Griggers James I, Alcantar Sergio, Gonzalez Marcos R, Lozano-Calderon Santiago A
Medical College of Georgia, Augusta, Georgia, USA.
Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Surg Oncol. 2025 Apr;131(5):932-941. doi: 10.1002/jso.27975. Epub 2024 Nov 7.
Intramedullary nailing (IMN) is a common option for managing impending or pathologic fractures of the humerus secondary to metastatic disease. We sought to assess the (1) early complications, (2) failure rates and mechanisms, and (3) functional outcomes. A systematic review using the PubMed, Embase, and Cochrane databases was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The study was registered on PROSERO (CRD42023406905). The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for quality assessment. Studies describing postoperative outcomes of patients with impending or pathologic fractures of the humerus treated with IMN were included. Implant failure was classified into mechanical and nonmechanical causes. Functional outcomes were assessed via the Musculoskeletal Tumor Society (MSTS) score. Overall, 41 studies comprising 1431 patients were included. Early complications occurred in 5.5% of patients, with 2.8% of patients having systemic complications. The overall implant failure rate was 4.9%, and the mean MSTS score at the last follow-up was 79.9%. IMN was associated with good postoperative functional outcomes and low implant failure rates. Systemic complications were the most common type of early complication, and tumor progression was the main cause of implant failure. LEVEL OF EVIDENCE: III.
髓内钉固定术（IMN）是治疗继发于转移性疾病的肱骨即将发生的骨折或病理性骨折的常用方法。我们试图评估（1）早期并发症，（2）失败率及机制，以及（3）功能结局。我们使用PubMed、Embase和Cochrane数据库进行了系统评价。遵循系统评价和Meta分析的首选报告项目指南。该研究已在PROSERO（CRD42023406905）注册。采用流行病学观察性研究报告强化清单进行质量评估。纳入描述采用IMN治疗肱骨即将发生的骨折或病理性骨折患者术后结局的研究。将植入物失败分为机械性和非机械性原因。通过肌肉骨骼肿瘤学会（MSTS）评分评估功能结局。总体而言，纳入了41项研究，共1431例患者。5.5%的患者发生早期并发症，2.8%的患者出现全身并发症。植入物总体失败率为4.9%，末次随访时MSTS评分的平均值为79.9%。IMN与良好的术后功能结局和低植入物失败率相关。全身并发症是最常见的早期并发症类型，肿瘤进展是植入物失败的主要原因。证据级别：III级。
