Rovere G, Meschini C, Piazza P, Messina F, Caredda M, De Marco D, Noia G, Maccagnano G, Ziranu A
Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2022 Nov;26(1 Suppl):100-105. doi: 10.26355/eurrev_202211_30288.
The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis location, on the patient's status and on the residual functional capacity. Metadiaphysis is an area of conflict in the choice between megaprosthesis implant and intramedullary nail osteosynthesis. This study compares these two surgical procedures in terms of reacquired functionality and local control of metastasis.
Thirty-eight patients (17 males and 21 females; mean age: 66 years old) treated in our institution between January 2010 and December 2020 for pathological humeral metadiaphyseal fractures caused by metastasis, were included in this study. We choose the Musculoskeletal Tumor Society rating system (MSTS) and the Quick Disability of Arm-Shoulder-Hand (QuickDASH) scores for the evaluation of the upper limb function after surgery.
Eighteen (47%) pathological fractures were treated by resection and megaprosthesis implantation, twenty (53%) were treated by medullary nail osteosynthesis. A reduction in pain and greater mechanical stability in the immediate post-operative period was found in all patients. Twenty-two patients died (58%) and sixteen survived (42%). Long-term functional recovery of patients undergoing osteosynthesis is greater than megaprothesis group.
Both medullary nail osteosynthesis and resection and megaprosthesis implantation guarantee excellent recovery at 72 months after surgery, improvement in quality of life and pain relief. Patients treated with osteosynthesis showed a great short-term functional recovery since the joint portion of the limb is not involved, whereas patients treated with megaprosthesis showed better local oncologic control. It is therefore possible to define the type of treatment not only on the localization of the fracture (diaphysis or epiphysis) but above all on the conditions and characteristics of the patient.
肱骨是第二常见受病理性骨折影响的长骨。根据卡潘纳（Capanna）和坎帕纳奇（Campanacci）标准，手术选择基于骨转移部位、患者状况和残余功能能力。骨干中段是在选择使用大假体植入还是髓内钉骨固定术时存在争议的区域。本研究比较了这两种手术方法在功能恢复和转移灶局部控制方面的情况。
本研究纳入了2010年1月至2020年12月期间在我院接受治疗的38例患者（17例男性和21例女性；平均年龄：66岁），这些患者因转移导致肱骨骨干中段病理性骨折。我们选择肌肉骨骼肿瘤学会评分系统（MSTS）和上肢肩-手快速残疾量表（QuickDASH）评分来评估术后上肢功能。
18例（47%）病理性骨折采用切除及大假体植入治疗，20例（53%）采用髓内钉骨固定术治疗。所有患者在术后即刻均出现疼痛减轻且机械稳定性增强。22例患者死亡（58%），16例存活（42%）。接受骨固定术患者的长期功能恢复情况优于大假体组。
髓内钉骨固定术以及切除及大假体植入术均能在术后72个月保证良好的恢复效果、提高生活质量并缓解疼痛。接受骨固定术治疗的患者由于肢体关节部分未受累，短期功能恢复良好，而接受大假体治疗的患者局部肿瘤控制效果更佳。因此，不仅可以根据骨折部位（骨干或骨骺）来确定治疗类型，最重要的是要依据患者的病情和特征来确定。
