Eravsar Ebubekir, Gulec Ali, Ciftci Sadettin, Mercan Numan, Safali Selim, Aydin Bahattin Kerem
Department of Orthopedics and Traumatology, Selcuk University Faculty of Medicine, Konya, Turkiye.
Department of Orthopedics and Traumatology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkiye.
Orthop Surg. 2025 Aug;17(8):2342-2349. doi: 10.1111/os.70101. Epub 2025 Jun 29.
Intramedullary nailing is a treatment method for metastatic humerus fractures that stabilizes a large area while minimizing damage to the surrounding soft tissues. However, the results of this treatment may vary depending on certain factors. This study aimed to investigate the factors influencing functional outcomes and survival in patients with pathological humeral fractures treated using humeral nails.
This retrospective study included 41 patients who underwent humeral nailing for metastatic pathological humerus fractures between 2009 and 2024. Functional outcomes were compared based on factors such as gender, age, cancer type, another pathological fracture surgery, visceral metastases, cancer diagnosis prior to fracture, fracture type and location, and cement use, using VAS improvement, MSTS, KPS scores, and ROM measurement. Survival analysis was performed considering these same factors. Statistical analyses included the Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, and Kaplan-Meier survival curves. Cox regression analyses were used to identify factors associated with mortality.
In younger patients, better VAS improvement(p = 0.001), MSTS(p = 0.038), KPS(p = 0.028), and ROM(p = 0.045) were observed compared to those 65 and older. Cancer type and visceral metastases negatively impacted MSTS(p = 0.007, p = 0.049) and KPS(p = 0.002, p = 0.022). Actual fractures showed greater VAS improvement than impending fractures(p = 0.002), and shaft fractures had greater VAS improvement than proximal fractures(p = 0.037). Unknown cancer diagnosis prior to fracture led to better VAS improvement(p = 0.008), MSTS(p = 0.018), KPS(p = 0.023), and ROM(p = 0.006). Rapid growth tumor(p < 0.001) and visceral metastasis(p = 0.007) were independently associated with poor survival. No significant effects were seen for gender or cement use on functional outcomes and mortality.
Although intramedullary nails are feasible implants for humeral pathological fractures, there are significant factors that affect their functional outcomes and survival. Actual fractures and shaft fractures showed better pain relief. Patients with a known cancer diagnosis prior to fracture and older patients had poor functional outcomes. Rapid cancer type and visceral metastasis negatively affect both functional outcomes and survival. Although cement use carries a risk of thrombosis, no significant changes in mortality and functional outcomes were observed with cement use.
IV.
髓内钉固定术是治疗转移性肱骨骨折的一种方法，它能稳定大面积区域，同时将对周围软组织的损伤降至最低。然而，这种治疗的结果可能因某些因素而有所不同。本研究旨在调查使用肱骨钉治疗病理性肱骨骨折患者的功能结局和生存的影响因素。
这项回顾性研究纳入了2009年至2024年间因转移性病理性肱骨骨折接受肱骨钉固定术的41例患者。基于性别、年龄、癌症类型、另一次病理性骨折手术、内脏转移、骨折前癌症诊断、骨折类型和部位以及骨水泥使用等因素，采用视觉模拟评分法（VAS）改善情况、肌肉骨骼肿瘤学会（MSTS）评分、卡氏评分（KPS）和活动度测量来比较功能结局。考虑相同因素进行生存分析。统计分析包括曼-惠特尼U检验、克鲁斯卡尔-沃利斯检验、卡方检验和Kaplan-Meier生存曲线。采用Cox回归分析确定与死亡率相关的因素。
与65岁及以上患者相比，年轻患者的VAS改善情况更好（p = 0.001）、MSTS评分更高（p = 0.038）、KPS评分更高（p = 0.028）以及活动度更大（p = 0.045）。癌症类型和内脏转移对MSTS评分（p = 0.007，p = 0.049）和KPS评分（p = 0.002，p = 0.022）有负面影响。实际骨折的VAS改善情况比即将发生的骨折更好（p = 0.002），骨干骨折的VAS改善情况比近端骨折更好（p = 0.037）。骨折前癌症诊断不明导致VAS改善情况更好（p = 0.008）、MSTS评分更高（p = 0.018）、KPS评分更高（p = 0.023）以及活动度更大（p = 0.006）。肿瘤快速生长（p < 0.001）和内脏转移（p = 0.007）与生存不良独立相关。性别和骨水泥使用对功能结局和死亡率无显著影响。
尽管髓内钉是治疗肱骨病理性骨折的可行植入物，但有一些重要因素会影响其功能结局和生存。实际骨折和骨干骨折的疼痛缓解效果更好。骨折前已知癌症诊断的患者和老年患者的功能结局较差。快速生长的癌症类型和内脏转移对功能结局和生存均有负面影响。尽管使用骨水泥有血栓形成的风险，但使用骨水泥时死亡率和功能结局未见显著变化。
四级
