骨水泥填充加锁定钢板内固定治疗长骨转移癌伴病理性骨折  

Internal fixation with locked plate and bone cement in treatment of long bone pathologic fractures due to metastatic carcinoma

作　　者：张余[1] 徐亮[1] 张涛[1] 陈晓东[2] 柏瑞[3] 尹庆水[1] 黄华扬[1] 吴峰[1] 张德春[1] 

机构地区：[1]广州军区广州总医院骨科医院骨病关节科,广州流花路111号510010 [2]广州军区广州总医院病理科,广州流花路111号510010 [3]广州军区广州总医院放射科,广州流花路111号510010

出　　处：《中国矫形外科杂志》2010年第13期1061-1064,共4页Orthopedic Journal of China

摘　　要：[目的]探讨病灶清除后骨水泥填充加锁定钢板内固定治疗长骨转移癌伴病理性骨折的临床疗效。[方法]2005年2月～2008年2月,对本院收治15例骨转移癌伴长骨病理性骨折患者,其中肱骨3例,尺骨2例,桡骨1例,股骨5例,胫骨4例,采用骨水泥填充+锁定钢板内固定进行手术治疗。[结果]所有患者均有随访,随访时间24～46个月,平均35.6个月。术后14例(93.3%)疼痛症状明显减轻,疼痛评分改善率[(手术前评分-手术后评分)/手术前评分]为75%;术后2周Enneking肢体功能评分为优者13例(86.7%),改善率[(手术后评分-手术前评分)/手术后评分]为72%。手术前、后患者生活质量评分有显著统计学意义(P<0.05)。本组病例术后6个月生存率为60%,术后2年生存率为26.7%。[结论]对于长骨转移癌伴病理性骨折患者,尤其是近关节部位,骨水泥填充+锁定钢板内固定是一种安全、有效的手术方式,该手术可明显减轻患处疼痛、改善肢体功能、提高患者的生活质量,同时还能方便患者接受护理和进一步综合治疗。手术中骨水泥灌注确实、选择合适锁定钢板,是提高临床效果的有效办法。Abstract： [ Objective ] To investigate internal fixation with locked plate and bone cement in treatment of long bone patho- logic fractures due to metastatic carcinoma. [ Methods] From February 2005 to February 2008, 15 patients suffering from path- ologic fractures caused by metastatic lesions of the humerus （3 cases） , ulna （2 cases） , radius （1 cases）, femur （5 cases） and tibia （4 cases） have been surgically treated with internal fixation with locked plate and bone cement. [ Results ] All pa- tients were followed up after operation for ranging from 24 - 46 months. Pain relief was achieved in 14 patients （ 93.3% ） . Thirteen （86. 7% ） patients got excellent Enneking scores at 2 weeks postoperatively. The quality of life had significant differ- ence betwen before and after operation （P 〈0. 05） . The survival rate was 60% at six months and 26. 7% at two years. Three cases （ 15. 8% ） recurred and 2 accepted re - operations. Implanted devices failed in 2 patients （ 10. 5% ）, and 1 （5.3%） of them died 2 days after the re - operation. [ Conclusion ] For patients with long bone pathologic fractures due to metastatic carcinoma, internal fixation with locked plate and bone cement is a safe and effective way to relieve pain, restore limb function and improve quality of life. It is also convenient for nursing and further treatment.

关 键 词：锁定钢板 内固定 骨水泥 转移癌 病理性骨折 

分 类 号：R738[医药卫生—肿瘤]