Ito Kanako, Shimizu Hirokazu, Matsuoka Masatake, Soma Tamotsu, Takahashi Daisuke, Shimizu Tomohiro, Nishimoto Toshiyuki, Hiraga Hiroaki, Iwasaki Norimasa, Iwata Akira
Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.
Department of Musculoskeletal Oncology, NHO Hokkaido Cancer Center, 2- chōme-3-54, Kikusui 4 Jō, Shiroishi Ward, Sapporo, 003-0804, Hokkaido, Japan.
Sci Rep. 2025 May 13;15(1):16578. doi: 10.1038/s41598-025-01126-8.
Fracture surgery for metastatic femur is frequently performed in older adults. In contrast to impending fracture (IF), complete pathological fracture (CF) renders patients bedridden during the preoperative period, which might affect the postoperative recovery of ambulation. Thus, we aimed to investigate the clinical significance of the recovery in older adults after fracture surgery for femoral metastasis, and predictors for recovery after CF. This multicenter retrospective study enrolled 146 adults aged ≥55 years undergoing surgery. A total of 78.1% (114/146) patients showed recovery; no association was observed between the presence of postoperative weight-bearing restriction and recovery (p = 0.50). The rate of chemotherapeutic intervention was higher in patients who had recovered compared to the others (52/114 vs. 8/32, p = 0.03). Non-recovery of ambulation was an independent poor prognostic factor for one-year suvival (hazard ratio, 1.85; 95% confidence interval, 1.06-3.22; p < 0.01). Subgroup analyses showed shorter preoperative waiting periods in the recovered patients than in the others (5.6 ± 0.6 vs. 7.9 ± 1.1; p = 0.03) among CF cases. Recovery of ambulation was a prognostic factor and was associated with postoperative chemotherapy. Shorter preoperative waiting time was associated with the recovery in patients with CF. Prompt surgical intervention should be considered when older adults develop CF due to femoral metastasis.
转移性股骨骨折手术在老年人中经常进行。与即将发生的骨折（IF）相比，完全病理性骨折（CF）会使患者在术前卧床，这可能会影响术后行走功能的恢复。因此，我们旨在研究老年人股骨转移骨折手术后恢复的临床意义，以及CF后恢复的预测因素。这项多中心回顾性研究纳入了146名年龄≥55岁接受手术的成年人。共有78.1%（114/146）的患者显示恢复；术后负重限制的存在与恢复之间未观察到关联（p = 0.50）。与未恢复的患者相比，恢复的患者化疗干预率更高（52/114 vs. 8/32，p = 0.03）。行走功能未恢复是一年生存率的独立不良预后因素（风险比，1.85；95%置信区间，1.06 - 3.22；p < 0.01）。亚组分析显示，在CF病例中，恢复的患者术前等待时间比未恢复的患者短（5.6±0.6 vs. 7.9±1.1；p = 0.03）。行走功能恢复是一个预后因素，并且与术后化疗相关。较短的术前等待时间与CF患者的恢复相关。当老年人因股骨转移发生CF时，应考虑及时进行手术干预。
