Maurer F, Ambacher T, Volkmann R, Weller S
Berufsgenossenschaftliche Unfallklinik, Tübingen.
Langenbecks Arch Chir. 1995;380(4):207-17. doi: 10.1007/BF00207909.
Compared with bone fractures caused by trauma, pathologic fractures due to diseased bone are rare events. A pathologic fracture is one that occurs without adequate trauma and is caused by a benign or malignant bone lesion. Diagnosis of the basic disease is important for the subsequent therapy. In cases of benign bone lesions the aim of treatment is total osseus healing with complete restoration of function. In malignant pathologic fractures surgery is an essential part of the overall oncologic treatment design. In most cases it is combined with adjuvant therapy. Various surgical procedures are available for fractures at different sites and depending on whether the operation is performed with curative or palliative intent. In cases of progressive neoplastic disease stabilization is necessary to attenuate pain and to maintain mobility. Between 1983 and 1993 we treated 131 patients with 143 pathologic fractures. Conservative therapy was possible in 10 cases, while 133 fractures had to be treated surgically. Most fractures were caused by skeletal metastasis (61), solitary bone cysts (19), osteoporosis (17) and plasmocytoma (16). The most frequent localizations of pathologic fractures were humerus and femur. The favoured methods of surgical stabilization were endoprosthesis and reinforced osteosynthesis. Most fractures appeared in adolescent patients up to the age of 19 and in adults between the 5th and the 7th decade, and 57.3% of the fractures were caused by a primary or secondary malignant tumour lesion. Surgical treatment was performed in all but 1 case of malignant pathologic fractures. Of 74 patients, with malignant bone lesions 6 (8.1%), are still alive. For 68 patients who died after stabilization, the average survival time was 11.6 months; individual survival time depended on the kind of the tumour present. In 55 patients with fractures in the area of benign bone lesions complete healing was achieved, in 9 cases with conservative therapy. The rate of recurrence for solitary bone cysts treated by curettage or segment resection was 23.5%. Compared with the recurrence rates published by other authors this is a very good result.
与创伤性骨折相比，由病变骨骼导致的病理性骨折较为罕见。病理性骨折是指在没有足够外力作用下发生的骨折，由良性或恶性骨病变引起。基础疾病的诊断对后续治疗很重要。对于良性骨病变，治疗目的是实现完全骨愈合并使功能完全恢复。在恶性病理性骨折中，手术是整体肿瘤治疗方案的重要组成部分。多数情况下，手术与辅助治疗相结合。针对不同部位的骨折，根据手术是根治性还是姑息性目的，有多种手术方法可供选择。对于进展性肿瘤疾病，进行固定手术很有必要，以减轻疼痛并维持活动能力。1983年至1993年间，我们共治疗了131例患者的143例病理性骨折。10例可行保守治疗，而133例骨折需手术治疗。多数骨折由骨转移（61例）、孤立性骨囊肿（19例）、骨质疏松（17例）和浆细胞瘤（16例）引起。病理性骨折最常见的部位是肱骨和股骨。手术固定的常用方法是植入假体和加强骨合成。多数骨折发生在19岁以下的青少年患者以及50至70岁的成年人中，57.3%的骨折由原发性或继发性恶性肿瘤病变引起。除1例恶性病理性骨折外，其余均进行了手术治疗。74例患有恶性骨病变的患者中，6例（8.1%）仍存活。68例骨折固定术后死亡患者的平均生存时间为11.6个月；个体生存时间取决于所患肿瘤的类型。55例良性骨病变部位骨折患者中，9例经保守治疗实现了完全愈合。经刮除术或节段切除术治疗的孤立性骨囊肿复发率为23.5%。与其他作者公布的复发率相比，这是一个非常好的结果。
