Orthopedic Surgery Division, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
National Unit of Orthopedic Oncology, Tel Aviv Sourasky Medical Center affiliated with Tel Aviv University, Tel Aviv, Israel.
Clin Biomech (Bristol). 2020 Dec;80:105155. doi: 10.1016/j.clinbiomech.2020.105155. Epub 2020 Aug 24.
Most benign active and latent lesions of proximal femur do not predispose a patient to a pathologic fracture. Nonetheless, there is a tendency to perform internal fixation due to the lack of accurate clinical tools that may reliably confirm low risk of pathologic fracture. As many as 30% of these surgeries may be unnecessary. A patient-specific CT-based finite element analysis may quantify bone strength and risk of fracture under normal weight-bearing conditions.
The clinical relevance of such finite element analysis was investigated in a retrospective study on a cohort of 17 patients. Finite element analysis results (high risk = indication for surgery, low or moderate risk = follow-up) were compared to actual clinical decisions (surgery vs follow-up). All patients predicted by the finite element analysis as high risk underwent internal fixation and had good outcomes (n = 6).
Four of the 11 low- and moderate-risk finite element analysis patients (36%) were operated immediately, and seven (64%) were either operated after a delay of at least 6 months or were never operated. None sustained a pathologic fracture. Patients who were predicted as low fracture risk by finite element analysis remained fracture-free for a minimal period of 6 months. Prediction of high risk of pathologic fracture by finite element analysis was in complete agreement with the conventional clinical evaluation.
We consider finite element analysis a promising decision support system for the management of patients with benign tumors of femur, and that it may reliably endorse the decision to withhold surgery for patients at low fracture-risk.
大多数股骨近端的良性活动性和潜伏性病变并不会使患者易于发生病理性骨折。尽管如此，由于缺乏可靠的临床工具来确认低风险的病理性骨折，仍存在进行内固定的倾向。多达 30%的这些手术可能是不必要的。基于患者的 CT 的有限元分析可以量化在正常承重条件下的骨强度和骨折风险。
在一项对 17 名患者的队列进行的回顾性研究中，研究了这种有限元分析的临床相关性。有限元分析结果（高风险=手术指征，低或中风险=随访）与实际临床决策（手术与随访）进行了比较。所有被有限元分析预测为高风险的患者均接受了内固定治疗，且效果良好（n=6）。
11 名低风险和中风险有限元分析患者中的 4 名（36%）立即接受了手术，7 名（64%）患者在至少 6 个月后延迟手术或从未接受手术。均未发生病理性骨折。通过有限元分析预测骨折风险较低的患者在 6 个月的最短时间内保持无骨折状态。通过有限元分析预测病理性骨折的高风险与传统临床评估完全一致。
我们认为有限元分析是一种有前途的决策支持系统，可用于管理股骨良性肿瘤的患者，它可以可靠地支持对骨折风险低的患者不进行手术的决策。
