Narazaki Douglas Kenji, de Alverga Neto Carlos Coelho, Baptista André Mathias, Caiero Marcelo Tadeu, de Camargo Olavo Pires
Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2006 Aug;61(4):313-20. doi: 10.1590/s1807-59322006000400007.
Pathological fractures caused by metastases sharply decrease the quality of life and increase mortality rates for patients with malignant neoplasias. Orthopedic advances in osteosynthesis and endoprosthesis have been beneficial in the prevention and treatment of such fractures. The objective of our study was to determine which prognostic factors for pathologic fractures treated in our Service were significant.
This was a retrospective study enrolling 112 patients treated for pathologic fractures secondary to metastatic tumors between April 1994 and December 2004 in our Service. Patients were analyzed according to sex, age, bone metastasis site, visceral metastases, origin of primary tumor, treatment type, serum hemoglobin, and survival.
The most affected site was the femur (44%), the most frequent primary tumor was breast cancer (25%); the most frequently employed surgical treatment was unconventional endoprosthesis (66%). Sex, age, primary tumor, site affected, non-bone metastasis, and clinical versus surgical treatment variables were not good predictors for survival. The only significant predictor was the type of surgery employed. Patients who received an endoprosthesis presented a worse prognosis (21.6 months) than patients undergoing osteosynthesis (47.8 months).
Patients undergoing osteosynthesis, with a less morbid surgical technique and earlier rehabilitation, had longer survival times than patients who received endoprostheses. Our case series is similar to international ones, where the most frequent primary tumor is breast tumor, followed by tumors of undetermined origin, prostate, and lung tumors.
转移瘤所致病理性骨折会显著降低恶性肿瘤患者的生活质量并提高死亡率。骨内固定和假体植入方面的骨科进展对这类骨折的预防和治疗有益。我们研究的目的是确定在我们科室接受治疗的病理性骨折的哪些预后因素具有显著性。
这是一项回顾性研究，纳入了1994年4月至2004年12月间在我们科室接受转移性肿瘤继发病理性骨折治疗的112例患者。根据性别、年龄、骨转移部位、内脏转移情况、原发肿瘤的来源、治疗类型、血清血红蛋白和生存率对患者进行分析。
最常受累的部位是股骨（44%），最常见的原发肿瘤是乳腺癌（25%）；最常采用的手术治疗方式是非常规假体植入（66%）。性别、年龄、原发肿瘤、受累部位、非骨转移以及临床与手术治疗变量均不是生存的良好预测因素。唯一具有显著性的预测因素是所采用的手术类型。接受假体植入的患者预后（21.6个月）比接受骨内固定的患者（47.8个月）更差。
接受骨内固定的患者，手术技术创伤较小且康复较早，其生存时间比接受假体植入的患者更长。我们的病例系列与国际上的类似，其中最常见的原发肿瘤是乳腺肿瘤，其次是来源不明的肿瘤、前列腺癌和肺癌肿瘤。
