J Am Acad Orthop Surg. 2014 Feb;22(2):90-100. doi: 10.5435/JAAOS-22-02-90.
Management of metastatic long bone fractures requires identification of the lesion and the use of sound fracture fixation principles to relieve pain and restore function. The treating surgeon must understand the principles of pathologic fracture fixation before initiating treatment. Because these fractures occur in the context of a progressive systemic disease, management typically involves a multidisciplinary approach. When considering surgical stabilization of these fractures, the abnormal (or absent) healing environment associated with diseased bone and the overall condition of the patient must be taken into account. The goal of surgery is to obtain a rigid mechanical construct, which allows for early mobility and weight bearing. This can be achieved using internal fixation with polymethyl methacrylate cement or segmental resection and joint reconstruction. Prosthetic joint arthroplasty is a more reliable means of fracture management when insufficient bone is present for fixation. Prophylactic stabilization of impending pathologic fractures can reduce the morbidity associated with metastatic lesions.
转移性长骨骨折的治疗需要确定病变部位，并采用合理的骨折固定原则来缓解疼痛和恢复功能。治疗医生在开始治疗前必须了解病理性骨折固定的原则。由于这些骨折发生在进行性全身性疾病的背景下，因此治疗通常需要多学科的方法。在考虑对这些骨折进行手术稳定时，必须考虑到与患病骨骼相关的异常（或缺失）愈合环境以及患者的整体状况。手术的目标是获得刚性的机械结构，从而实现早期活动和负重。这可以通过使用聚甲基丙烯酸甲酯水泥内固定或节段切除和关节重建来实现。当固定用的骨骼不足时，假体关节置换术是一种更可靠的骨折治疗方法。预防性稳定即将发生的病理性骨折可以降低与转移性病变相关的发病率。
