Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
Coxa Hospital for Joint Replacement, Tampere, Finland.
Eur J Surg Oncol. 2019 Dec;45(12):2424-2430. doi: 10.1016/j.ejso.2019.05.021. Epub 2019 May 21.
Skeletal metastases can weaken the bone, necessitating surgery, and surgical treatment options vary. The aim of this study was to investigate the revision rate of reconstructions in surgically treated diaphyseal skeletal metastases.
Between 2000 and 2018 at Helsinki and Tampere university hospitals in Finland, a total of 164 cases with diaphyseal skeletal metastases were identified from a prospectively maintained database. Tumor location was humerus, femur, and tibia in 106 (65%), 53 (32%), and 5 (3.0%) cases, respectively. A total of 82 (50%) cases were treated with intramedullary nailing (IMN), 73 (45%) with IMN and cementation, and 9 (5%) with another technique.
In the upper extremity, implant survival (IS) was 96.4% at 1, 2, and 5 years; in the lower extremity, it was 83.8%, 69.1%, and 57.6% at 1, 2, and 5 years, respectively. Lower extremity IS for impending lesions was 100% at 1, 2, and 5 years, and in cases operated for true pathologic fracture, it was 71.6%, 42.9%, and 21.5% at 1, 2, and 5 years, respectively. In IMN cases without cement, the complication rate was 16% (13/82) when compared to 6% (4/73) in IMN cases with cementation.
We would advocate for early intervention in patients with metastatic bone disease affecting the femur rather that watchful waiting with the risk for fracture and the need for urgent intervention. However, this choice must be balanced against the underlying risk of surgical intervention in a potentially fragile population with often limited prognoses.
骨骼转移可导致骨质变弱，需要进行手术，而手术治疗的选择也各有不同。本研究旨在调查外科治疗骨干转移中重建的翻修率。
在芬兰赫尔辛基和坦佩雷大学医院，从一个前瞻性维护的数据库中，于 2000 年至 2018 年期间共确定了 164 例骨干转移病例。106 例（65%）肿瘤位于肱骨、53 例（32%）位于股骨、5 例（3.0%）位于胫骨。82 例（50%）采用髓内钉（IMN）治疗，73 例（45%）采用 IMN 联合骨水泥治疗，9 例（5%）采用其他技术治疗。
在上肢，植入物生存率（IS）在 1、2 和 5 年分别为 96.4%、83.8%和 69.1%；在下肢，IS 在 1、2 和 5 年分别为 83.8%、57.6%和 42.9%。对于即将发生的病变，下肢 IS 在 1、2 和 5 年时均为 100%，而对于因真正病理性骨折而接受手术的病例，IS 在 1、2 和 5 年时分别为 71.6%、42.9%和 21.5%。在未使用骨水泥的 IMN 病例中，并发症发生率为 16%（13/82），而在使用骨水泥的 IMN 病例中，并发症发生率为 6%（4/73）。
我们主张对患有影响股骨的转移性骨病的患者进行早期干预，而不是观察等待，以免发生骨折和需要紧急干预。然而，在预后通常有限且身体脆弱的患者中，必须权衡这种选择与手术干预的潜在风险。
