Cipriano Cara A, Arvanitis Leonidas D, Virkus Walter W
Department of Orthopaedic Surgery, Rush University Medical Center, 1725 W Harrison Ave, Ste 440, Chicago, IL 60612, USA.
Orthopedics. 2012 Jan 16;35(1):e48-52. doi: 10.3928/01477447-20111122-09.
Intramedullary nail fixation is the treatment of choice for impending and pathologic fractures secondary to metastatic cancer; however, this procedure has been shown to cause systemic embolization of intramedullary contents. This article reports the use of the reamer-irrigator-aspirator (RIA) (Synthes, Paoli, Pennsylvania) instead of a standard femoral reamer to decrease tumor intravasation during femoral intramedullary nail fixation for impending or pathologic fractures.Twenty-one consecutive patients indicated for fixation of malignant femoral lesions were treated with intramedullary nail placement. The RIA was used for canal preparation, and solid reamings were collected and submitted for analysis by a single pathologist. The volume of each specimen was recorded, and representative samples were examined histologically to determine their percent tumor content. These data were then used to estimate the volume of tumor retrieved by the RIA in each case. The mean volume of reamings collected by the RIA was 75.0 cc per case (range, 23.4-196.0 cc), and the mean tumor content was 24.8% (range, 1.0%-60.0%). The mean estimated volume of tumor retrieved in each case was 16.7 cc (range, 0.35-36.0 cc). In 2 cases, the tip of the RIA dissociated from the device intraoperatively but was retrieved without adverse consequence to the patient. Use of the RIA in cases of femoral intramedullary nail fixation for pathologic lesions or fractures effectively retrieves variable amounts of intramedullary contents, including tumor. By preventing the systemic dissemination of malignant cells, this technique may reduce the risk of distant metastases.
髓内钉固定术是转移性癌症继发的潜在骨折和病理性骨折的首选治疗方法；然而，该手术已被证明会导致髓内内容物的全身栓塞。本文报道了使用扩髓-冲洗-吸引器（RIA）（辛迪斯公司，宾夕法尼亚州波利）替代标准股骨扩髓器，以减少股骨髓内钉固定潜在骨折或病理性骨折时肿瘤细胞的进入。连续21例有恶性股骨病变需要固定的患者接受了髓内钉置入治疗。使用RIA进行髓腔准备，收集实心的扩髓碎屑并由一名病理学家进行分析。记录每个标本的体积，并对代表性样本进行组织学检查以确定其肿瘤含量百分比。然后使用这些数据估算每个病例中通过RIA获取的肿瘤体积。RIA收集的扩髓碎屑平均体积为每例75.0立方厘米（范围为23.4 - 196.0立方厘米），平均肿瘤含量为24.8%（范围为1.0% - 60.0%）。每个病例中估算的平均肿瘤获取体积为16.7立方厘米（范围为0.35 - 36.0立方厘米）。在2例病例中，RIA的尖端在术中与器械分离，但已取出，对患者未造成不良后果。在股骨病理性病变或骨折的髓内钉固定病例中使用RIA可有效获取不同量的髓内内容物，包括肿瘤。通过防止恶性细胞的全身播散，该技术可能降低远处转移的风险。
