Yang Yi, Yang Rong-li, Guo Wei
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2011 Oct 18;43(5):681-5.
To evaluate different operative treatment options for patients with metastases of the humerus focusing on surgical procedures, complications, function, and survival rate.
From 2000 to 2009, 62 bone metastases of the humerus in 59 patients were surgically treated in our institutions. Histological types were of lung (n=19), myeloma (n=10), breast (n=8), kidney (n=5), gastrointestinal tract (n=2), thyroid (n=2), prostate (n=1), bile duct (n=1), larynx (n=1), ovarian (n=1), melanoma (n=1) and unknown tumors (n= 8). Severe osteolytic lesions close to the shoulder and elbow joint were treated with resection and endoprosthetic replacement (n=32). Twenty-eight metasteses were stabilized by intramedullary locked nailing (17 cases) or plate/screws (11 cases) with polymethylmethacrylate-assisted reconstruction. The remaining 2 lesions were treated with amputation because of wide tumor contaminations after pathological fracture. Mirels' rating system was used to predict the risk of pathological fracture. The function of the upper limb was assessed using the Musculoskeletal Tumor Society (MSTS) rating scale and survival rate was retrospectively analyzed.
The mean survival time of patients after surgery was 9.6 months. The mean Mirels' score for impending pathologic fractures was 9.3. Complications of endoprosthetic replacement recorded included disease relapse (n=2) and soft tissue infection (n=1), whereas, for intramedullary locked nailing and plate/screws fixation, there were two cases of local recurrence, one case of plate/screw break and one case of radial nerve palsy. The mean MSTS score for the follow-up was 71% for endoprosthesis and 75.1% for locked intramedullary nailing or plate/screws fixation.
Immediate stability and pain relief were the main purpose of surgical procedures to treat humerus metastases. Radiotherapy was only a local treatment; however systemic therapies, such as chemotherapy, hormonotherapy and bisphophonate play a critical role in increasing survival rate of bone metastatic patients.
评估针对肱骨转移瘤患者的不同手术治疗方案，重点关注手术操作、并发症、功能及生存率。
2000年至2009年期间，我们机构对59例患者的62处肱骨骨转移瘤进行了手术治疗。组织学类型包括肺癌（n = 19）、骨髓瘤（n = 10）、乳腺癌（n = 8）、肾癌（n = 5）、胃肠道癌（n = 2）、甲状腺癌（n = 2）、前列腺癌（n = 1）、胆管癌（n = 1）、喉癌（n = 1）、卵巢癌（n = 1）、黑色素瘤（n = 1）及不明肿瘤（n = 8）。靠近肩关节和肘关节的严重溶骨性病变采用切除及人工关节置换治疗（n = 32）。28处转移瘤通过髓内锁定髓内钉固定（17例）或钢板/螺钉固定（11例）并辅以聚甲基丙烯酸甲酯重建实现稳定。其余2处病变因病理性骨折后肿瘤广泛污染而进行了截肢。采用Mirels评分系统预测病理性骨折风险。使用肌肉骨骼肿瘤学会（MSTS）评分量表评估上肢功能，并对生存率进行回顾性分析。
患者术后平均生存时间为9.6个月。即将发生病理性骨折的平均Mirels评分为9.3分。记录的人工关节置换并发症包括疾病复发（n = 2）和软组织感染（n = 1），而对于髓内锁定髓内钉及钢板/螺钉固定，有2例局部复发、1例钢板/螺钉断裂及1例桡神经麻痹。随访时，人工关节置换的平均MSTS评分为71%，髓内锁定髓内钉或钢板/螺钉固定为75.1%。
即刻稳定和缓解疼痛是治疗肱骨转移瘤手术的主要目的。放疗仅是局部治疗；然而，全身治疗，如化疗、激素治疗和双膦酸盐在提高骨转移患者生存率方面起着关键作用。
