Department of Diagnostic and Interventional Radiology, Institut Bergonié, Regional Comprehensive Cancer Center, F-33076, Bordeaux, France.
Department of Clinical Epidemiology Research, Institut Bergonié, F-33076, Bordeaux, France.
Eur J Radiol. 2019 Nov;120:108694. doi: 10.1016/j.ejrad.2019.108694. Epub 2019 Sep 29.
To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients.
All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors.
140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031).
Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.
评估癌症患者经皮髋臼骨水泥成形术（PCA）后髋臼骨折（OWAF）发生或恶化的临床、影像学和围手术期特征。
纳入 2008 年 1 月至 2015 年 12 月期间在我们综合癌症中心接受 PCA 治疗的所有髋臼转移患者。报告了临床特征、CT 扫描（CT 扫描）上转移特征（位置[穹顶、四边形表面、前柱和后柱]、位置数量、基质、关节内/外骨折、骨外或软骨下延伸）和手术特征（关节内/外骨水泥渗漏（IACL）、每个位置的填充百分比、并发症），以及 PCA 前后的治疗。终点是 PCA 随访期间 CT 扫描上的 OWAF。采用对数秩检验和 Cox 模型来确定预后因素。
在 129 名患者（11 例双侧手术，中位年龄：66.6 岁）中确定了 140 例 PCA。18 例（18/140，12.9%）存在初始关节骨折。12 例（12/140，8.6%）PCA 存在 IACL。唯一与 IACL 相关的特征是存在关节内骨折（p=0.009）。在有影像学随访的 111 名患者中，18 例（16.2%）出现 OWAF。多变量分析显示，所有髋臼转移性病变部位的骨水泥填充（即使是部分填充）是 OWAF 无进展生存的唯一预测因素（风险比=3.8，p=0.031）。
在所有受髋臼转移影响的区域注入骨水泥可预防 OWAF。由于 PCA 后的生存率不容忽视，因此完成初次 PCA 不足可能有助于维持患者的生活质量。
