Weiss K R, Bhumbra R, Biau D J, Griffin A M, Deheshi B, Wunder J S, Ferguson P C
Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, Shadyside Medical Center, 5200 Centre Avenue, Suite 415, Pittsburgh, Pennsylvania 15232, USA.
J Bone Joint Surg Br. 2011 Aug;93(8):1093-7. doi: 10.1302/0301-620X.93B8.26194.
Pathological fractures of the humerus are associated with pain, morbidity, loss of function and a diminished quality of life. We report our experience of stabilising these fractures using polymethylmethacrylate and non-locking plates. We undertook a retrospective review over 20 years of patients treated at a tertiary musculoskeletal oncology centre. Those who had undergone surgery for an impending or completed pathological humeral fracture with a diagnosis of metastatic disease or myeloma were identified from our database. There were 63 patients (43 men, 20 women) in the series with a mean age of 63 years (39 to 87). All had undergone intralesional curettage of the tumour followed by fixation with intramedullary polymethylmethacrylate and plating. Complications occurred in 14 patients (22.2%) and seven (11.1%) required re-operation. At the latest follow-up, 47 patients (74.6%) were deceased and 16 (25.4%) were living with a mean follow-up of 75 months (1 to 184). A total of 54 (86%) patients had no or mild pain and 50 (80%) required no or minimal assistance with activities of daily living. Of the 16 living patients none had pain and all could perform activities of daily living without assistance. Intralesional resection of the tumour, filling of the cavity with cement, and plate stabilisation of the pathological fracture gives immediate rigidity and allows an early return of function without the need for bony union. The patient's local disease burden is reduced, which may alleviate tumour-related pain and slow the progression of the disease. The cemented-plate technique provides a reliable option for the treatment of pathological fractures of the humerus.
肱骨病理性骨折会引发疼痛、发病、功能丧失以及生活质量下降。我们报告了使用聚甲基丙烯酸甲酯和非锁定钢板固定这些骨折的经验。我们对一家三级肌肉骨骼肿瘤中心20年来治疗的患者进行了回顾性研究。从我们的数据库中确定那些因即将发生或已完成的病理性肱骨骨折而接受手术且诊断为转移性疾病或骨髓瘤的患者。该系列中有63例患者（43例男性，20例女性），平均年龄63岁（39至87岁）。所有患者均接受了肿瘤病灶内刮除术，随后用髓内聚甲基丙烯酸甲酯和钢板固定。14例患者（22.2%）出现并发症，7例（11.1%）需要再次手术。在最近一次随访时，47例患者（74.6%）已死亡，16例（25.4%）存活，平均随访时间为75个月（1至184个月）。共有54例（86%）患者无疼痛或疼痛轻微，50例（80%）在日常生活活动中不需要或仅需要极少帮助。16例存活患者均无疼痛，且均可独立进行日常生活活动。肿瘤病灶内切除、用骨水泥填充骨腔以及对病理性骨折进行钢板固定可立即提供稳定性，并允许早期恢复功能而无需骨愈合。患者的局部疾病负担减轻，这可能减轻肿瘤相关疼痛并减缓疾病进展。骨水泥钢板技术为治疗肱骨病理性骨折提供了一种可靠的选择。
