Frassica Frank J, Frassica Deborah A
Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA.
Clin Orthop Relat Res. 2003 Oct(415 Suppl):S212-8. doi: 10.1097/01.blo.0000093052.96273.a7.
The humerus is the second most common long bone site of metastatic disease, and the proximal third and diaphysis are frequent sites. Purely lytic disease and cortical bone destruction increase the risk of fracture more than 50%. For most patients, external beam irradiation is effective as a means of pain control and halting bone destruction. Fractures of the head or surgical neck can be treated with standard endoprostheses, whereas extensive proximal bone destruction is treated with custom proximal humeral replacements. Impending and complete diaphyseal fractures can be treated effectively with either intramedullary nail fixation or plate fixation. Rigid fixation, which can be achieved with dual plate fixation, is optimal because patients can begin immediate unrestricted activities using the upper extremity. Methylmethacrylate is an effective adjuvant for filling defects and for augmenting the fixation of intramedullary nails and screws. Postoperative external beam irradiation is necessary to prevent progressive bone destruction and subsequent loss of fixation.
肱骨是转移性疾病第二常见的长骨部位，近端三分之一和骨干是常见部位。单纯溶骨性病变和皮质骨破坏使骨折风险增加超过50%。对大多数患者而言，外照射是控制疼痛和阻止骨质破坏的有效方法。肱骨头或外科颈骨折可用标准假体治疗，而近端广泛骨质破坏则用定制的近端肱骨置换物治疗。即将发生的和完全的骨干骨折可用髓内钉固定或钢板固定有效治疗。双钢板固定可实现的坚强固定是最佳的，因为患者可立即开始使用上肢进行不受限制的活动。甲基丙烯酸甲酯是填充缺损和增强髓内钉及螺钉固定的有效辅助剂。术后外照射对于防止进行性骨质破坏和随后的固定失败是必要的。
