股骨转移性肿瘤的手术治疗

The operative treatment of metastatic tumors in femur

目的 探讨手术治疗股骨转移性肿瘤的效果及意义.方法 回顾分析我院1991-2005年经手术治疗的股骨转移性肿瘤患者临床资料,资料完整者共29例,其中男16例,女13例,年龄47～72岁,平均年龄62.3岁,转移灶在股骨颈4例,股骨粗隆部5例,股骨粗隆下8例,股骨干9例,股骨髁上3例,其中伴发病理性骨折18例.手术采取瘤段骨切除人工假体置换术12例,肿瘤切除骨水泥填充加股骨交锁髓内钉固定11例,不处理肿瘤单纯内固定的6例. 结果术后所有患者疼痛明显缓解或消失,16例个人生活能够自理, 8例能够基本自理,5例仍需家人护理照顾.随访4个月～2年,行瘤段骨切除并人工假体置换术者,术后5个月死亡1例,5～6个月3例,7～12个月死亡4例,12～18个月死亡2例,存活2 年以上2例,行肿瘤切除交锁髓内钉内固定者,术后4个月死亡1例,4～6个月4例,7～12个月死亡3例,12～18个月死亡2例,存活2年以上1例,仅行单纯内固定者,术后4个月死亡2例 ,4～6个月4例.结论 对于股骨转移性肿瘤宜早期积极手术,采用人工假体置换或内固定手术可以缓解疼痛,部分恢复患肢功能,便于减少长期卧床所致并发症,提高患者生存质量.

Objective To confirm the efficacy of surgical intervention for cases of metastatic tumors in femur. Methods This is a retrospective study enrolling the patients with metastatic tumors in femur treated by operation between 1991 and 2005 in our service. There are 29 patients with an average age of 62, 3 years. There are 3 metastatic loci lying on femoral head, 4 lying on femoral neck, 5 lying on intertrochanteric region, 8 lying on subtrochanteric region, 9 lying on femoral diaphysis. Eighteen patients （62 % ） had pathological fractures, Out of all patients, 12 cases were treated by resection of metastatic loci lying on bone and prosthetic replacement, 11 cases were adopted focal cleaning and intramedullary nails therapy. The others did not receive resecting metastatic loci lying on bone. Results After operation, the pain in all cases was remarkably relieved or com- pletely vanished. Sixteen patients could take care of themselves, 8 patients took care of themselves reluctantly, and 5 cases still needed to be attended by others. Following up from 3 months to 2 years, 3 patient lived for 4 months, 12 patients lived for 5 to 6 months, 7 patients lived for 7 to 12 months, 4 patients lived for 12 to 18 months, 3 patients lived for 2 years or more. Conclusion To treat metastatic tumors in femur with early active prosthetic replacement and intramedullary nails therapy can relieve pain, recover function of affected extremity,reduce the complications due to long-term in bed, and improve the quality of life.