Moura Diogo Lino, Alves Filipe, Fonseca Rúben, Freitas João, Casanova José
Serviço de Ortopedia e Traumatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Rev Bras Ortop (Sao Paulo). 2019 Apr;54(2):149-155. doi: 10.1016/j.rbo.2017.10.012. Epub 2019 Mar 25.
This was a retrospective observational study in patients submitted to intramedullary nail fixation after established or impeding pathological humerus-shaft tumoral fracture in the context of disseminated tumoral disease along 22 years of experience at the same institution. Sample with 82 patients and 86 humeral fixations with unreamed rigid interlocking static intramedullary nail by the antegrade or retrograde approaches. The most prevalent primary tumors were breast carcinoma (30.49%), multiple myeloma (24.39%), lung adenocarcinoma (8.54%), and renal cell carcinoma (6.10%). The average surgical time was 90.16 ± 42.98 minutes (40-135 minutes). All of the patients reported improvement in arm pain and the mean Musculoskeletal Tumor Society (MSTS) score rose from 26% in the preoperative period to 72.6% in the evaluation performed in patients still alive 3 months after the surgery. The overall survival was 69.50% 3 months after the surgery, 56.10% at 6 months, 26.70% at 1 year, and 11.90% at 2 years. No death was related to the surgery or its complications. There were only 4 surgery-related complications, 1 intraoperative and 3 late, corresponding to a 4.65% complication risk. Closed unreamed static interlocking intramedullary nailing (both in the antegrade or retrograde approaches) of the humerus is a fast, safe, effective, and low morbidity procedure to treat pathological fractures of the humerus shaft, assuring a stable arm fixation and consequently improving function and quality of life in these patients during their short life expectation.
这是一项回顾性观察研究，研究对象为在同一机构有22年经验的、因已确诊或即将发生的病理性肱骨干肿瘤骨折而接受髓内钉固定的患者，这些患者患有播散性肿瘤疾病。样本包括82例患者和86例肱骨固定术，采用顺行或逆行入路，使用未扩髓的刚性交锁静态髓内钉。最常见的原发肿瘤是乳腺癌（30.49%）、多发性骨髓瘤（24.39%）、肺腺癌（8.54%）和肾细胞癌（6.10%）。平均手术时间为90.16±42.98分钟（40 - 135分钟）。所有患者均报告手臂疼痛有所改善，肌肉骨骼肿瘤学会（MSTS）平均评分从术前的26%升至术后3个月仍存活患者评估时的72.6%。术后3个月总生存率为69.50%，6个月时为56.10%，1年时为26.70%，2年时为11.90%。没有死亡与手术或其并发症相关。仅有4例手术相关并发症，1例术中并发症和3例晚期并发症，并发症风险为4.65%。肱骨闭合未扩髓静态交锁髓内钉固定术（顺行或逆行入路）是一种快速、安全、有效的低发病率手术，用于治疗肱骨干病理性骨折，可确保手臂稳定固定，从而在这些患者预期寿命较短的情况下改善其功能和生活质量。
