经皮骨成形联合多孔导管骨水泥灌注治疗转移性肿瘤所致长骨濒临骨折

Percutaneous osteoplasty combined with multiholed catheter bone cement injection for metastatic tumor-induced impending fracture of the long bone

背景:长骨是骨转移瘤较常见发病部位,在外力作用下易导致骨折。经皮骨成形可达到加固局部骨骼强度、杀伤肿瘤的目的,但对长骨整体强度作用不大,难以避免长骨骨折的发生。目的:比较经皮骨成形和经皮骨成形联合多孔导管骨水泥灌注治疗转移性肿瘤所致长骨濒临骨折的临床疗效。方法:将42例长骨转移瘤患者按治疗方案分为2组,对照组21例进行经皮骨成形骨水泥灌注治疗,试验组21例进行经皮骨成形术联合多孔导管骨水泥灌注治疗,统计术中骨水泥渗漏情况。治疗后1周、1个月、3个月,检测两组目测类比评分、Karnofsky功能状态评分及长骨骨折发生例数。结果与结论:(1)两组患者均顺利完成穿刺并骨水泥灌注,对照组骨水泥外溢7例,实验组骨水泥外溢8例,两组骨水泥外溢率比较差异无显著性意义(P> 0.05);(2)两组患者治疗后不同时间点的目测类比评分、Karnofsky功能状态评分均较治疗前明显改善(P <0.05),两组组间治疗后不同时间点的目测类比评分、Karnofsky功能状态评分比较差异均无显著性意义(P> 0.05);(3)对照组病变部位发生骨折5例,试验组未发生骨折;(4)结果表明,经皮骨成形联合多孔导管骨水泥灌注治疗转移性肿瘤所致长骨濒临骨折,可预防病变部位骨折的发生。

BACKGROUND:The long bone is the recurrent site of metastatic tumors.Broken sclerotin weakens the support strength of long bone,which leads to fracture under external force.Percutaneous osteoplasty can reinforce local bone strength and kill tumor cells.But it cannot fortify the whole long bone enough to avoid fracture occurrence.OBJECTIVE:To compare the efficacy of percutaneous long bone cementoloplasty with and without embedding a cement-filled catheter in the medullary canal for painful long bone metastases with impending fracture.METHODS:Forty-two patients were divided into two groups according to the treatment schedule.Patients in control group were treated with percutaneous osteoplasty combined with bone cement injection and the other patients in experimental group were treated with percutaneous osteoplasty combined with multiholed catheter bone cement injection.Rate of bone cement leakage was statistically analyzed.Visual analogue scale score,Karnofsky function score and number of cases of long bone fracture were detected and compared between the two groups.RESULTS AND CONCLUSION:(1)All the patients completed puncture and bone cement injection.There were seven cases of bone cement leakage in the control group and eight cases of bone cement leakage in the experimental group,and no difference existed in two groups(P>0.05).(2)The visual analogue scale score and Karnofsky function score in each patient were both improved after treatment(P<0.05),but there was no difference between the two groups(P>0.05).(3)Five cases of bone re-fracture were found in the control group,but no case in the experimental group.To conclude,the use of percutaneous osteoplasty combined with multiholed catheter bone cement injection for metastatic tumor-induced impending fracture of the long bone can prevent bone fracture at the lesion site.