股骨转子周围转移性肿瘤的手术治疗

Surgical treatment for patients with metastatic tumors of the peritrochanteric region of the femur

目的股骨转子周围是恶性肿瘤转移的好发部位之一，探讨是否应该对其采取积极的手术治疗。方法７例股骨转子周围转移性肿瘤患者中，病变累及股骨转子下者５例，股骨头颈者２例。其中４例股骨转子下及１例股骨头颈转移性肿瘤出现病理性骨折。经病理诊断证实原发疾病分别为：肺癌３例，肾癌１例，乳腺癌１例，甲状腺癌１例，前列腺癌１例。患者分别采用股骨交锁髓内钉或Ｒｅｃｏｎ钉内固定，骨水泥充填及人工假体置换。结果７例患者术后生存时间１．５－２４个月，平均约８个月。４例内固定患者术后可下床行走，２例假体置换患者恢复至术前活动水平。结论采用假体置换、股骨交锁髓内钉或Ｒｅｃｏｎ钉固定、局部病灶刮除和骨水泥充填结合辅助治疗，可以安全地治疗股骨转子周围转移性肿瘤，缓解疼痛，恢复行走功能，对提高患者的生存质量有较大意义。

To confirm the efficacy of surgical intervention for cases of metastatic tumors in the peritrochanteric region. Methods There were seven patients(5 men and 2 women) with an average age of 60. 7 years. The primary diseases confirmed by pathology are cancer of lung (3 cases), kidney 1, breast 1, thyroid gland 1 and prostate gland 1 respectively. Surgical procedures were done in 5 patients for complete fracture, and in the other 2 patients for impending fracture. Results The average survival in 7 patients was 8 months(1. 5－24 months). Every patient in this series had relief of pain postoperatively, and 4 had improved ambulation. Conclusion Prosthetic replacement, intramedullary nails, PMMA augmentation, and adjuvant radiation can be performed safely to patients with peritrochanteric metastasis for pain relief and recovery of ambulatory function.