Unit of Orthopedic Oncology, University La Sapienza, Rome, Italy.
Department of Orthopedics, Catholic University, Rome, Italy.
Injury. 2014 Feb;45(2):412-7. doi: 10.1016/j.injury.2013.09.025. Epub 2013 Sep 19.
Pathologic fractures of the femur because of bone metastases seriously affect the quality of life of cancer patients. Different surgical options are indicated to achieve a durable and solid fixation, depending on several clinical, prognostic and mechanical factors. Locked intramedullary nailing is currently used to treat pathologic femoral fractures in patients with multiple metastases when the trochanteric region or shaft is mainly involved. This study evaluates intramedullary nailing for treatment of patients with pathologic femoral fractures, focussing on complications, clinical and functional outcomes and survival rates. The series included 80 pathologic fractures treated with a titanium alloy Proximal Nail (Standard or Antirotation) or Lateral Anterograde Femoral Nail (PFN, PFNA or LAFN, Synthes) inserted in a locked static mode. Acrylic cement was used to fill the bone cavity after nail insertion in eight patients; percutaneous cementoplasty was simultaneously performed in 11 cases of severe ipsilateral acetabular osteolysis. Postoperative outcomes focussed on pain relief, postoperative mobility and quality of life and they were analysed retrospectively using QOL-ACD and ECOG. Eleven patients (13.75%) suffered from non-fatal DVT post-surgery, with no pulmonary embolism. Six patients (7.5%) developed superficial wound infections and two patients (2.5%) developed pnaeumonia. There was no loss of reduction, breakage, screw pull out, or hardware or implant failure that required component substitution or revision. Lung histotype and the contemporary presence of cerebral and visceral metastases appeared to be predisposing factors in reducing survival time. All patients attained satisfactory pain relief, early deambulation and a marked clinical improvement during the first 6-10 postoperative months, with gradual worsening thereafter from deterioration of their general condition due to cancer progression. The patients' survival rate was 40% at 1 year, 25% at 2 years and 15% at 3 years. Results confirm that multiple factors related to patients and primary cancer may affect survival rate after femoral fracture. Intramedullary nailing should be indicated for pathologic fractures at femoral diaphysis and metaphysis when cancer is in an advanced stage. This procedure offers good and durable stability, and enables pain relief, early postoperative mobilisation and weight-bearing, thus improving the quality of life of cancer patients.
由于骨转移导致的股骨病理性骨折严重影响癌症患者的生活质量。根据多种临床、预后和力学因素，不同的手术选择可以实现持久而稳定的固定。当转子区或骨干主要受累时，锁定髓内钉目前用于治疗多发性转移患者的股骨病理性骨折。本研究评估了髓内钉治疗股骨病理性骨折患者的效果，重点关注并发症、临床和功能结果以及生存率。该系列包括 80 例股骨病理性骨折患者，采用钛合金近端钉（标准或抗旋转）或外侧顺行股骨钉（PFN、PFNA 或 LAFN、Synthes）以锁定静态模式插入。在 8 例患者中，在插入钉子后使用丙烯酸水泥填充骨腔；在 11 例严重同侧髋臼骨溶解的情况下同时进行经皮骨水泥成形术。术后结果侧重于疼痛缓解、术后活动能力和生活质量，并使用 QOL-ACD 和 ECOG 进行回顾性分析。11 例（13.75%）患者术后发生非致命性 DVT，无肺栓塞。6 例（7.5%）患者发生浅表伤口感染，2 例（2.5%）患者发生肺炎。没有出现复位丢失、断裂、螺钉拔出、或硬件或植入物失效，需要更换部件或进行翻修。肺组织类型和同时存在的脑转移和内脏转移似乎是降低生存时间的危险因素。所有患者在术后 6-10 个月内获得了满意的疼痛缓解、早期活动和明显的临床改善，此后由于癌症进展导致一般状况恶化而逐渐恶化。患者的 1 年生存率为 40%，2 年生存率为 25%，3 年生存率为 15%。结果证实，与患者和原发性癌症相关的多种因素可能影响股骨骨折后的生存率。当癌症处于晚期时，应在股骨骨干和干骺端出现病理性骨折时选择髓内钉。该手术提供了良好且持久的稳定性，可缓解疼痛，术后早期活动和负重，从而提高癌症患者的生活质量。
