恶性肿瘤致四肢长骨病理性骨折治疗对策

目的探讨恶性肿瘤致四肢长骨病理性骨折的治疗方法。方法1991~2003年我院共收治恶性肿瘤致四肢长骨病理性骨折病人41例,其中下肢病理性骨折23例,上肢病理性骨折18例。对所有病例分别行交锁髓内钉治疗、植骨钢板内固定、加压螺钉内固定和人工关节置换等途径治疗。结果23例下肢病理性骨折,伤口不愈合1例,延迟愈合2例,骨不连发生1例,全髋假体松动及移位1例,股骨头坏死1例;18例上肢病理性骨折,使用钢板植骨内固定的所有病例无一例发生骨不连,延迟愈合2例,畸形愈合1例,1例行交锁髓内钉的患者发生骨不连。结论当前开展的这些外科治疗技术,如交锁髓内钉、钢板内固定、加压螺钉内固定和人工髋关节置换等,均获得了非常好的效果。

Surgical treatment of long bone pathologic fracture of malignancy

Objective To study the surgical treatment of long bone pathologic fracture of malignancy.Methods Forty-one patients with long bone fractures of limbs resulted from malignancy between 1991 and 2003 were treated in our hospital.Twenty-three were lower extremity long bone fractures,and eighteen were upper extremity long bone fractures.All cases were treated with different methods,such as intramedullary interlocking nails,bone graft and internal fixation,compression screw,and artificial hip joint replacement.Results In the twenty-three lower extremity pathological fractures,there were two fractures with delayed healing,one fracture with not-healing,and one fracture with loosening and displacement of total hip prostheses,and one fracture with necrosis of femoral head.Of the eighteen upper extremity long bone fractures,there was no fracture with not-healing by the use of internal fixation devices,but one fracture with not-healing occurred under the use of intramedullary interlocking nails.And there were two fractures with delayed union,one fracture with malunion.Conclusion Current techniques for surgical treatment of these fractures are extremely effective,such as intramedullary interlocking nails,internal fixation of plate,compression screw,and artificial hip joint replacement and so on.