81例转移性骨病所致病理性髋臼骨折行切开重建或非手术治疗后的功能结果。
Functional outcomes after open reconstruction or nonoperative management of 81 pathologic acetabular fractures from metastatic bone disease.
作者信息
Leland Christopher R, Morris Carol D, Forsberg Jonathan A, Levin Adam S
机构信息
Harvard Combined Orthopaedic Residency Program, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Division of Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
出版信息
J Orthop. 2023 Aug 16;44:22-30. doi: 10.1016/j.jor.2023.08.001. eCollection 2023 Oct.
BACKGROUND
Pathologic acetabular fracture secondary to skeletal metastasis may result in debilitating pain, inability to ambulate, and impaired quality of life, which may mark the first period of dependent care in cancer patients. Acetabular reconstruction may involve morbid procedures with increased complication rates. This study aimed to evaluate the evolution of pain, performance status, and ambulation following nonoperative management or open reconstruction of pathologic acetabular fractures.
METHODS
A retrospective cohort of 2630 adult patients with osseous metastatic disease treated at a high-volume cancer center between 2005 and 2021 was screened for pathologic fractures of the acetabulum. The study outcomes were pain, performance status, and the ability to ambulate. We identified 78 patients (median age, 60 years; 37 female patients [46%]) with 81 fractures. Of these, treatment consisted of open reconstruction (n = 34) or nonoperative management alone (n = 47). The mean follow-up in surviving patients was 3.4 years.
RESULTS
Open reconstruction was performed more frequently for displaced fractures (P < 0.01), Harrington class III or IV acetabula (P < 0.01), and patients with a performance status ≥3 at hospitalization (P = 0.00). Open reconstruction was associated with clinically meaningful improvements in pain (adjusted odds ratio [aOR], 8.3; 95% CI, 1.4-50.6; P = 0.02) and performance status (aOR, 10.9; 95% CI, 1.7-71.0; P = 0.01) at discharge and a restoration of ambulation (aOR, 7.5; 95% CI, 1.9-29.8; P < 0.01) at final follow-up.
CONCLUSIONS
In patients with pathologic acetabular fracture due to osseous metastatic disease, functional improvements in pain, performance status, and ambulation were observed following open acetabular reconstruction in carefully selected patients, with no impact on survival, while noninferior improvements were observed in patients receiving nonoperative management when considering their larger clinical context.
LEVEL OF EVIDENCE
Level III, therapeutic study.
背景
骨骼转移继发的病理性髋臼骨折可导致使人衰弱的疼痛、无法行走及生活质量受损，这可能标志着癌症患者进入首个需要依赖他人照料的阶段。髋臼重建可能涉及有较高并发症发生率的创伤性手术。本研究旨在评估非手术治疗或开放性重建病理性髋臼骨折后疼痛、身体状况及行走能力的变化。
方法
对2005年至2021年期间在一家大型癌症中心接受治疗的2630例成年骨转移瘤患者的回顾性队列进行筛查，以确定髋臼病理性骨折情况。研究结果包括疼痛、身体状况及行走能力。我们确定了78例患者（中位年龄60岁；37例女性患者[46%]），共81处骨折。其中，治疗方式包括开放性重建（n = 34）或单纯非手术治疗（n = 47）。存活患者的平均随访时间为3.4年。
结果
对于移位骨折（P < 0.01）、哈林顿Ⅲ级或Ⅳ级髋臼（P < 0.01）以及住院时身体状况≥3级的患者（P = 0.00），更常进行开放性重建。开放性重建与出院时疼痛（调整优势比[aOR]，8.3；95%置信区间[CI]，1.4 - 50.6；P = 0.02）和身体状况（aOR，10.9；95% CI，1.7 - 71.0；P = 0.01）的临床显著改善以及最终随访时行走能力的恢复（aOR，7.5；95% CI，1.9 - 29.8；P < 0.01）相关。
结论
在因骨转移瘤导致病理性髋臼骨折的患者中，经精心挑选的患者接受开放性髋臼重建后，疼痛、身体状况及行走能力有功能改善，且对生存无影响，而在考虑其更大临床背景时，接受非手术治疗的患者也有非劣效性改善。
证据级别
Ⅲ级，治疗性研究。
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