股骨转移癌的外科疗效分析(附39例报告)

Surgical management of metastasis in the femur

[目的]探讨股骨转移癌病人外科治疗的疗效和意义。[方法]回顾性分析本院2005年3月~2013年8月手术治疗的股骨转移癌病人39例。女18例;年龄39~83岁,平均63岁。男21例;年龄30~86岁,平均63岁。对其预期生存时间及实际生存时间进行评估与对比。对濒临骨折的病人术前进行Mirels评分。股骨近端转移癌25例,其中2例有双侧股骨近端转移病灶。病灶位于股骨颈8例,粗隆间12例,粗隆下7例。股骨干转移癌12例,其中1例为双侧股骨干病理性骨折。股骨远端转移癌2例。术前术后进行疼痛评分。术后分别于3、6、12个月和最后随访时间采用Enneking评分标准对病人进行术后功能评估。[结果]平均随访时间为14个月（1~63个月）,其中28例病人死亡,11例病人目前仍生存。死亡病人中位生存时间为8.5个月（1~63个月）。术前术后疼痛评分差异有统计学意义（P〈0.05）。实际生存时间大于预期生存时间且差异有统计学意义（P〈0.05）。术后分别于3、6、12个月和末次随访时间的Enneking功能评分为14~26分之间。[结论]根据股骨是否存在病理性骨折、濒临骨折、病灶部位、累及范围选择手术治疗方法。作为综合治疗的手段之一,可有效地缓解疼痛,改善肢体功能,提高生存质量。

[Objective] To investigate the efficacy and significance of surgical management of metastasis in the femur. [Methods] Thirty nine patients with metastases in the femur treated surgically were investigated and followed up between March, 2005 and August, 2013 in our department retrospectively. The expecting and actual life span was estimated and com- pared. The patients with impending fracture were evaluated by MirelsJscoring system. The location of lesion was in proximal femur for 25 cases, including two patients with bilateral lesions. There were 8 cases with lesion in femoral neck, 12 cases in intertro- chanteric area and 7 cases in subtrochanteric area. The location of lesion was in diaphysis of femur for 12 cases including one pa- tient with bilateral lesion with pathologic fracture. The other two patients had metastasis in distal femur. The pain score was as- sessed before and after surgery. The functional level was assessed by Ennekingj rating scale in the third, sixth, twelfth and last follow- up months respectively. [Results] The average follow- up was 14 months （1 -63 months） . Twenty eight patients deceased. Eleven patients were alive in the last follow up. The median survival was 8.5 months （1 ~ 63months） for patients de- ceased. The pain decreased significantly after surgery than that before surgery （P 〈 0.05 ） . The actual survival time was longer than the expecting survival time by the Dutch model scoring system and the difference was found significant statistically （P 〈 0. 05 ） . The functional level score ranged from 14 to 26 points postoperatively during the follow - up. [ Conclusion] The surgi- cal management should be referred to the complete fracture, impending fracture, location, extent of involvement of the lesion in the femur. As one of the systemic management of metastasis, surgical management of metastasis in the femur played an important role in the relief of pain, improvement of the functional level and the quality of life.