在股骨近端转移瘤中，假体的使用寿命长于髓内装置。
Endoprostheses last longer than intramedullary devices in proximal femur metastases.
机构信息
Department of Orthopedics, University of Southern California + Los Angeles County Medical Center, Los Angeles, CA, USA.
出版信息
Clin Orthop Relat Res. 2012 Mar;470(3):684-91. doi: 10.1007/s11999-011-2038-0.
BACKGROUND
The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages.
QUESTIONS/PURPOSES: We determined whether function, complications, and survivorship differed between the two approaches.
METHODS
We retrospectively reviewed 158 patients with 159 proximal femur metastatic lesions treated with surgical stabilization. Forty-six were stabilized with IMN and 113 were treated with EPR. The minimum followup was 0.25 months (mean, 16 months; median, 17 months; range, 0.25-86 months).
RESULTS
The mean Musculoskeletal Tumor Society score was 24 of 30 (80%) after IMN and 21 of 30 (70%) after EPR. There were 12 complications (26%) in the IMN group, including 10 nonunions, six of which went on to mechanical failure. There were complications in 20 of 113 (18%) of the EPR group, which consisted of 10 dislocations (9%) and 10 infections (9%). There were no mechanical failures with EPR. Both implants remained functional for the limited lifespan of these patients in each group at all time intervals. EPRs were associated with increased implant longevity compared with IMNs (100% versus 85% 5-year survival, respectively) and a decreased rate of mechanical failure (0% versus 11%, respectively) when compared with the intramedullary devices.
CONCLUSIONS
Patients with metastatic disease to the proximal femur may live for long periods of time, and these patients may undergo stabilization with either IMN or EPR with comparable functional scores and the implant survivorship exceeding patient survivorship at all time intervals. Endoprostheses demonstrate a lower mechanical failure rate and a higher rate of implant survivorship without mechanical failure than IMN devices.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
股骨近端是骨转移手术最常见的部位，通过髓内固定（IMN）或内置假体重建（EPR）可实现稳定。髓内器械价格较低，侵入性较小，功能可能优于内置假体。然而，尚不清楚两者中哪一种具有优势。
问题/目的：我们确定两种方法在功能、并发症和存活率方面是否存在差异。
方法
我们回顾性分析了 158 例股骨近端转移瘤患者的 159 处病变，这些患者均接受了手术稳定治疗。46 例采用 IMN 固定，113 例采用 EPR 治疗。最低随访时间为 0.25 个月（平均 16 个月；中位数 17 个月；范围 0.25-86 个月）。
结果
IMN 组的肌肉骨骼肿瘤学会评分平均为 30 分中的 24 分（80%），EPR 组为 30 分中的 21 分（70%）。IMN 组有 12 例并发症（26%），包括 10 例骨不连，其中 6 例发生机械故障。EPR 组有 20 例并发症（18%），包括 10 例脱位（9%）和 10 例感染（9%）。EPR 组无机械故障。在每组的所有时间间隔内，两种植入物对于这些患者的有限寿命都是功能性的。与 IMN 相比，EPR 与更高的植入物长期存活率（分别为 100%和 85%，5 年生存率）和较低的机械故障发生率（分别为 0%和 11%）相关。
结论
股骨近端转移瘤患者可能会存活很长时间，这些患者可以通过 IMN 或 EPR 进行稳定，两种方法的功能评分相当，且在所有时间间隔内，植入物的存活率都超过了患者的存活率。与 IMN 器械相比，内置假体的机械故障发生率较低，且无机械故障的植入物存活率更高。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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