Department of Orthopaedic Oncology, MD Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA.
Clin Orthop Relat Res. 2011 Aug;469(8):2367-70. doi: 10.1007/s11999-011-1814-1. Epub 2011 Feb 17.
The risk of death during simultaneous nailing of pathologic and impending fractures in patients with metastatic disease is believed to be so high that some authors have advocated a staged approach, especially for impending fractures. However, there are limited data to either support or refute the appropriateness of staging of multiple impending or pathologic fractures.
QUESTIONS/PURPOSES: We therefore determined the rate of pulmonary mortality and morbidity in patients who underwent simultaneous nailing for metastatic disease of the skeleton.
We retrospectively reviewed 16 patients who underwent simultaneous intramedullary nailing of impending or pathologic fractures between 1993 and 2009. There were 10 men and six women with a mean age of 60 years (range, 40-78 years). The intramedullary nailings included 15 femurs, 17 humeri, and one tibia. Thirty-one nails were reamed and two were unreamed.
Three of 16 patients died before discharge; two of these deaths were presumed to be the direct result of acute pulmonary complications related to simultaneous nailing and one was intraoperative. For the 13 patients who survived after discharge, there were three pulmonary complications. There were no intraoperative or perioperative deaths in the prophylactic nailing group.
Simultaneous nailing of impending and pathologic fractures can be performed with lower mortality rates than previously reported. Patients with impending fractures did not appear to be at higher risk than patients with pathologic fractures.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
患有转移性疾病的患者同时进行病理性和即将发生的骨折的钉合术，其死亡率较高，因此一些作者主张分期治疗，尤其是针对即将发生的骨折。然而，目前关于分期治疗多处即将发生或病理性骨折的适宜性的数据有限，既没有支持也没有反驳其合理性。
问题/目的：因此，我们确定了同时治疗骨骼转移性疾病的患者接受同时钉合术的肺部死亡率和发病率。
我们回顾性分析了 1993 年至 2009 年间接受同时髓内钉固定即将发生或病理性骨折的 16 例患者。男 10 例，女 6 例，平均年龄 60 岁（范围 40-78 岁）。髓内钉固定包括 15 例股骨、17 例肱骨和 1 例胫骨。31 例髓内钉扩孔，2 例未扩孔。
16 例患者中有 3 例在出院前死亡；其中 2 例死亡被认为是与同时钉合术相关的急性肺部并发症的直接结果，1 例发生在手术中。对于出院后存活的 13 例患者，有 3 例发生肺部并发症。预防性钉合组无术中或围手术期死亡。
与先前报道的相比，同时进行即将发生和病理性骨折的钉合术可以降低死亡率。即将发生骨折的患者的死亡率似乎不比病理性骨折患者高。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
