股骨转移性肿瘤的手术疗效随访分析

Follow-up of the operative outcomes after the surgery for metastatic tumor in the femur

目的为有效地提高股骨转移性肿瘤患者的生存质量,探讨手术治疗股骨转移性肿瘤的意义。方法回顾1993年10月至2008年10月有完整临床资料并得到随访的股骨转移性肿瘤30例,其中男18例,女12例,年龄48～76岁,平均年龄62.6岁,转移部位:股骨颈及粗隆部11例,股骨粗隆下8例,股骨干6例,股骨远端5例,其中伴发病理性骨折21例。手术采取瘤段切除人工假体置换术8例,肿瘤切刮除骨水泥填充加股骨交锁髓钉或梅花型髓内钉内固定14例,肿瘤切刮除骨水泥填充加钢板内固定6例,不处理肿瘤仅做单纯做外固定支架固定2例。结果术后存活时间1.5—76个月,平均15.86个月,存活6个月以上的患者23例(76.7%),存活1年以上的患者13例(43.3%),术后6周内疼痛明显缓解或消失者29例(96.7%),所有患者术后Enneking功能评估为优者占76.7%,生活质量得到明显提高。结论对于股骨转移瘤患者应积极手术治疗,采用人工假体置换或内固定手术可以缓解疼痛,部分患者可恢复下肢功能,可减少长期卧床所致并发症,提高患者生存质量;全身多器官转移合并股骨病理性骨折,预计生存期短者,能够耐受手术者,可使用外固定支架固定,手术创伤小,疼痛减轻明显,患者及家属满意度高。

Objective To effectively improve the quality of life （QOL） of patients with metastatic tumor in the femur, and to investigate the significance of surgery in the treatment of metastatic tumor in the femur. Methods We conducted a retrospective study on 30 patients （18 men and 12 women, aged from 48 to 76, with 62.6 on average） whose clinical data were complete. All patients were treated and followed-up from October 1993 to October 2008. The metastatic tumor was at femoral neck and trochanterica （n=11）, sunbtrochanteric region （n=8）, femoral diaphysis （n=6） and distal femur （n=5）. Among all fractures, 21 were pathological ones. 8 patients underwent tumor resection and prosthesis replacement： 14 underwent tumor resection and bone cementing with interlocking intramedullary nail fixation or plum-shaped intramedullary nail fixation： 6 underwent tumor resection and bone cementing with plate fixation, and 2 underwent only external fixation without tumor resection. Results Survival time after surgery was 1.5 to 76 months, 15.86 on average. 23 patients （76.7%） survived for more than 6 months. 13 patients （43.3%） survived for more than 1 year. 29 patients （96.7%） demonstrated significant pain relief. Enneking evaluation after surgery showed that 23 patients （76.7%） had good function and their QOL was significantly elevated. Conclusions To treat metastatic tumors in the femur, timely surgery should be used. Prosthetic replacement or internal fixation can relieve pain. Some patients can regain function of the lower limbs. The treatment can reduce complications and elevate QOL. For patients with multi- organ metastasis associated with femoral pathological fracture who have short life expectancy, if they ca endure surgery, external fixation can be used. The procedure causes small incision, and can achieve significant pain relier2 The patients and their relatives showed high level of satisfaction.