股骨近端转移癌的外科治疗

Surgical Management of Metastasis in Mroximal Femur

目的探讨股骨近端转移癌病人外科治疗的疗效。方法回顾性分析我院2005年3月至2009年2月期间收治的股骨近端转移癌病人13例。对其预期生存时间及实际生存时间进行评估与对比。对濒临骨折的病人术前进行Mirels′评分,Mirels′评分大于8分行预防性内固定。4例未行手术治疗。行骨水泥型双极人工股骨头置换术2例次,行股骨近端髓内钉（proximal femoral nail,PFN）内固定术2例次,其中1例病人一侧行骨水泥型人工股骨头置换术,另1例行PFN内固定术。2例行普通交锁髓内钉内固定术,3例行γ钉内固定术,1例行重建钉内固定术。术后分别于3、6、12个月和最后随访时间采用Enneking评分标准对病人进行术后功能评估。结果平均随访时间为8.5个月（2-21个月）,其中10例病人死亡,3例病人目前仍生存。死亡病人中平均随访时间为8.1个月（3-13个月）,目前生存病人中随访时间分别为3、5、21个月。术后Enneking功能评分为16-27分。结论根据股骨近端是否骨折、病灶部位、累及范围选择手术治疗方法。作为综合治疗的手段之一,可有效地缓解疼痛,改善肢体功能,提高生存质量。

Objective To investigate the efficacy of surgical management of metastasis in proximal femur. Methods Thirteen patients with metastases in the proximal femur were investigated and followed up between March,2005 and February,2009 in our department retrospectively. The expecting and actual life span was estimated and compared. The patients with impending fracture were evaluated by Mirels＇ scoring system. Two patients were treated by a standard cemented bipolar hemiarthroplasty, 2 by common interlocking intramedullary nail, 3 by Gamma nail, 1 by reeon struction nail,2 by Proximal Femoral Nail. The functional level was assessed by Enneking＇ rating scale in the third, sixth, twelfth and last follow-up months respectively. Results The average follow-up was 8. 5 months （2 - 21 months）. Ten patients died. 3 patients are alive in the last follow up. The average follow-up was 8.1 months in the passed away patients （3-13 months）. The other three patient were followed up for 3,5,21 months. The functional level rate was ranged from 22 to 27 points postoperatively during the follow up. Conclusion The surgical treatment was referred to the impending fracture ,complete fracture, location ,extent of involvement of the lesion in the proximal femur. As one of the systemic management of metastasis,surgical management of metastasis in the proximal femur played an important role in the relief of pain,improvement of the functional level and the quality of life.