likelihood of resuming support-free ambulation (35% versus 12%). Internal stabilization with a reconstruction-type intramedullary nail provided satisfactory pain relief and functional preservation for most patients with impending pathologic femur fractures (69 of 97, 71%), although alternate forms of internal fixation (21 of 97, 22%) or cemented arthroplasty (seven of 97, 7%) were used successfully. Completed pathologic fractures were more likely to require some form of arthroplasty (47 of 85, 55%), although reconstruction-type nails (20 of 85, 24%), and other internal fixation techniques (18 of 85, 21%) also were used. Modular oncology-type arthroplasty systems offered a viable salvage option in both groups. In the absence of conflicting goals or contraindications, internal stabilization of impending pathologic fractures before the completion of the fracture seems to be reasonable and appropriate.