两种方式重建股骨近端转移癌患者的围手术期安全性比较

Perioperative safety comparison between two reconstruction methods in treating patients with metastases of proximal femur

背景:股骨近端转移癌切除重建方法的选择需要综合考虑多种因素,其中原发肿瘤的生物学行为、股骨病变破坏范围、患者一般状况以及围手术期风险是最值得关注的。目的:比较股骨近端转移癌患者接受髓内针/接骨板内固定和假体置换的围手术期安全性和早期功能。方法:回顾性分析2003年1月至2011年12月接受手术治疗的88例股骨近端转移性肿瘤患者的围手术期临床资料(随访资料完整),年龄15～87岁,中位年龄58岁。患者平均预期生存期10.26个月。按手术重建方式分为髓内针/接骨板内固定组33例;假体置换组55例。比较两组患者的术中出血量、手术时间、围手术期并发症和术后早期功能。结果:随访时间为1～44个月,平均8.74个月。两组患者手术时间(P=0.173)、围手术期并发症(χ2=0.014,P=0.905)和术后早期功能(P=0.777)等围手术期指标无统计学差异。髓内针/接骨板内固定组1例于术后3周死于多器官衰竭,假体置换组患者术中出血量显著低于髓内针/接骨板内固定组(P=0.043)。结论:假体置换和髓内针/接骨板内固定均为股骨近端转移癌的重要手术方式,两种重建方法的围手术期并发症和术后早期功能无统计学差异,但鉴于髓内针/接骨板内固定的远期失败率较高,对预期生存期较长的患者来说,假体置换是更好的选择。

Background：Selecting the reconstruction method for resection of the metastases of proximal femur needs an overall consideration of various factors,among which the biological behavior of the primary tumor,the damage scope of the fumer lesion,the general condition of the patient,and the perioperative risk deserve the most consideration.Objective：To compare the perioperative safety and early function of the intramedullary nail/plate internal fixation and the prosthesis replacement in treating patients with metastases of proximal femur.Methods：The perioperative clinical data（the follow-up data is complete） of 88 patients with proximal femoral metastatic lesions who received surgical treatment in Peking University People＇s Hospital from January 2003 to December 2011 was retrospectively analyzed.The age of these patients varied from 15 to 87 years old,with a median age of 58.The mean estimated survival time was 10.26 months.Classified by the reconstruction method,the patients were divided into two groups：the intramedullary nail/plate internal fixation group（33 cases） and the prosthesis replacement group（55 cases）.The perioperative blood loss,the duration of the surgery,the perioperative complications,and the postoperative early functions of the two groups were compared.Results：The mean follow-up period was 8.74 months（1-44 months）.Perioperative factors such as the duration of the surgery（P=0.173）,perioperative complications（χ 2 =0.014,P=0.905）,and the postoperative early functions（P=0.777） of the two groups showed no significant difference.One case in the intramedullary nail/plate internal fixation group died of multiple organ failure 3 weeks later after the surgery.The blood loss of the prosthesis replacement group was significantly less than the intramedullary nail/plate internal fixation group（P=0.043）.Conclusions：Both prosthesis replacement and intramedullary nail/plate internal fixation are important operation methods in treating the metastases of proximal femur.These two reconstruction methods have no significant differences in the perioperative complications and the postoperative early functions.However,as the intramedullary nail/plate internal fixation has a higher future failure rate,it is better to select the prosthesis replacement for patients with an estimated longer survival time.