Department of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
J Shoulder Elbow Surg. 2012 Aug;21(8):1049-55. doi: 10.1016/j.jse.2011.06.019. Epub 2011 Oct 7.
The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus.
This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10.
The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years.
Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate.
肱骨是转移性骨病第二常见的长骨部位。我们报告了一组大量接受肱骨转移瘤手术治疗的患者的并发症、失败风险因素和生存率。
本研究基于 208 例接受手术治疗的 214 例肱骨转移瘤患者。148 例采用髓内钉重建，35 例采用内假体，21 例采用钢板固定，10 例采用其他方法。
手术时的中位年龄为 67 岁（范围 29-87 岁）。乳腺癌是原发肿瘤的占 31%。手术重建的总体失败率为 9%。肱骨近端的再手术率为 7%，骨干为 8%，骨远端为 33%。在 36 例涉及假体的手术中，有 2 例失败（6%），而 178 例骨合成装置中有 18 例失败（10%）。在骨合成组中，髓内钉失败率为 7%，钢板固定失败率为 22%。多变量 Cox 回归分析显示，前列腺癌与手术后失败的风险增加相关（风险比，7；P < 0.033）。手术后的累积生存率为 1 年时为 40%（95%置信区间 [CI] 34-47），2 年时为 21%（95% CI，15-26），3 年时为 16%（95% CI，12-19）。
我们的首选方法是对病理性肱骨近端骨折采用带水泥的半假体，对骨干病变采用交锁髓内钉。肱骨远端病理性骨折不常见，但与很高的再手术率相关。
