Nakajima Kosei, Sugiyama Daichi, Miyahara Akiharu, Bannai Karen
Division of Orthopedic Surgery, Faculty of Veterinary Medicine, Imabari Campus, Okayama University of Science, Ehime, Japan.
Division of Translational Research, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Tokyo, Japan.
Open Vet J. 2025 May;15(5):2251-2258. doi: 10.5455/OVJ.2025.v15.i5.42. Epub 2025 May 31.
Pathological fractures result from abnormal bone remodeling caused by local bone lesions, such as malignant tumors, compromising bone strength. Tumor-derived factors disrupt the balance between bone resorption and formation, leading to osteolytic and osteosclerotic lesions that weaken bone integrity. While surgical treatments, including limb amputation and limb-sparing surgery, are commonly used, the therapeutic efficacy of fracture repair remains unclear due to limited evidence.
This study characterized pathological fractures and evaluated survival time and functional prognoses following surgical repair in dogs. The goal was to provide robust evidence to inform clinical decision-making and improve treatment outcomes.
A systematic review and meta-analysis were conducted following a PRISMA-compliant approach. MEDLINE (PubMed) and Google Scholar were used to search for relevant studies published from database inception to March 1, 2025. Data from past reports were integrated with cases from our institution, comprising 70 dogs with pathological fractures. Survival and prognosis were analyzed using the Kaplan-Meier method, and outcomes between adjuvant chemotherapy were compared using the log-rank test.
Osteosarcoma was the most common cause of pathological fractures ( = 55; 78.6%), followed by multiple myeloma, undifferentiated sarcoma, and bone metastases. Surgical stabilization was the most common therapeutic intervention ( = 40; 57.1%), with plate stabilization being the most frequently used technique ( = 20; 28.6%). The median time to lameness recurrence was 163 days (95% confidence interval [CI]: 130-510 days), while the median survival time with osteosarcoma was 292 days (95% CI: 163-518 days). The subgroup analysis revealed no significant difference in survival between patients who received adjuvant therapy (radiation therapy or chemotherapy) and those who did not ( = 0.675). Clinical and statistical heterogeneities were not assessed due to the integration of case reports and case series.
Surgical stabilization of pathological fractures resulting from osteosarcoma should be considered a palliative treatment option for cases in which amputation is declined by the owner or in dogs with advanced disease, including metastatic lesions. With appropriate patient selection, this approach may represent a viable third-line treatment following limb-sparing surgery and amputation.
病理性骨折是由局部骨病变（如恶性肿瘤）引起的异常骨重塑导致的，会损害骨强度。肿瘤衍生因子破坏了骨吸收与形成之间的平衡，导致溶骨性和骨硬化性病变，削弱了骨的完整性。虽然包括截肢和保肢手术在内的外科治疗方法常用，但由于证据有限，骨折修复的治疗效果仍不明确。
本研究对病理性骨折进行了特征描述，并评估了犬类手术修复后的生存时间和功能预后。目标是提供有力证据，为临床决策提供参考并改善治疗结果。
按照符合PRISMA标准的方法进行了系统评价和荟萃分析。使用MEDLINE（PubMed）和谷歌学术搜索从数据库建立到2025年3月1日发表的相关研究。将过去报告中的数据与我们机构的病例（包括70例病理性骨折犬）相结合。使用Kaplan-Meier方法分析生存和预后，并使用对数秩检验比较辅助化疗之间的结果。
骨肉瘤是病理性骨折最常见的原因（n = 55；78.6%），其次是多发性骨髓瘤、未分化肉瘤和骨转移瘤。手术固定是最常见的治疗干预措施（n = 40；57.1%），钢板固定是最常用的技术（n = 20；28.6%）。跛行复发的中位时间为163天（95%置信区间[CI]：130 - 510天），而骨肉瘤的中位生存时间为292天（95%CI：163 - 518天）。亚组分析显示，接受辅助治疗（放疗或化疗）的患者与未接受辅助治疗的患者之间的生存无显著差异（P = 0.675）。由于整合了病例报告和病例系列，未评估临床和统计异质性。
对于主人拒绝截肢的病例或患有晚期疾病（包括转移性病变）的犬，骨肉瘤导致的病理性骨折的手术固定应被视为一种姑息性治疗选择。经过适当的患者选择，这种方法可能是保肢手术和截肢后的一种可行的三线治疗方法。
