股骨干转移瘤不同手术重建方式的临床结果
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摘要
[目的]探讨股骨干转移瘤不同重建方式的外科治疗效果。[方法]回顾性分析本科2007年1月～2017年1月手术治疗的24例股骨干转移瘤患者,男15例、女9例,年龄52～70岁,平均(64.58±4.64)岁。股骨干转移瘤濒临骨折9例、病理性骨折15例。依据Mirls评分制定手术方案,其中,6例采用单纯髓内钉固定,9例瘤段切除或病灶刮除后髓内钉联合骨水泥重建,9例瘤段切除股骨干节段型假体重建。采用疼痛视觉模拟评分(VAS)、Karofsky体能状况评分(KPS评分)和MSTS评分评价临床结果,并随访记录生存情况。[结果]围手术期内患者未出现严重并发症。24例患者随访时间6～36个月,平均(18.00±7.08)个月。术后3个月,24例患者的VAS评分较术前显著降低,KPS评分较术前明显增加,差异有统计学意义(P<0.05),术后3个月24例患者MSTS功能评分为(25.33±3.96)分,临床结果评定为优12例、良6例、可6例。随访期间死亡15例,术后生存5～20个月,中位生存时间11.47个月。所有患者截至末次随访时,均未发生内置物松动、断裂,内置物周围感染、病理性骨折等相关并发症,瘤段切除病例无局部复发表现。[结论]股骨干转移瘤患者采用恰当手术方式治疗能够有效地缓解疼痛,降低术后并发症的发生率,提高生活质量。
[Objective] To explore the clinical outcomes of different surgical reconstructions for femoral metastases. [Methods] A retrospective study was conducted on 24 patients who underwent surgical treatment for femoral metastases from January2007 to January 2017. The patients, including 15 males and 9 females aged 52～70 years with a mean(64.58±4.64) years, suffered from femoral metastases on the verge of pathological fracture in 9 cases and pathological fracture secondary to femoral metastases in 15 cases. Based on Mirls score graded, 6 patients underwent internal fixation with intramedullary nail only, 9 patients had the tumor segment resected or scraped followed by reconstruction with intramedullary nail combined with bone cement, and the remaining 9 patients received were en block resection of the lesion combined with reconstruction with femoral shaft prosthesis. The visual analogue scale(VAS), Karofsky performance score(KPS) and MSTS score was used to assess clinical consequences. In addition, survival states were evaluated as the follow-up progressed. [Results] No serious complications happened in anyone of the 24 patients during the perioperative period. The patients were followed up for 6～36 months with an average of(18.00±7.08) months. At 3 months after operation, the VAS score significantly decreased, while KPS score significantly increased in all the patients compared with those preoperatively(P<0.05). The MSTS functional score was graded as(25.33±3.96)on average, in parallel with clinical outcomes graded as excellent in 12, good in 6, fair in 6 cases at 3 months postoperatively.During the follow up, 15 patients died, associated with survival period of 5～20 months and the median survival time of 11.47 months. To the latest follow up, no implant loosening or breaking, prosthetic infection, refracture and lesion recurrence were proved in any patient. [Conclusions] For patients with femoral metastases, an appropriate surgical treatment selected does effectively relieve pain, reduce the incidence of postoperative complications, and improve the quality of life of patients.
[Objective] To explore the clinical outcomes of different surgical reconstructions for femoral metastases. [Methods] A retrospective study was conducted on 24 patients who underwent surgical treatment for femoral metastases from January2007 to January 2017. The patients, including 15 males and 9 females aged 52～70 years with a mean(64.58±4.64) years, suffered from femoral metastases on the verge of pathological fracture in 9 cases and pathological fracture secondary to femoral metastases in 15 cases. Based on Mirls score graded, 6 patients underwent internal fixation with intramedullary nail only, 9 patients had the tumor segment resected or scraped followed by reconstruction with intramedullary nail combined with bone cement, and the remaining 9 patients received were en block resection of the lesion combined with reconstruction with femoral shaft prosthesis. The visual analogue scale(VAS), Karofsky performance score(KPS) and MSTS score was used to assess clinical consequences. In addition, survival states were evaluated as the follow-up progressed. [Results] No serious complications happened in anyone of the 24 patients during the perioperative period. The patients were followed up for 6～36 months with an average of(18.00±7.08) months. At 3 months after operation, the VAS score significantly decreased, while KPS score significantly increased in all the patients compared with those preoperatively(P<0.05). The MSTS functional score was graded as(25.33±3.96)on average, in parallel with clinical outcomes graded as excellent in 12, good in 6, fair in 6 cases at 3 months postoperatively.During the follow up, 15 patients died, associated with survival period of 5～20 months and the median survival time of 11.47 months. To the latest follow up, no implant loosening or breaking, prosthetic infection, refracture and lesion recurrence were proved in any patient. [Conclusions] For patients with femoral metastases, an appropriate surgical treatment selected does effectively relieve pain, reduce the incidence of postoperative complications, and improve the quality of life of patients.
引文
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[4] Manfrini M, Tiwari A, Ham J, et al. Evalution of surgical treatment for sarcomas of proximal humerus in children:retrospective review at a single institute over 30 years[J]. J Pediatr Orthop, 2011, 31(1):56-64.
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[6] Costantino E, Andreas M, Luca C, et al. Treatment for long bone metastases based on a systematic literature review[J]. Eur J Orthop Surg Traumatol, 2017, 27(2):205-211.
[7] Miller BJ, Soni EE, Gibbs CP,etal. Intramedullary nails for long bone metastases:why do they fail[J/OL]. Orthopedics, 2011, 34,DOI:10.3928/01477447-20110228-12.
[8] Szendr i M, Antal I, Szendr i A, et al. Diagnostic algorithm, prognostic factors and surgical treatment of metastatic cancer diseases of the long bones and spine[J]. EFORT Open Rev, 2017, 2(9):372-381.
[9] Aldlyami E, Abudu A, Grimer RJ, etal. Endoprosthetic replacement of diaphyseal bone defects long-term results[J]. Int Orthop,2005, 29(1):25-29.ics, 2011, 34,
[2] Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity[J]. Clin Cancer Res, 2006, 12(20):6243s-6249s.
[3] Shimada H, Setoguchi T, Nakamura S, et al. Evaluation of prognostic scoring systems for bone metastases using single-center data[J]. Mol Clin Oncol, 2015, 3(6):1361-1370.
[4] Manfrini M, Tiwari A, Ham J, et al. Evalution of surgical treatment for sarcomas of proximal humerus in children:retrospective review at a single institute over 30 years[J]. J Pediatr Orthop, 2011, 31(1):56-64.
[5] Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures[J]. Clin Orthop, 1989, 249:256-264.
[6] Costantino E, Andreas M, Luca C, et al. Treatment for long bone metastases based on a systematic literature review[J]. Eur J Orthop Surg Traumatol, 2017, 27(2):205-211.
[7] Miller BJ, Soni EE, Gibbs CP,etal. Intramedullary nails for long bone metastases:why do they fail[J/OL]. Orthopedics, 2011, 34,DOI:10.3928/01477447-20110228-12.
[8] Szendr i M, Antal I, Szendr i A, et al. Diagnostic algorithm, prognostic factors and surgical treatment of metastatic cancer diseases of the long bones and spine[J]. EFORT Open Rev, 2017, 2(9):372-381.
[9] Aldlyami E, Abudu A, Grimer RJ, etal. Endoprosthetic replacement of diaphyseal bone defects long-term results[J]. Int Orthop,2005, 29(1):25-29.ics, 2011, 34,