两种术式治疗股骨转子下区骨转移瘤的临床疗效

Clinical Efficacy of Two Surgical Methods in the Treatment of Bone Metastases in the Subtrochanteric Region of Femur

目的探讨两种不同手术方式治疗股骨转子下区骨转移瘤病理性骨折的临床疗效。方法回顾性分析本院2013年1月至2020年1月行手术治疗的32例股骨转子下区骨转移瘤患者,男15例,女17例;年龄44~77岁,平均(60.84±8.16)岁。其中濒临骨折8例、病理性骨折24例。根据Mirls评分制定手术方案,Mirls评分>8分,行手术治疗。15例采用病灶刮除后交锁髓内钉联合骨水泥重建,17例行瘤段切除人工假体重建。所有手术均由同一组术者完成,对比两组患者的一般临床资料及疗效评价指标进行统计分析,分别采用疼痛视觉模拟评分(visual analogue scale,VAS)评估疼痛、Karofsky体能状况评分(Kamofsky performance scale,KPS)评估体能、国际骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)评分评估术后患肢功能情况,随访记录局部复发及生存期情况。结果32例患者随访时间4~25个月,平均(14.23±1.32)个月。术后1个月、3个月的VAS评分、KPS评分、MSTS评分较术前明显改善,差异有统计学意义(P<0.05)。随访期间死亡26例,术后生存时间:人工假体组(15.89±1.72)个月,髓内钉组(12.61±1.97)个月,两组术后生存期比较差异无统计学意义(P>0.05)。末次随访,髓内钉组中6例发生局部病灶复发,肿瘤假体组未出现。未出现围手术期及术后内置物松动、断裂、周围感染、再发骨折等并发症。结论两种术式治疗股骨转子下区骨转移瘤均可有效缓解疼痛,恢复肢体功能,提高生活质量,降低并发症的发生。髓内钉固定有利于早期下地活动,肿瘤假体重建有利于肿瘤局部控制。

Objective To investigate the clinical efficacy of two different surgical methods in the treatment of pathological fractures with bone metastases in the subtrochanteric region of the femur.Methods Retrospective analysis was performed on 32 patients with subtrochanteric bone metastatic tumor who received surgical treatment in our hospital from January 2013 to January 2020,including 15 males and 17 females,aged 44 to 77 years old,with an average age of(60.84±8.16)years old.There were 7 cases of near fracture and 25 cases of pathological fracture.The surgical plan was made according to the Mirls score.The Mirls score was more than 8 points,and the surgical treatment was performed.Fifteen cases were treated with intramedullary nailing combined with bone cement after curettage,and 17 cases were treated with tumor segmentectomy and artificial weight reconstruction.All all have the same set of performer to complete the surgery,comparative analysis of two groups of patients with general statistical analysis of clinical data and curative effect evaluation index pain visual analogue scale(VAS)were used respectively to assess pain,Karofsky fitness score(KPS)evaluation of fitness,bone and soft tissue tumor association(MSTS)score evaluation,limb function after surgery for follow-up record local recurrence and survival.Results The follow-up time of 32 patients ranged from 4 to 25 months,with an average of(14.23±1.32)months.VAS scores,KPS scores and MSTS scores at 1 and 3 months after surgery were significantly improved compared with those before surgery,and the differences were statistically significant(P<0.05).During follow-up,26 patients died,and the postoperative survival time was(12.61±1.97)months in the artificial prosthesis group and(15.89±1.72)months in the intramedullary nail group.There was no significant difference in postoperative survival time between the two groups(P>0.05).In all patients up to the last follow-up,6 patients in the intramedullary nail group had local lesion recurrence,but no tumor prosthesis group.There were no perioperative or postoperative complications such as loosening,fracture,peripheral infection and recurrence of fracture.Conclusion Both of the two surgical methods can effectively relieve pain,restore limb function,improve life quality,and reduce the incidence of complications.The fixation of intramedullary nail is beneficial to the early subsoil activity,and the establishment of tumor prosthesis is beneficial to the local control of tumor.