Sabo D, Bernd L
Abteilung Orthopädie I, Orthopädische Universitätsklinik Heidelberg.
Orthopade. 1998 May;27(5):274-81. doi: 10.1007/s001320050231.
Operations on skeletal metastases of the extremities represent the most frequent surgical treatment in orthopedic oncology. From 1970 to 1997, 340 patients were operated on in 383 surgical procedures in the Orthopedic Department of the University of Heidelberg. Carcinoma of the breast and renal cell carcinoma were the most common primary tumors. Operations concerned mainly the femur with acetabulum (55%) and the humerus with glenoid (25%). A pathologic fracture occurred in 51%. While in these cases surgical treatment is absolutely necessary, it is contraindicated in preterminal patients. In imminent fractures or peripheral compression syndromes, the indication is relative and has to be justified on a multidisciplinary basis. Marginal resection of the tumor is allowed because of the limited life expectancy of most patients. Only in patients with solitary metastases and a better prognosis the resection of metastasis margin can be more extensive. Intensification of local therapy by adjuvant irradiation is indicated in an R2 situation, depending on the patient's prognosis. An analysis of our cases from 1994 to 1996 exemplifies the increasing use of modular tumor endoprostheses (52%). In meta-diaphyseal and diaphyseal cases, cement-augmented osteosynthesis is mainly used (34%). The application of these established reconstruction techniques after metastasis resection in cases with adjuvant radiotherapy assures a pain-free extremity capable of weight bearing.
肢体骨转移瘤手术是骨肿瘤外科最常见的手术治疗方式。1970年至1997年，海德堡大学骨科对340例患者进行了383次手术。乳腺癌和肾细胞癌是最常见的原发肿瘤。手术主要涉及髋臼股骨（55%）和盂肱肱骨（25%）。51%的患者发生了病理性骨折。虽然在这些病例中手术治疗绝对必要，但对于终末期患者是禁忌的。对于即将发生的骨折或周围压迫综合征，手术指征是相对的，必须在多学科基础上进行论证。由于大多数患者预期寿命有限，允许对肿瘤进行边缘切除。只有孤立性转移且预后较好的患者，转移灶边缘切除范围可以更广。在R2情况下，根据患者预后，可通过辅助放疗强化局部治疗。对我们1994年至1996年病例的分析表明，模块化肿瘤内置假体的使用日益增加（52%）。在干骺端和骨干病例中，主要采用骨水泥增强骨固定术（34%）。在辅助放疗的情况下，转移瘤切除后应用这些成熟的重建技术可确保患肢无痛且能负重。
