原位微波灭活术联合钢板内固定术治疗四肢骨干转移瘤合并病理性骨折的临床观察

Clinical observation on in situ microwave inactivation combined with plate internal fixation for treatment of upper and lower limb bone metastases complicated with pathological fractures

目的观察原位微波灭活术联合钢板内固定术治疗四肢骨干转移瘤合并病理性骨折的临床疗效。方法 19例四肢骨干转移瘤并病理性骨折患者,采用原位微波灭活术联合骨水泥填充、锁定钢板内固定术治疗。比较患者术前及术后1个月的疼痛视觉模拟评分得分情况,并于术后3个月对患者的肢体功能进行评估,计算3个月、6个月,1年、2年的生存率。结果 19例患者均顺利完成手术,手术时间(90±15)min,术中出血量(250±80)ml。19例患者均获得16(8~30)个月随访。术后1个月疼痛视觉模拟评分明显低于术前(P<0.05),术后3个月肢体功能Enneking评分优良率为94.7%(18/19)。术后6个月局部复发1例,术后6个月、1年及2年生存率分别为84.2%、68.4%及42.1%。随访期内所有患者骨折内固定良好,无内固定失效或再次骨折发生。结论原位微波灭活术联合钢板内固定术治疗四肢骨干骨转移瘤并发病理性骨折,能够缓解患者疼痛,恢复肢体功能。

Objective To observe the clinical effect of in situ microwave inactivation combined with plate internal fixation on upper and lower limb bone metastases and pathological fractures. Methods Nineteen patients with upper and lower limb bone metastases and pathological fractures were treated with in situ microwave inactivation combined with bone cement filling and locked plate internal fixation. Patients＇ Visual Analogue Scale（VAS） score before operation was compared with the score at one month after operation, and an assessment on the patients＇ limb function was conducted after 3 months of operation. The 3-month, 6-month, 1-year and 2-year survival rates were calculated. Results Nineteen patients completed the operation successfully, with operation time of（ 90 ± 15 ） minutes and intraoperative blood loss of（ 250 ±80）ml. All of the 19 patients were followed up for 16 （8 -30 ） months. The VAS score after one month of operation was significantly lower than the preoperative （P 〈 0.05 ）. The excellent and good rate of Enneking score for limb function was 94.7% （ 18/19 ） at 3 months after operation. Local recurrence was observed in one case at 6 months after operation. The postoperative 6-month, 1 -year and 2-year survival rates were 84.2% ,68.4% and 42.1% respectively. During the follow-up, excellent fracture fixation was observed in all patients, and no internal fixation failure or refracture occurred. Conclusion in situ microwave inactivation combined with plate internal fixation could relieve patients＇ pain and restore limb function in the treatment of upper and lower limb bone metastases with pathological fractures.