Yao Long, Wang Bing, Wang Ziyi, Wei Ancheng, Huang Xin, Wang Zhiqiang
Department of Orthopedic, Chengdu University of Traditional Chinese Medicine, Shierqiao Road, Jinniu District, Chengdu City, Sichuan Province,People's Republic of China.
Department of Orthopedic, Yibin Sixth People's Hospital, Yibin City, Sichuan Province, People's Republic of China.
Ann Med Surg (Lond). 2024 Aug 6;86(9):5595-5599. doi: 10.1097/MS9.0000000000002427. eCollection 2024 Sep.
Bone is one of the common sites of metastasis in lung cancer. Pathological fractures of the femur significantly reduce patients' quality of life and increase the risk of death. However, there is still no consensus on the optimal treatment of pathological femoral fractures. The authors' report provides a treatment method for a patient with pathological fracture of lung cancer with preoperative HIFU lesion ablation followed by combined intramedullary nail fixation.
A 61-year-old Chinese woman was hospitalized with severe pain in her right thigh. X-ray and CT examination at admission considered pathological fracture of the right femur. MRI showed a comminuted fracture of the middle and lower part of the right femur, swelling of the surrounding soft tissue, and effusion. WBS showed an abnormal concentration of imaging agent at the right femoral fracture end and abnormal bone metabolism. After a lung biopsy, it was diagnosed as lung cancer with femoral metastasis and pathological fracture.
The patient underwent HIFU ablation before surgery to reduce the lesion, and a re-examination MRI showed that the signal at the lesion was significantly reduced, and the lesion volume was significantly reduced. The operation was performed by open reduction and intramedullary nail fixation, focal excision, and bone cement filling. After 6 months of follow-up, the patient's bone metastasis was not aggravated, and there was no loosening or fracture of the right femoral intramedullary nail.
This is a case of pathological fracture of the femur caused by bone metastases from pulmonary cancer. The patient used HIFU to reduce the lesion before the operation and combined it with intramedullary nail internal fixation to treat the pathological fracture. A satisfactory therapeutic effect was obtained. The authors believe that this is a safe and effective treatment. This case may be beneficial to the treatment of pathological fracture of bone metastasis of lung cancer.
骨骼是肺癌常见的转移部位之一。股骨病理性骨折会显著降低患者的生活质量并增加死亡风险。然而，对于股骨病理性骨折的最佳治疗方法仍未达成共识。作者的报告提供了一种针对肺癌合并病理性骨折患者的治疗方法，即术前进行高强度聚焦超声（HIFU）病灶消融，随后联合髓内钉固定。
一名61岁的中国女性因右大腿剧痛入院。入院时的X线和CT检查考虑为右股骨病理性骨折。磁共振成像（MRI）显示右股骨中下段粉碎性骨折，周围软组织肿胀及积液。全身骨显像（WBS）显示右股骨骨折端显像剂异常浓聚及骨代谢异常。经肺活检后，诊断为肺癌伴股骨转移及病理性骨折。
患者术前接受HIFU消融以缩小病灶，复查MRI显示病灶处信号明显降低，病灶体积显著减小。手术采用切开复位髓内钉固定、局部切除及骨水泥填充。随访6个月，患者骨转移未加重，右股骨髓内钉无松动或断裂。
这是一例由肺癌骨转移导致的股骨病理性骨折病例。患者术前采用HIFU缩小病灶，并联合髓内钉内固定治疗病理性骨折，获得了满意的治疗效果。作者认为这是一种安全有效的治疗方法。该病例可能对肺癌骨转移病理性骨折的治疗有益。
