Kim Yong-Il, Kang Hyun Guy, Lee Jung Min, Kim June Hyuk, Kim Seok-Ki, Kim Han Soo
Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Orthopaedic Oncology Clinic (H.G.K. and J.H.K.) and Department of Nuclear Medicine (S.-k.K.), National Cancer Center, Gyeonggido, South Korea.
JB JS Open Access. 2017 May 18;2(2):e0018. doi: 10.2106/JBJS.OA.16.00018. eCollection 2017 Jun 26.
We introduced a new surgical method of percutaneous hollow perforated screw (HPS) fixation with concomitant bone-cement injection for the treatment of femoral neck metastasis and evaluated its efficacy for the palliative treatment of patients with advanced cancer.
The study included 87 patients (39 men and 48 women; mean age [and standard deviation], 64.2 ± 10.2 years; mean body mass index, 24.3 ± 3.2 kg/m) who underwent percutaneous HPS fixation and cementoplasty (mean cement amount, 19.8 ± 8.3 mL) for the treatment of unilateral or bilateral femoral neck metastasis (total, 95 sites). Anesthesia type, operative time, operative blood loss, pain score changes (according to a visual analog scale [VAS]), walking status, and complications were assessed. The mean duration of follow-up was 10.1 ± 10.8 months (range, 2 to 43 months).
The majority of procedures were performed with local (3 patients) or spinal (72 patients) anesthesia (total, 75 patients; 86.2%). The mean operative time was 35.9 minutes, and the mean operative blood loss was 97.0 mL. The VAS score for pain improved significantly, from 6.8 ± 2.8 preoperatively to 2.8 ± 2.3 and 2.9 ± 2.8 at 1 and 6 weeks postoperatively (p < 0.001). At 6 weeks postoperatively, 63 (80.8%) of 78 patients were able to walk (with either normal or limping gait, a cane or crutch, or a walker). The prevalence of major local complications (cement leakage into the hip joint, fixation failure) was 10.5% (10 of 95), but major systemic complications (distant cement embolism) were not found.
Percutaneous HPS fixation and cementoplasty for the treatment of femoral neck metastasis is a minimally invasive technique that provides effective pain relief and early stabilization. This technique seems to be useful for patients with advanced cancer for whom open surgery would be hazardous.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
我们引入了一种新的手术方法，即经皮空心穿孔螺钉（HPS）固定并同时注入骨水泥，用于治疗股骨颈转移瘤，并评估其对晚期癌症患者的姑息治疗效果。
该研究纳入了87例患者（39例男性和48例女性；平均年龄[及标准差]为64.2±10.2岁；平均体重指数为24.3±3.2kg/m²），他们接受了经皮HPS固定及骨水泥成形术（平均骨水泥用量为19.8±8.3mL），以治疗单侧或双侧股骨颈转移瘤（共95个部位）。评估了麻醉类型、手术时间、术中失血量、疼痛评分变化（根据视觉模拟量表[VAS]）、行走状态及并发症情况。平均随访时间为10.1±10.8个月（范围为2至43个月）。
大多数手术采用局部麻醉（3例患者）或脊髓麻醉（72例患者）（共75例患者；86.2%）。平均手术时间为35.9分钟，平均术中失血量为97.0mL。疼痛的VAS评分显著改善，术前为6.8±2.8，术后1周和6周分别为2.8±2.3和2.9±2.8（p<0.001）。术后6周时，78例患者中有63例（80.8%）能够行走（步态正常或跛行，使用手杖、拐杖或助行器）。主要局部并发症（骨水泥渗漏至髋关节、固定失败）的发生率为10.5%（95例中的10例），但未发现主要全身并发症（远处骨水泥栓塞）。
经皮HPS固定及骨水泥成形术治疗股骨颈转移瘤是一种微创技术，可有效缓解疼痛并实现早期稳定。该技术对于无法进行开放手术的晚期癌症患者似乎是有用的。
治疗性四级证据。有关证据水平的完整描述，请参阅作者指南。
