四肢骨转移癌手术治疗69例分析

Surgical Treatment of Metastatic Carcinoma of Four Extremities:An Annlysis of 69 Cases

目的探讨四肢骨转移癌手术治疗方法、术后功能及生存率。方法 1995年1月至2011年12月明确诊断的198例四肢骨转移性肿瘤患者,以Mirels评分判断其骨折风险。Mirels评分大于9分的69例(肺癌23例,肾癌16例,乳腺癌15例,前列腺癌9例,肝癌3例,甲状腺癌1例,不明来源2例)选择外科手术结合放化疗(研究组),其中人工关节置换9例,骨水泥加带锁髓内钉内固定39例,骨水泥加钢板内固定21例。另129例单纯接受放化疗(对照组)。结果 2组随访5～62个月,平均38个月。研究组术后疼痛得到明显缓解,术后功能明显改善,术后6个月Enneking评分,功能为优良占68.1%,中占23.2%,差占8.7%;研究组2年生存率为36.2%,3年生存率为31.9%,对照组2年生存率为22.5%,3年生存率为18.6%,研究组2、3年生存率均高于对照组(P<0.05)。结论手术治疗四肢转移性肿瘤可以有效缓解疼痛、治疗和预防病理性骨折的发生,改善肢体功能及提高患者的生存质量和生存率。

Objective To evaluate different operative treatment options for metastatic carcino- ma of four extremities focusing on surgical procedures, postoperative function and survival rate. Methods Fracture risk was assessed by Mirels＇ rating in 198 patients who were diagnosed as having metastatic carcinoma of four extremities between January 1995 and December 2011. A- mong the 69 patients with Mirels score greater than 9 who received surgery, radiotherapy and chemotherapy （23 cases of lung cancer, 16 cases of kidney cancer, 15 cases of breast cancer, 9 cases of prostate cancer, 3 cases of liver cancer, 1 case of thyroid cancer and 2 cases of unknown cancer study group）,prosthetic replacement was performed in 9, bone cement and intramedullary inter- locking nail fixation fixation in 39,and bone cement and steel plate fixation in 21. In addition,ra- diotherapy and chemotherapy were performed in 129 patients （control group）. Results All pa- tients were followed-up for an average of 38 months （range 5 to 62 months）. The pain was signifi- cantly alleviated and limb function was obviously improved in study group after operation. Ennek- ing scores showed excellent function in 68.1% ,fair in 23.2% and poor in 8.7%. The 2-year and 3-year survival rates were,respectively,36.2% and 31.9% in study group,and 22.5% and 18.6% in control group. Differences in survival rates were significant between the two groups （PO. 05）. Conclusions Surgical treatment of metastatic carcinoma of four extremities can effectively relieve pain,treat and prevent pathological fracture, and improve limb function, life quality and survival rate.