- 作者：Rikard Wedin ; Bjarne H. Hansen ; Minna Laitinen ; Clement Trovik ; Olga Zaikova ; Peter Bergh ; Anders Kal¨¦n ; Gunnar Schwarz-Lausten ; Fredrik Vult von Steyern ; Anders Walloe ; Johnny Keller ; R¨¹diger J. Weiss
- 关键词：Level IV ; Case Series ; Treatment Study
- 刊名：Journal of Shoulder and Elbow Surgery
- 出版年：2012
- 出版时间：August, 2012
- 年：2012
- 卷：21
- 期：8
- 页码：1049-1055
- 全文大小：431 K
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.