在病理性股骨病变骨折治疗后，采用基于CT的硬度分析进行预防性手术治疗。

Prophylactic surgical treatment using CT-based rigidity analysis after the fact fracture treatment of pathologic femoral lesions.

作者信息

DeHority Kaitlyn, Craig Tina, Damron Timothy A

机构信息

Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, New York, NY, USA.

出版信息

Ann Jt. 2022 Apr 15;7:12. doi: 10.21037/aoj-20-92. eCollection 2022.

DOI:10.21037/aoj-20-92

PMID:38529166

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10929439/

Abstract

BACKGROUND

Accurate comparison of prophylactic surgical treatment (PST) to after fracture treatment (AF) of patients with femoral metastatic disease requires more accurately identifying patients for impending fracture, such as with CT-based structural rigidity analysis (CTRA). This study compares a more accurately defined PST group (of impending fractures defined by CTRA) to AF for metastatic femoral disease.

METHODS

PST patients were enrolled and treated by the PI in a longitudinal multicenter study of impending pathologic fractures evaluated for accuracy by CTRA. The AF patients were also treated by the senior author and were identified by retrospective chart review. Fifty-five patients were treated surgically for metastatic femoral lesions and were divided into three groups for the purpose of this study: Group I (AF), Group II (PST-high), and Group III (PST-low). Demographic information, comorbidities, and clinical variables of interest were collected by retrospective chart review; cost data was collected by collaboration with our hospital financial personnel (office of the Chief Financial Officer).

RESULTS

Survival showed statistically significant differences favoring Group II. Transfusions in Group I were nearly twice those of Groups II and III, but there was no statistically significant (NS) difference between groups. Estimated blood loss (EBL) was generally with NS difference. Similarly, there were NS differences in LOS between groups. Discharge disposition showed statistically significant differences between groups (P=0.012, global). Discharge to home was highest in Group II (76%) and lowest in Group I (27%). Discharge to rehab was lowest in Group II (24%) and highest in Group I (47%). There were no discharges to hospice or morgue in Group II, while both occurred in Group I. Mean direct and total costs were highest in Group I ($18,837 and $31,997, respectively) and lowest in Group II ($16,094 and $27,357) but the differences were NS.

CONCLUSIONS

This study shows benefits of PST over AF in a group of PST patients more accurately defined to have impending pathologic fractures by CTRA definition.

摘要

背景

对于股骨转移性疾病患者，要准确比较预防性手术治疗（PST）与骨折后治疗（AF），需要更准确地识别即将发生骨折的患者，比如通过基于CT的结构刚度分析（CTRA）。本研究比较了一个更准确界定的PST组（由CTRA界定的即将发生骨折的患者）与股骨转移性疾病的AF组。

方法

在一项纵向多中心研究中，主要研究者招募并治疗了PST患者，该研究通过CTRA评估即将发生的病理性骨折的准确性。AF患者也由资深作者进行治疗，并通过回顾性病历审查进行识别。55例患者接受了股骨转移性病变的手术治疗，为进行本研究将其分为三组：第一组（AF）、第二组（PST-高）和第三组（PST-低）。通过回顾性病历审查收集人口统计学信息、合并症及感兴趣的临床变量；成本数据通过与我院财务人员（首席财务官办公室）合作收集。

结果

生存率显示出有利于第二组的统计学显著差异。第一组的输血次数几乎是第二组和第三组的两倍，但组间无统计学显著差异。估计失血量（EBL）通常无显著差异。同样，组间住院时间（LOS）无显著差异。出院处置在组间显示出统计学显著差异（P = 0.012，总体）。第二组出院回家率最高（76%），第一组最低（27%）。第二组出院至康复机构的比例最低（24%），第一组最高（47%）。第二组无人出院至临终关怀机构或太平间，而第一组均有发生。平均直接成本和总成本在第一组最高（分别为18,837美元和31,997美元），在第二组最低（16,094美元和27,357美元），但差异无统计学意义。