Carolino D K, Tud A R
Musculoskeletal Tumor Service, Philippine Orthopedic Center, Quezon City, Philippines.
Malays Orthop J. 2025 Mar;19(1):96-101. doi: 10.5704/MOJ.2503.012.
The proximal femur is the most common long bone affected by metastatic disease. Pathologic fractures in this area are frequent, secondary to weight-bearing and deforming forces. Long-stem endoprosthetic replacement is often used to replace and bypass segments affected by metastases. However, implant cost remains prohibitive for patients in low-resource settings. An improvised megaprosthesis using a hip implant combined with Kuntscher nail provides an economic option.
This is a case series of three patients diagnosed with pathologic fracture of the hip secondary to metastatic bone disease who underwent proximal femoral resection with reconstruction using an improvised endoprosthesis in a single tertiary hospital. Outcomes determined include total blood loss, total surgical time, length of hospital stay, latest functional score using the Musculoskeletal Tumour Society (MSTS) score, and pain scale using the numerical rating scale (NRS).
For case 1, a 42-year-old female with metastatic breast carcinoma, currently alive with disease and able to perform activities of daily living (ADLs) with minimal assistance; for case 2, a 77-year-old male diagnosed with prostatic carcinoma, able to ambulate with assistive device before expiring 2 years post-surgery; and for case 3, a 57-year-old female with metastatic breast carcinoma, able to resume unassisted ADLs at 3 months post-surgery before refusing systemic treatment in her second year of surveillance monitoring.
An improvised megaprosthesis is a cost-effective implant option in low-resource settings, which may help decrease complications related to immobilisation for patients undergoing palliative surgery for metastatic bone disease.
股骨近端是受转移性疾病影响最常见的长骨。该部位的病理性骨折很常见，是由负重和变形力所致。长柄假体置换常用于替换和绕过受转移影响的节段。然而，对于资源匮乏地区的患者来说，植入物成本仍然过高。一种使用髋关节植入物与克氏针组合的简易型大假体提供了一种经济的选择。
这是一个病例系列，包含三名被诊断为转移性骨病继发髋部病理性骨折的患者，他们在一家三级医院接受了使用简易型假体进行重建的股骨近端切除术。所确定的结果包括总失血量、总手术时间、住院时间、使用肌肉骨骼肿瘤学会（MSTS）评分的最新功能评分以及使用数字评分量表（NRS）的疼痛量表。
病例1是一名42岁患有转移性乳腺癌的女性，目前仍存活且在极少帮助下能够进行日常生活活动（ADL）；病例2是一名77岁被诊断为前列腺癌的男性，术后2年去世前能够借助辅助器械行走；病例3是一名57岁患有转移性乳腺癌的女性，术后3个月能够在无人协助下恢复ADL，之后在第二年的监测期拒绝了全身治疗。
在资源匮乏地区，简易型大假体是一种具有成本效益的植入选择，这可能有助于减少接受转移性骨病姑息性手术患者因固定不动而产生的并发症。
