Ofluoglu Onder, Erol Bulent, Ozgen Zerrin, Yildiz Muzaffer
Lutfi Kirdar Research Hospital, Istanbul, Turkey.
Int Orthop. 2009 Jun;33(3):707-12. doi: 10.1007/s00264-008-0540-0. Epub 2008 Apr 3.
Most patients with pathological fractures due to cancer metastasis have a limited life expectancy. Orthopaedic procedures, therefore, should be minimally invasive in order to avoid additional surgical morbidity. The purpose of this study was to analyse the results of minimally invasive approaches, including locked intramedullary nailing, followed by early postoperative radiation for pathological humeral shaft fractures. Twenty-four pathological fractures of the humerus diaphysis in 23 patients were treated with the prospective protocol, including antegrade unreamed intramedullary nailing and postoperative radiotherapy (20 Gy and five fractions). The patients and results of the surgery were evaluated by the Musculoskeletal Tumor Society upper extremity scoring system. All patients had a stable extremity, and the average function of 20 patients was 64% of the normal upper extremity function. Only one patient required revision surgery. The minimally invasive treatment of patients with pathological fractures of the humeral shaft with closed unreamed intramedullary nailing combined with adjuvant radiotherapy is an effective and safe procedure, even in seriously ill patients.
大多数因癌症转移导致病理性骨折的患者预期寿命有限。因此，骨科手术应尽量微创，以避免额外的手术并发症。本研究的目的是分析微创治疗方法的结果，包括锁定髓内钉固定，随后对病理性肱骨干骨折进行术后早期放疗。采用前瞻性方案治疗了23例患者的24例肱骨干病理性骨折，包括顺行非扩髓髓内钉固定和术后放疗（20 Gy，分5次）。采用肌肉骨骼肿瘤学会上肢评分系统对患者和手术结果进行评估。所有患者的肢体均保持稳定，20例患者的平均功能为正常上肢功能的64%。只有1例患者需要翻修手术。即使是重症患者，采用闭合非扩髓髓内钉固定联合辅助放疗对肱骨干病理性骨折患者进行微创治疗也是一种有效且安全的方法。
