Spencer S J, Holt G, Clarke J V, Mohammed A, Leach W J, Roberts J L B
Western Infirmary, Glasgow, Scotland.
J Bone Joint Surg Br. 2010 Jan;92(1):142-5. doi: 10.1302/0301-620X.92B1.22399.
The humerus is a common site for skeletal metastases in the adult. Surgical stabilisation of such lesions is often necessary to relieve pain and restore function. These procedures are essentially palliative and should therefore provide effective relief from pain for the remainder of the patient's life without the need for further surgical intervention. We report a retrospective analysis of 35 patients (37 nails) with symptomatic metastases in the shaft of the humerus which were treated by locked, antegrade nailing. There were 27 true fractures (73.0%) and ten painful deposits (27.0%). Relief from pain was excellent in four (11.4%), good in 29 (82.9%) and fair in two (5.7%) on discharge. Function was improved in all but one patient. One case of palsy of the radial nerve was noted. The mean postoperative survival was 7.1 months (0.2 to 45.5) which emphasises the poor prognosis in this group of patients. There were no failures of fixation and no case in which further surgery was required. Antegrade intramedullary nailing is an effective means of stabilising the humerus for the palliative treatment of metastases. It relieves pain and restores function to the upper limb with low attendant morbidity.
肱骨是成人骨骼转移瘤的常见部位。对此类病变进行手术固定往往是缓解疼痛和恢复功能所必需的。这些手术本质上是姑息性的，因此应能在患者余生有效缓解疼痛，而无需进一步的手术干预。我们报告了一项对35例（37枚髓内钉）肱骨骨干有症状性转移瘤患者进行的回顾性分析，这些患者接受了锁定顺行髓内钉治疗。其中有27例真性骨折（73.0%）和10例疼痛性骨转移灶（27.0%）。出院时，4例（11.4%）疼痛缓解极佳，29例（82.9%）良好，2例（5.7%）一般。除1例患者外，所有患者的功能均有改善。记录到1例桡神经麻痹病例。术后平均生存期为7.1个月（0.2至45.5个月），这突出了该组患者预后较差。没有固定失败的情况，也没有需要进一步手术的病例。顺行髓内钉固定是稳定肱骨以进行转移瘤姑息治疗的有效方法。它能缓解疼痛并恢复上肢功能，且并发症发生率较低。
