Bayram Serkan, Özmen Emre, Birişik Fevzi, Kıral Doğan, Salduz Ahmet, Erşen Ali
Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
Department of Orthopaedics and Traumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
J Orthop Sci. 2019 Nov;24(6):1068-1073. doi: 10.1016/j.jos.2019.08.022. Epub 2019 Sep 19.
Intramedullary nailing is the procedure of choice for pathologic fractures in humeral shaft because it allows early pain relief and mobilization. The aim of this study was to analyze the prognostic factors affecting survival of patients with pathologic humeral shaft fractures treated with intramedullary nailing without tumor removal.
We performed a retrospective study by evaluating the records of patients treated in our clinic between 2003 and 2018 for pathologic humerus shaft fractures with a minimum follow-up of one year. Kaplan-Meier methods were applied to estimate overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with survival.
52 patients (56 humeral fractures) were operated. The average age at the time of surgery was 58.9 years. There were 28 women and 24 men. In our series, multiple myeloma accounted for 52% of the cases. At the time of this study, 34 (65.3%) patients had deceased. Survival rates at first month, 6 months and 1 year after surgery were 96.2%, 67.4% and 59.6%, respectively. The median survival after surgery was 7.5 (6 days-84 months) months for deceased patients and 18 (34.7%) surviving patients with a median survival of 68.6 months. Rapid growth tumor, presence of pathological fracture in other extremities and, Eastern Cooperative Oncology Group performance status (ECOG-PS) were independently associated with a worse overall survival.
More than 50% of patients with pathological humerus shaft fractures were diagnosed with multiple myeloma. Rapid growth tumors such as lung cancer and renal cell cancer increased mortality by a factor of 1 while presence of operative metastases in other extremities increased mortality by a factor of 3.1 and ECOG-PS increased mortality by a factor 6.8. Rapid growth tumors, ECOG-PS and presence of pathological fracture in other extremities were important prognostic factors influencing overall survival.
髓内钉固定术是肱骨干病理性骨折的首选治疗方法，因为它能使患者早期缓解疼痛并实现活动。本研究的目的是分析影响采用髓内钉固定术且未切除肿瘤的肱骨干病理性骨折患者生存的预后因素。
我们进行了一项回顾性研究，评估了2003年至2018年在我们诊所接受治疗的肱骨干病理性骨折患者的记录，这些患者的最短随访时间为一年。采用Kaplan-Meier方法估计总生存率。应用多变量Cox算法识别与生存独立相关的因素。
52例患者（56处肱骨骨折）接受了手术。手术时的平均年龄为58.9岁。女性28例，男性24例。在我们的系列研究中，多发性骨髓瘤占病例的52%。在本研究时，34例（65.3%）患者已死亡。术后第1个月、6个月和1年的生存率分别为96.2%、67.4%和59.6%。死亡患者术后的中位生存期为7.5（6天至84个月）个月，18例（34.7%）存活患者的中位生存期为68.6个月。肿瘤生长迅速、其他肢体存在病理性骨折以及东部肿瘤协作组体能状态（ECOG-PS）与较差的总生存率独立相关。
超过50%的肱骨干病理性骨折患者被诊断为多发性骨髓瘤。肺癌和肾细胞癌等生长迅速的肿瘤使死亡率增加1倍，而其他肢体存在手术转移使死亡率增加3.1倍，ECOG-PS使死亡率增加6.8倍。肿瘤生长迅速、ECOG-PS以及其他肢体存在病理性骨折是影响总生存的重要预后因素。
