四肢转移性肿瘤合并病理性骨折治疗研究

目的对于合并骨转移的晚期肿瘤患者,一旦发生病理性骨折应给予积极的预防和治疗,本研究旨在对转移性骨肿瘤引起的病理性骨折的诊断和治疗进行分析和探讨。方法收集2009年8月～2010年8月选择在某院接受住院治疗的四肢转移性肿瘤合并病理性骨折患者25例,其中股骨颈骨折5例、股骨粗隆间骨折5例、股骨骨折7例、肱骨干骨折5例、肱骨外科颈骨折3例。针对这些患者分别性肿瘤假体置换术、动力髋螺钉内固定术、髓内钉闭合复位内固定术、切开复位骨水泥填充及钢板固定治疗。并分析其治疗后随访情况、疼痛、肢体功能及生活质量评分情况。结果本组25例四肢转移性肿瘤合并病理性骨折患者行手术治疗的患者后,均获得随访,随访时间2～36个月,平均(21.50±8.25)个月。其中有5例患者于随访期间死于多器官转移等其他并发症,其余20例患者经化疗、放疗、双膦酸盐治疗及中西医结合等治疗后,至今存活。本组25例患者的术前VAS评分为(8.25±1.30)分,术后VAS评分为(3.18±1.12)分,经统计比较发现患者术后VAS评分较术前明显降低,且差异有统计学意义(t=4.38,P﹤0.05),表明本组患者于手术后疼痛明显改善。本组存活的20例患者在术后3个月均能恢复行走或扶拐行走;Enneking评分结果显示本组20例患者中优6例,良8例,中2例,差1例,优良率达85.00%。本组存活的20例患者的Kanofsky评分结果显示,其中显效3例,有效8例,无效4例,总有效率为75.00%。结论手术治疗四肢转移性骨肿瘤的病理性骨折可以有效减轻患者的疼痛,保存和改善肢体功能,提高生活质量,从而延长生存期。

Study on the treatment for the Metastatic tumor with pathological fracture

OBJECTIVE For advanced cancer patients with bone metastasis,upon the occurrence of pathological fractures should be given positive prevention and treatment,the aims of this study was to explore diagnosis and treatment for the pathological fracture of patients with metastatic bone tumors.METHODS From August 2009 to August 2010 in our hospital,25 patients with metastatic tumor and pathological fracture were collected,including 5 cases of femoral neck fractures,5 cases with femoral intertrochanteric fracture,7 cases with femoral fractures,5 cases with humeral fracture,and 3 cases with fracture of surgical neck of humerus.These patients were performed with tumor prosthesis replacement,dynamic hip screw fixation,intramedullary nailing of closed reduction and internal fixation,open reduction and plate fixation with bone cement.We analyzed the situation of follow-up after treatment,pain,physical function and quality of life score.RESULTS 25 patients with metastatic tumor with pathological fracture patients were followed-up after operation,they were followed up for 2 to 36 months,and the average follow-up time was 21.50 ± 8.25 months.5 patients in the follow-up period died of multiple organ metastasis and other complications,and the remaining 20 cases were treated with chemotherapy,radiotherapy,bisphosphonate therapy and combination of TCM and Western medicine treatment,and they were survived.The VAS scores of 25 patients before preoperation was 8.25 ± 1.3,VAS postoperative score was 3.18 ± 1.12,the statistical comparison of findings in patients with postoperative VAS score were obviously reduced,and the difference was significant(t = 4.38,P﹤0.05).This suggests that this group of patients in pain after operation were significantly improved.This survived 20 patients can recover walking or walking stick after operation for 3 months;Enneking score showed 6 patients was excellent,8 cases were good,2 cases showed favorable,one was poor,and the excellent and good rate was 85%.This survived 20 patients with Kanofsky score results showed excellent in 3 cases,effective in 8 cases,ineffective in 4 cases,and the total effective rate was 75%.CONCLUSION The operation in treatment of metastatic bone tumor pathologic fracture can be effectively relieve patients’ pain,preservation and improvement of limb function,improve the quality of life,thereby prolong the survival period.