Lozano-Calderon Santiago A, Gonzalez Marcos R, Werenski Joseph O, Quinn Kayla, Freiberger Diana, Raskin Kevin A
Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
JB JS Open Access. 2024 Sep 13;9(3). doi: 10.2106/JBJS.OA.24.00016. eCollection 2024 Jul-Sep.
The stabilization of metastatic lesions in the periacetabular region can be successfully performed using percutaneous techniques. Photodynamic nails (PDNs) are among the available tools for stabilization. Data on postoperative complications and functional outcomes are, however, scarce.
Patients undergoing percutaneous stabilization using PDNs (IlluminOss Medical) for impending or actual minimally displaced pathological fractures of the pelvis from metastatic bone disease, multiple myeloma, or primary bone lymphoma were enrolled prospectively. Outcomes were assessed preoperatively and postoperatively at the 2-day, 2-week, 6-week, 3-month, 6-month, and 1-year time points. Functional outcomes assessed included the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, Combined Pain and Ambulatory Function (CPAF), EuroQol-Visual Analogue Scale (EQ-VAS), and Musculoskeletal Tumor Society (MSTS) scores. Pain was assessed using a VAS.
A total of 30 patients treated with PDNs were included. The median VAS pain score dropped from 60 points preoperatively to 30 at 6 weeks postoperatively (p = 0.004). The median CPAF score improved from 6 preoperatively to 7 postoperatively at the 6-week mark. The median EQ-VAS score showed significant improvement at 6 weeks (70 versus 50; p = 0.006). The median 2-week PROMIS Pain Interference score was significantly lower than preoperatively (64.1 versus 66.9; p = 0.03). An improvement in the median PROMIS Physical Function score was seen at 6 weeks following surgery compared with preoperatively (37 versus 30.1; p = 0.001). A significant improvement in the MSTS score was seen as soon as 2 days after surgery (77% versus 40%; p < 0.0001).
Among patients with pelvic bone metastases, multiple myeloma, or primary bone lymphoma, we found that treatment using PDNs resulted in immediate return to ambulation and rapid functional outcome improvement, with low complication rates. In this population, this technique represents a safe alternative to open surgery.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
使用经皮技术可成功实现髋臼周围区域转移病灶的稳定。光动力钉（PDN）是可用的稳定工具之一。然而，关于术后并发症和功能结果的数据却很稀少。
前瞻性纳入因转移性骨病、多发性骨髓瘤或原发性骨淋巴瘤导致骨盆即将发生或实际发生轻度移位病理性骨折而接受使用PDN（IlluminOss Medical）进行经皮稳定治疗的患者。在术前以及术后2天、2周、6周、3个月、6个月和1年的时间点评估结果。评估的功能结果包括患者报告结果测量信息系统（PROMIS）身体功能、PROMIS疼痛干扰、疼痛与步行功能综合评分（CPAF）、欧洲五维度健康量表视觉模拟评分（EQ-VAS）以及肌肉骨骼肿瘤学会（MSTS）评分。使用视觉模拟量表（VAS）评估疼痛。
总共纳入了30例接受PDN治疗的患者。VAS疼痛评分中位数从术前的60分降至术后6周时的30分（p = 0.004）。CPAF评分中位数在术后6周时从术前的6分提高到了7分。EQ-VAS评分中位数在6周时显示出显著改善（70对50；p = 0.006）。术后2周的PROMIS疼痛干扰评分中位数显著低于术前（64.1对66.9；p = 0.03）。与术前相比，术后6周时PROMIS身体功能评分中位数有所改善（37对30.1；p = 0.001）。术后仅2天MSTS评分就有显著改善（77%对40%；p < 0.0001）。
在患有骨盆骨转移、多发性骨髓瘤或原发性骨淋巴瘤的患者中，我们发现使用PDN进行治疗可使患者立即恢复行走，并迅速改善功能结果且并发症发生率较低。在这一人群中，该技术是开放手术的一种安全替代方法。
治疗性四级。有关证据水平的完整描述，请参阅作者须知。
