Wedin R, Bauer H C, Wersäll P
Department of Orthopedics, Stockholm, Sweden.
Clin Orthop Relat Res. 1999 Jan(358):128-39.
This study was based on 192 patients treated surgically for 228 metastatic lesions of the long bones from 1986 through 1995. The survival rate was 0.3 at 1 year after surgery. The surgical treatment consisted of resection and reconstruction of the involved bone (18), intralesional curettage (133), or stabilization only (77). Reconstruction was achieved by an endoprosthesis in 54 cases, by an osteosynthetic device in 162, by cement only in 10. In two cases no reconstruction was performed. The local failure rate was 11% and the median time to failure was 8 months. Local failure was most frequent in patients with kidney cancer (24%) and in diaphyseal and distal femoral lesions (20%). Among 162 operations involving osteosynthetic devices, 22 (14%) were failures as compared with one of 54 (2%) endoprostheses. Sixty percent of the patients received preoperative or postoperative radiotherapy. Five of the six patients who had surgery for local tumor progression had not received radiotherapy. Eight of 10 nonunions and all five patients who developed a stress fracture had been treated with radiotherapy. It is concluded that endoprosthetic reconstructions are preferable to osteosynthetic devices. The skeletal complications associated with radiotherapy may be circumvented by the use of endoprostheses.
本研究基于1986年至1995年间接受手术治疗的192例患者，这些患者共有228处长骨转移性病变。术后1年生存率为0.3。手术治疗包括受累骨的切除与重建（18例）、病灶内刮除术（133例）或仅行固定术（77例）。54例采用假体植入重建，162例采用骨固定装置重建，10例仅用骨水泥重建。2例未进行重建。局部失败率为11%，失败的中位时间为8个月。局部失败在肾癌患者（24%）以及骨干和股骨远端病变患者中最为常见（20%）。在162例采用骨固定装置的手术中，22例（14%）失败，而54例假体植入手术中只有1例（2%）失败。60%的患者接受了术前或术后放疗。6例因局部肿瘤进展接受手术的患者中有5例未接受放疗。10例骨不连患者中的8例以及所有5例发生应力性骨折的患者均接受了放疗。研究得出结论，假体植入重建优于骨固定装置。使用假体植入可避免与放疗相关的骨骼并发症。
