Sas Amelie, Tanck Esther, Sermon An, van Lenthe G Harry
Biomechanics Section, KU Leuven, Leuven, Belgium.
Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Bone Rep. 2020 May 26;12:100286. doi: 10.1016/j.bonr.2020.100286. eCollection 2020 Jun.
Patients with bone metastases have an increased risk to sustain a pathological fracture as lytic metastatic lesions damage and weaken the bone. In order to prevent fractures, prophylactic treatment is advised for patients with a high fracture risk. Mechanical stabilization of the femur can be provided through femoroplasty, a minimally invasive procedure where bone cement is injected into the lesion, or through internal fixation with intra- or extramedullary implants. Clinicians face the task of determining whether or not prophylactic treatment is required and which treatment would be the most optimal. Finite element (FE) models are promising tools that could support this decision process. The aim of this paper is to provide an overview of the state-of-the-art in FE modeling for the treatment decision of metastatic bone lesions in the femur. First, we will summarize the clinical and mechanical results of femoroplasty as a prophylactic treatment method. Secondly, current FE models for fracture risk assessment of metastatic femurs will be reviewed and the remaining challenges for clinical implementation will be discussed. Thirdly, we will elaborate on the simulation of femoroplasty in FE models and discuss future opportunities. Femoroplasty has already proven to effectively relieve pain and improve functionality, but there remains uncertainty whether it provides sufficient mechanical strengthening to prevent pathological fractures. FE models could help to select appropriate candidates for whom femoroplasty provides sufficient increase in strength and to further improve the mechanical benefit by optimizing the locations for cement augmentation.
骨转移患者发生病理性骨折的风险增加，因为溶骨性转移病灶会损害并削弱骨骼。为了预防骨折，建议对骨折风险高的患者进行预防性治疗。可以通过股骨成形术（一种将骨水泥注入病灶的微创手术）或通过使用髓内或髓外植入物进行内固定来实现股骨的机械稳定。临床医生面临着确定是否需要进行预防性治疗以及哪种治疗最为理想的任务。有限元（FE）模型是有望支持这一决策过程的工具。本文的目的是概述用于股骨转移性骨病变治疗决策的有限元建模的最新进展。首先，我们将总结股骨成形术作为一种预防性治疗方法的临床和力学结果。其次，将回顾当前用于评估转移性股骨骨折风险的有限元模型，并讨论临床应用中尚存的挑战。第三，我们将详细阐述有限元模型中股骨成形术的模拟，并探讨未来的机遇。股骨成形术已被证明能有效缓解疼痛并改善功能，但它是否能提供足够的机械强化以预防病理性骨折仍存在不确定性。有限元模型有助于选择那些股骨成形术能充分增强强度的合适患者，并通过优化骨水泥强化的位置进一步提高力学效益。
