Division of Orthopaedic Trauma & Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ (Dr. Pizzo and Dr. Miller), and the Division of Orthopaedic Oncology & Sarcoma Surgery, Department of Orthopaedic Surgery, Morristown Medical Center, Morristown, NJ (Mr. Hoskins, Dr. Patel, Mr. Goyette, Mr. Mazzei, and Dr. Wittig).
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 12;4(6). doi: 10.5435/JAAOSGlobal-D-20-00090. eCollection 2020 Jun.
The humerus is a common site of metastatic tumor involvement and pathologic fracture. Intramedullary nailing is a treatment option that offers the benefit of protecting a long segment of diseased bone, but it is not without complications. This study aims to examine the survival, functional outcomes, and complications of patients treated with cement-augmented unlocked intramedullary nailing for actual and impending pathologic fractures of the humeral shaft.
From 2014 to 2019, 26 patients were treated with this technique. Functional outcomes were assessed using the Musculoskeletal Tumor Society scoring system. Outcome scores, complications, reoperations, and mortality were determined by retrospective chart reviews and direct patient examinations.
The mean age at the time of surgery was 66.8 years. The mean follow-up was 20.2 months. Patients reported significant improvement in the mean Musculoskeletal Tumor Society score from 10.5 preoperatively to 26.1 after surgery ( < 0.001). Five patients died of disease during the follow-up period. One patient had intraoperative fracture propagation during implant placement, and one patient experienced a postoperative rotator cuff tear.
Unlocked intramedullary nailing with cement augmentation is a reliable treatment method for actual and impending pathologic fractures of the humerus that results in favorable outcomes, including consistent pain relief and restoration of function.
肱骨是转移性肿瘤累及和病理性骨折的常见部位。髓内钉固定是一种治疗选择，它具有保护长段病变骨的优点，但并非没有并发症。本研究旨在研究使用水泥增强非锁定髓内钉治疗肱骨干实际和即将发生的病理性骨折的患者的生存率、功能结果和并发症。
2014 年至 2019 年，26 例患者采用该技术治疗。使用肌肉骨骼肿瘤学会评分系统评估功能结果。通过回顾性图表审查和直接患者检查确定预后评分、并发症、再次手术和死亡率。
手术时的平均年龄为 66.8 岁。平均随访 20.2 个月。患者报告肌肉骨骼肿瘤学会评分从术前的 10.5 分显著提高到术后的 26.1 分（<0.001）。随访期间有 5 例患者死于疾病。1 例患者在植入物放置过程中发生术中骨折传播，1 例患者发生术后肩袖撕裂。
水泥增强非锁定髓内钉固定是治疗肱骨干实际和即将发生的病理性骨折的可靠方法，可获得良好的结果，包括持续的疼痛缓解和功能恢复。
