Harrington K D
California Pacific Medical Center, San Francisco, USA.
Clin Orthop Relat Res. 1995 Mar(312):136-47.
Bony metastases are ubiquitous in patients with advanced cancer, and pathologic fractures may occur within either lytic or blastic foci. Approximately 90% of such fractures that require surgical intervention occur in the femur, humerus, or periacetabular pelvis. Techniques for internal fixation or prosthetic replacement have been designed with the realization that destructive bony lysis often extends well proximal and distal to the actual fracture site, and bony union will not occur after irradiation unless absolutely rigid fixation is achieved. Intramedullary fixation using some type of interlocking device, either proximally or distally, is preferable to extramedullary fixation of fractures. The mean postfracture survival for most patients is approximately 2 years.
骨转移在晚期癌症患者中很常见，病理性骨折可能发生在溶骨性或成骨性病灶内。大约90%需要手术干预的此类骨折发生在股骨、肱骨或髋臼周围骨盆。由于认识到破坏性骨溶解通常会向实际骨折部位的近端和远端广泛延伸，并且除非实现绝对牢固的固定，否则放疗后不会发生骨愈合，因此设计了内固定或假体置换技术。使用某种类型的近端或远端锁定装置进行髓内固定优于骨折的髓外固定。大多数患者骨折后的平均生存期约为2年。
