股骨干转移性肿瘤的外科治疗

Surgical Management of Metastasis in Femoral Diaphysis

目的：探讨股骨干转移性肿瘤的外科治疗方法及临床意义。方法回顾性分析2008年1月至2013年7月手术治疗的13例14肢股骨干转移性肿瘤临床资料。其中男7例，女6例；左侧股骨6肢、右侧股骨8肢；年龄50-83岁，平均68岁。12例患者为股骨单发转移病灶，另一例患者为双侧病理性骨折病例。濒临骨折患者5例，术前Mirls 评分8-11分，平均9.4分。病理性骨折肢体9例。术前活检及术后病理检查示来源于肺癌7例，食管癌2例，乳腺癌1例，肾癌1例，胃肠道肿瘤1例，另1例患者未发现原发癌灶。髓内钉固定13肢，钢板固定1肢。术前术后对患者疼痛进行 VAS（Visual Analogue Scale，VAS）评分。术后3个月内进行下肢功能评分，采用 Enneking 评分系统。结果术后9例患者死亡，术后生存2-15个月，中位生存时间8.7个月。其余4例分别随访1、4、6、7个月。所有患者疼痛症状均有明显缓解，术前术后疼痛评分差异有统计学意义（P ﹤0.05%）。术后 Enneking 功能评分9-28分，平均17.8分。9例患者在术后一周内可自行下床或借助助行器活动。另4例患者因综合体质较差仍需他人护理。1例肺癌骨转移患者由于肿胀疼痛，最终行髋关节离断术。本组患者无手术并发症。结论股骨干转移性肿瘤患者可以选择覆盖股骨全长髓内钉内固定术，作为综合治疗手段之一，可有效地缓解疼痛，改善肢体功能，提高生存质量。

Objective To investigate the surgical procedure and clinical significance of surgical management of metastasis in femoral diaphysis. Methods Clinical data of thirteen patients（ fourteen femurs）that were treated in our hospital from March 2008 to June 2013 were analyzed retrospectively. This group included 7 males,6 females（6 in left and 8 in right）with an average age of 68 years（range 50 - 83 years）. One single metastasis in unilateral femur was found in 12 patients and bilat-eral femurs in one patient. Five patients were diagnosed as impending fracture and assessed by Mirels’scoring system with an average point of 9. 4（8 - 11 points）. Nine patients were diagnosed as pathological fracture. The original cancer were lung canc-er in 7 patients,esophageal cancer in 2 patient,breast cancer in one patient,kidney cancer in one patient,gastroenteric tumor in one patient and unknown cancer in one patient. Thirteen femurs were fixed by intramedullary nail and one femur was fixed by plate. The pain was evaluated by Visual Analogue Scale before and after surgery. The function of lower limb was assessed by Enneking score system about 3 months after surgery. Results Nine patients deceased in the last follow up. The median surviv-al time was 8. 7 months（range 2 - 15 months）. The other four patients were alive for 1,4,6 and 7 months after surgery till the last follow up. Nine patients can walk with or without the walking aids after surgery. The other 4 patients still needed the help of the nursing care because of worser general status. The pain was relieved significantly after surgery and the difference of VAS score before and after surgery was statistically significant（P ﹤ 0. 05）. The average Enneking score was 17. 8 points（9 - 28 points）. One patient suffer from the lung metastasis was managed with the hip disarticulation because of pain and swelling in the compromised limb. The surgical complications were not found in all patients. Conclusion The intramedullary nail fixation is an important procedure for the metastasis in femoral diaphysis which covers the total length of femur. The surgical manage-ment of metastasis of femoral diaphysis can relieve the pain,restore the function and improve the life quality of these patients as one of the procedures in general management of cancer metastasis.