四肢骨转移癌126例手术疗效分析

Clinical results in surgical treatment of bone metastases in limbs: 126 cases report

目的回顾性分析手术治疗四肢骨转移癌126例的临床疗效。方法 2007年1月至2012年12月,我院收治四肢转移性肿瘤患者126例,男69例,女57例,年龄41～92（平均65.8）岁。其中肿瘤假体人工关节置换42例,单纯人工关节置换14例,骨水泥加带锁髓内钉内固定38例,骨水泥加钢板固定19例,瘤段灭活加钢板内固定4例,肢体短缩加钢板固定3例,外固定支架固定6例。对患者术前及术后1个月采用视觉模拟评分法（visual analogue scale,VAS）评分法进行疼痛评分;术前及术后3个月的生活质量（quality of life,QOL）采用SF-36评分系统进行评估;术后肢体功能按照美国肌肉骨骼肿瘤学会评分系统标准（American musculo-skeletal tumor society system,MSTS）于术后3个月进行评价。结果手术均顺利进行,无手术相关死亡病例,11例出现术后并发症,包括急性呼吸窘迫综合征1例、应激性溃疡1例、轻度脑梗塞2例、深静脉血栓3例、急性肾功能衰竭1例、伤口感染1例、髋关节脱位2例,给予相应治疗后均好转。126例均获3～60（平均32）个月随访。术后生存期3～12个月45例,13～24个月32例,25～36个月26例,另有23例存活超过3年。术后疼痛明显改善,VAS评分由术前的（6.85±3.11）分下降至术后1个月的（1.26±0.81）分（t=9.978,P〈0.001）。术后生活质量明显改善,术前QOL评分平均为（38.30±13.05）分提高至术后3个月的（65.78±10.65）分（t=-18.550,P〈0.001）。在肢体功能方面,术后MSTS评分范围17～30分,平均为（23.32±3.03）分（t=-1.450,P=0.016）。结论手术治疗四肢骨转移癌可以有效缓解疼痛、提高患者生存质量、改善肢体功能。

Objective To retrospectively analyze the clinical results in surgical treatment of bone metastases in limbs in 126 cases. Methods The data of 126 patients with bone metastases in limbs who were admitted from January 2007 to December 2012 were retrospectively analyzed. There were 69 males and 57 females, whose average age was 65.8 years old （ range： 41-92 years ）. Tumor-type prosthetic replacement was performed on 42 patients, prosthetic replacement on 14 patients, cement and interlocking intramedullary nailing on 38 patients, cement and plate fixation on 19 patients, tumor devitalization and plate fixation on 4 patients, limb shortening and plate fixation on 3 patients and external fixation support on 6 patients. The patients＇ pain preoperatively and at 1 month after the surgery was evaluated by using visual analogue scale （ VAS ）. The quality of life （ QOL ） preoperatively and at 3 months after the surgery was assessed by the short-form 36 （SF-36） questionnaire. Limb function at 3 months after the surgery was evaluated with the Musculoskeletal Tumor Society scale （ MSTS ）. Results All the procedures were successfully performed, and no surgery-related death occurred. Postoperative complications were found in 11 cases, including acute respiratory distress syndrome （ ARDS ） in 1 case, stress ulcer （ SU ） in 2 cases, cerebral infarction （ CI ） in 2 cases, deep vein thrombosis （ DVT ） in 3 cases, acute renal failure （ ARF ） in 1 case, incision infection in 1 case and prosthesis dislocation in 2 cases. The symptoms were improved in all the patients after the corresponding treatment. All the patients were followed up, and the mean follow-up period was 32 months （ range： 3-60 months ）. The postoperative survival time was 3-12 months in 45 cases, 12-24 months in 32 cases, 24-36 months in 26 cases and more than 3 years in 23 cases. The pain was significantly improved after the surgery. The VAS score was 6.85±3.11 before the operation,which was reduced to 1.26±0.81 at 1 month after the operation （ t=-9.978, P〈0.001 ）. The QOL was also significantly improved. The mean QOL score was 38.30±13.05 before the operation, which was increased to 65.78±10.65 at 3 months after the operation （ t=--18.550, P〈0.001 ）. The mean postopertive MSTS score was 23.32±3.03 （ range： 17-30 ） （ t=-1.450, P=0.016 ）. Conclusions The pain can by effectivley relieved and the QOL and limb function can be significantly inproved with the surgical treatment of bone metastases in limbs.