Shemesh Shai, Kosashvili Yona, Sidon Eliezer, Yaari Lee, Cohen Nir, Velkes Steven
Acta Orthop Belg. 2014 Mar;80(1):144-50.
Metastases in the proximal femur and in the femoral diaphysis are usually treated with either cephalomedullary or intramedullary nailing. The benefit of curettage and augmentation of the nail with methyl methacrylate remains controversial. The authors retrospectively studied the outcomes with cephalomedullary and intramedullary nailing without curettage and methyl-methacrylate augmentation for lytic metastases of the proximal/diaphyseal femur. Twenty-one complete (11) or impending (10) pathological fractures in 19 consecutive patients were treated between January 2006 and August 2013. There were 11 women and 8 men. Their mean age was 62 years (range, 38 to 87). All patients received adjuvant chemotherapy or radiotherapy.The average postsurgical survival was 9.7 months (range 1-36 months). A single deep infection was debrided. Seventeen out of 19 patients were ambulatory, with or without a walking aid. No implant failure was noted. In other words, patients succumbed to the disease prior to hardware failure. Femoral nail insertion without curettage and cement augmentation provided satisfactory stabilization of proximal and diaphyseal femur fractures, impending or complete, even when there was massive bone destruction.
股骨近端和股骨干的转移瘤通常采用头髓内钉或髓内钉治疗。刮除并用甲基丙烯酸甲酯强化钉的益处仍存在争议。作者回顾性研究了未进行刮除和甲基丙烯酸甲酯强化的头髓内钉和髓内钉治疗股骨近端/骨干溶骨性转移瘤的结果。2006年1月至2013年8月期间，对19例连续患者的21处完全性（11处）或即将发生的（10处）病理性骨折进行了治疗。其中女性11例，男性8例。他们的平均年龄为62岁（范围38至87岁）。所有患者均接受了辅助化疗或放疗。术后平均生存期为9.7个月（范围1至36个月）。1例深部感染进行了清创。19例患者中有17例可独立行走，无论是否借助助行器。未观察到内植物失败。换句话说，患者在硬件失败之前就死于疾病。不进行刮除和骨水泥强化的股骨钉插入术为即将发生或完全性的股骨近端和股骨干骨折提供了令人满意的稳定效果，即使存在大量骨质破坏。
