Premat Kévin, Clarençon Frédéric, Bonaccorsi Raphael, Degos Vincent, Cormier Évelyne, Chiras Jacques
Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Paris VI University Pierre et Marie Curie, Paris, France.
Eur Radiol. 2017 Sep;27(9):3973-3982. doi: 10.1007/s00330-017-4774-3. Epub 2017 Mar 13.
In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur.
Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22-85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1-27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS).
No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0-10) to 2.3 ± 2.4 (range 0-7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded.
RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery.
• Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty. • RC provides effective bone stability and pain relief. • RC is a suitable minimally invasive option for patients in poor general condition.
在长骨中，单纯的骨水泥成形术无法提供足够的稳定性，这可能会导致二次骨折。本研究回顾了强化骨水泥成形术（RC）（使用专用纺锤体进行经皮内固定并结合骨水泥成形术）治疗股骨近端颈转子区（CTR）不稳定恶性病变的安全性和有效性。
连续18例患者（9名女性[50%]和9名男性[50%]；平均年龄55.1±16.2岁；范围22 - 85岁）因CTR的19处不稳定病变接受了RC治疗（19处病变中16处[84.2%]为骨转移，3处[15.8%]为多发性骨髓瘤病变）。所有患者均被认为不适合手术。平均随访8.8±7.2个月（范围1 - 27个月）后判断临床结果。主要终点是随访期间二次骨折的发生情况以及通过视觉模拟量表（VAS）测量的局部疼痛缓解情况。
未发生二次骨折。VAS平均值从1个月时的5.9±3.1（范围0 - 10）改善至2.3±2.4（范围0 - 7）（p = 0.001），最终随访时改善至1.6±1.7（范围0 - 5）（p = 0.0002）。记录到1例有症状的骨水泥肺栓塞。
RC是一种原创的微创技术，可为不适合开放手术的患者的颈转子区不稳定恶性病变提供疼痛缓解和有效的骨稳定性。
• 强化骨水泥成形术（RC）将病灶内纺锤体置入与骨水泥成形术相结合。• RC可提供有效的骨稳定性并缓解疼痛。• RC是一般状况较差患者合适的微创选择。
