Department of Orthopaedics, Northampton General Hospital, Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, United Kingdom.
Surg Oncol. 2012 Sep;21(3):216-22. doi: 10.1016/j.suronc.2012.04.001. Epub 2012 May 2.
Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. Several key principals should be adhered to whenever operating on skeletal metastases. Discussions should be held early with an appropriate multi-disciplinary team prior to intervention. Detailed pre-assessment is essential to gauge a patient's suitability for surgery - recovery from elective surgery must be shorter than the anticipated survival. Staging and biopsies provide prognostic information. Primary bone tumours must be ruled out in the case of a solitary bone lesion to avoid inappropriate intervention. Prophylactic surgical fixation of a lesion prior to a pathological fracture reduces morbidity and length of hospital stay. Regardless of a lesion or pathological fracture's location, all regions of the affected bone must be addressed, to reduce the risk of subsequent fracture. Surgical implants should allow full weight bearing or return to function immediately. Post-operative radiotherapy should be utilised in all cases to minimise disease progression. Spinal surgery should be considered for those with spinal pain due to potentially reversible spinal instability or neurological compromise. The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention. Patients who suffer a slowly progressive deficit, present within hours of complete neurological deficit, or have compression caused by bone alone are those most likely to benefit from surgery. Back pain in the presence of MBD should be regarded as impending spinal cord compression, and investigated urgently to allow intervention prior to the development of neurological compromise.
肿瘤学和医学治疗的发展意味着转移性骨病 (MBD) 患者的预期寿命通常以年来衡量。MBD 的并发症可能会严重且不可逆转地影响患者的生活质量，因此仔细评估和适当管理这些患者至关重要。骨科和脊柱外科医生在 MBD 中的作用通常分为以下四类：诊断、对有骨折风险的转移性沉积物进行预防性固定（预防性手术）、对病理性骨折受影响的骨骼进行稳定或重建（反应性手术），或对脊柱、脊髓和神经根进行减压和稳定。在对骨骼转移进行手术时，应遵循几个关键原则。在干预之前，应尽早与适当的多学科团队进行讨论。详细的预评估对于评估患者是否适合手术至关重要——择期手术的恢复时间必须短于预期的生存时间。分期和活检提供预后信息。在单一骨骼病变的情况下，必须排除原发性骨肿瘤，以避免不当干预。在病理性骨折发生之前对病变进行预防性手术固定可降低发病率和住院时间。无论病变或病理性骨折的位置如何，都必须处理受影响骨骼的所有区域，以降低随后骨折的风险。手术植入物应允许完全负重或立即恢复功能。应在所有情况下使用术后放疗以最大程度地减少疾病进展。对于因潜在可逆转的脊柱不稳定或神经功能障碍而出现脊柱疼痛的患者，应考虑进行脊柱手术。应尽早征求脊柱外科医生的意见，因为转诊延迟与干预后功能恢复的恶化直接相关。那些患有进行性缓慢进展的缺陷、在完全神经功能缺陷后数小时内出现、或仅由骨骼引起的压迫的患者最有可能从手术中受益。MBD 存在背痛应被视为即将发生的脊髓压迫，并紧急进行调查，以便在发生神经功能障碍之前进行干预。
