Sarahrudi Kambiz, Wolf Harald, Funovics Philipp, Pajenda Gholam, Hausmann Jan Till, Vécsei Vilmos
Department of Traumatology, Medical University of Vienna, Vienna General Hospital, Währingergürtel, Vienna, Austria.
J Trauma. 2009 Mar;66(3):789-94. doi: 10.1097/TA.0b013e3181692132.
This report deals with the advantages and disadvantages associated with the most commonly used methods of stabilization after a pathologic fracture of the humerus shaft.
A total of 39 patients with 41 metastatic lesions and pathologic fractures of the humerus, treated surgically between 1992 and 2007, were retrospectively analyzed.
The rate of local complications was 14.6% (6 of 41). Radial nerve injury was the only local complication and was exclusively observed in patients who underwent open reduction and plate fixation. The overall rate of osteosynthesis failure was 12.2% (5 of 41). Two failures were observed in 21 patients with open reductions and plate fixations, compared with three failures in 20 procedures involving closed reductions and intramedullary stabilization. The 1- and 2-year survival rates were 0.35 and 0.2 in ORIF and 0.07 and 0 in patients with IM fixation retrospectively.
Intramedullary stabilization is a reliable method for fixation of pathologic fractures of the humerus diaphysis for patients in the advanced stage of metastatic disease. ORIF are preferable to IM fixations for the treatment of metaphyseal fractures and for those patients with a solitary metastasis in the humerus or those with a better prognosis.
本报告探讨肱骨干病理性骨折后最常用的稳定方法的优缺点。
对1992年至2007年间接受手术治疗的39例患有41处转移性病变及肱骨干病理性骨折的患者进行回顾性分析。
局部并发症发生率为14.6%（41例中的6例）。桡神经损伤是唯一的局部并发症，且仅在接受切开复位钢板固定的患者中观察到。骨合成失败的总体发生率为12.2%（41例中的5例）。21例接受切开复位钢板固定的患者中有2例失败，而20例采用闭合复位髓内固定的手术中有3例失败。回顾性分析显示，切开复位内固定患者的1年和2年生存率分别为0.35和0.2，髓内固定患者的1年和2年生存率分别为0.07和0。
对于转移性疾病晚期患者，髓内固定是肱骨干病理性骨折固定的可靠方法。对于治疗干骺端骨折以及肱骨有孤立转移灶或预后较好的患者，切开复位内固定优于髓内固定。
