Department of Orthopedic Surgery, Washington University, St. Louis, Missouri.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):694-9. doi: 10.1016/j.ijrobp.2012.01.021. Epub 2012 Aug 3.
Sacral insufficiency fractures after adjuvant radiation for rectal carcinoma can present similarly to recurrent disease. As a complication associated with pelvic radiation, it is important to be aware of the incidence and risk factors associated with sacral fractures in the clinical assessment of these patients.
Between 1998 and 2007, a total of 582 patients with locally advanced rectal carcinoma received adjuvant chemoradiation and surgical excision. Of these, 492 patients had imaging studies available for review. Hospital records and imaging studies from all 492 patients were retrospectively evaluated to identify risk factors associated with developing a sacral insufficiency fracture.
With a median follow-up time of 3.5 years, the incidence of sacral fractures was 7.1% (35/492). The 4-year sacral fracture free rate was 0.91. Univariate analysis showed that increasing age (≥60 vs. <60 years), female sex, and history of osteoporosis were significantly associated with shorter time to sacral fracture (P=.01, P=.004, P=.001, respectively). There was no significant difference in the time to sacral fracture for patients based on stage, radiotherapy dose, or chemotherapy regimen. Multivariate analysis showed increasing age (≥60 vs. <60 years, hazard ratio [HR] = 2.50, 95% confidence interval [CI] = 1.22-5.13, P=.01), female sex (HR = 2.64, CI = 1.29-5.38, P=.008), and history of osteoporosis (HR = 3.23, CI = 1.23-8.50, P=.02) were independent risk factors associated with sacral fracture.
Sacral insufficiency fractures after pelvic radiation for rectal carcinoma occur more commonly than previously described. Independent risk factors associated with fracture were osteoporosis, female sex, and age greater than 60 years.
直肠癌辅助放疗后发生骶骨不稳定性骨折的表现类似于复发疾病。作为与骨盆放疗相关的并发症，在对这些患者进行临床评估时，了解骶骨骨折的发生率和相关风险因素非常重要。
1998 年至 2007 年间，共有 582 例局部晚期直肠癌患者接受了辅助放化疗和手术切除。其中 492 例患者有影像学检查可供回顾。回顾性评估这 492 例患者的医院记录和影像学检查，以确定与发生骶骨不稳定性骨折相关的风险因素。
中位随访时间为 3.5 年，骶骨骨折的发生率为 7.1%（35/492）。4 年的无骶骨骨折生存率为 0.91。单因素分析显示，年龄较大（≥60 岁与<60 岁）、女性和骨质疏松史与发生骶骨骨折的时间较短显著相关（P=.01、P=.004、P=.001）。基于分期、放疗剂量或化疗方案，患者发生骶骨骨折的时间无显著差异。多因素分析显示，年龄较大（≥60 岁与<60 岁，风险比[HR] = 2.50，95%置信区间[CI] = 1.22-5.13，P=.01）、女性（HR = 2.64，CI = 1.29-5.38，P=.008）和骨质疏松史（HR = 3.23，CI = 1.23-8.50，P=.02）是与骶骨骨折相关的独立危险因素。
直肠癌盆腔放疗后发生骶骨不稳定性骨折比以前描述的更为常见。与骨折相关的独立危险因素是骨质疏松症、女性和年龄大于 60 岁。
