髓内钉联合辅助钢板骨水泥治疗四肢长骨转移性肿瘤所致病理性骨折

发布时间：2018-03-22 12:35

本文选题：髓内钉　切入点：辅助钢板　出处：《中国修复重建外科杂志》2017年12期 　论文类型：期刊论文

【摘要】：目的探讨髓内钉联合辅助钢板骨水泥在四肢长骨转移性肿瘤所致病理性骨折姑息性治疗中的应用。方法 2015年4月—2016年10月,应用髓内钉联合辅助钢板骨水泥治疗四肢长骨转移性肿瘤导致的病理性骨折11例。其中,男6例,女5例;年龄54~72岁,平均62.9岁。肿瘤转移至肱骨4例,股骨6例,胫骨1例;肿瘤浸润长度3.3~5.6 cm,平均4.6 cm,深度可达患肢骨质全层。术前均有患肢疼痛并日常活动能力丧失。病程1.0~1.5个月。术前疼痛视觉模拟评分(VAS)为(6.36±1.03)分,Karnofsky功能状态评分(KPS)为(42.73±10.09)分。记录患者手术时间、术中失血量、术后并发症发生情况。术后3个月通过VAS评分、KPS评分及国际肌肉骨骼肿瘤学会(MSTS)评分评定临床疗效。结果手术时间1.1~1.8 h,平均1.5 h;术中失血量102.5~211.3 mL,平均135.6 mL。术后患肢切口均Ⅰ期愈合,无感染、坏死、延迟愈合等并发症发生。11例患者术后均获随访,随访时间7~10个月,平均8.2个月。术后3个月,患肢全部恢复日常活动功能。VAS评分降至(0.82±0.75)分、KPS评分升高至(85.45±5.22)分,与术前比较差异均有统计学意义(t=35.218,P=0.000;t= 18.470,P=0.000);MSTS评分为(23.91±2.47)分。末次随访时,患肢正侧位X线片示无髓内钉及钢板断裂,无骨水泥松动、肢体短缩及对线不良等并发症发生。结论采用髓内钉联合辅助钢板骨水泥内固定治疗四肢长骨转移性肿瘤导致的病理性骨折,能在保证患肢长度及对线不变的前提下,清除病灶并恢复患肢骨生物力学稳定性,减轻患者疼痛,提高其生存质量。
[Abstract]:Objective to explore the application of intramedullary nail combined with steel plate and cement in palliative treatment of pathological fracture caused by metastatic tumor of long bone in extremities. Methods from April 2015 to October 2016, 11 cases of pathological fracture caused by metastatic tumor of long bone of extremities were treated with intramedullary nail and auxiliary plate bone cement. Among them, 6 cases were male and 5 cases were female, the age was 54 ~ 72 years old (mean 62.9 years), the tumor metastasized to humerus in 4 cases, femur in 6 cases, tibia in 1 case. The tumor invasion length was 3.3 ~ 5.6 cm (mean 4.6 cm). The depth of tumor invasion was as deep as the whole bone layer of the affected limb. There was pain of the affected limb and loss of daily activity before operation. The course of disease ranged from 1.0 to 1.5 months. The preoperative pain visual analogue score was 6.36 卤1.03 and Karnofsky functional status score (KPSs) was higher than that of the control group. The time of operation was recorded. Intraoperative blood loss, The clinical efficacy was evaluated by VAS score and International Society of Musculoskeletal Oncology score 3 months after operation. Results the operative time was 1.11. 8 h (mean 1.5 h), and the blood loss during operation was 102.5 mm / 211.3 mL (mean 135.6 mL). The first stage healing of limb incision was observed. No infection, necrosis, delayed healing and other complications were followed up in 11 patients. The follow-up time was 7 ~ 10 months (mean 8.2 months). After 3 months, the total recovery of the affected limbs was reduced to 0.82 卤0.75 and the KPS score increased to 85.45 卤5.22. The MSTS score was 23.91 卤2.47). At the last follow-up, there was no fracture of intramedullary nail and steel plate, and no loosening of bone cement. Conclusion Intramedullary nail combined with internal fixation with steel plate and cement for the treatment of pathological fracture caused by metastatic tumor of long bone of extremities can ensure the length and alignment of the affected limb to remain unchanged. To clear the lesion and restore the biomechanical stability of the affected limb, relieve the pain and improve the quality of life.
【作者单位】：武汉大学中南医院骨科中心;
【分类号】：R738

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