Comparative Reasearch On Two Kinds Of Surgical Treatment Of Femoral Shaft Metastatic Carcinoma

Objective:Bone tissue is a susceptible organ for metastatic carcinoma. Among metastatic bone tumors, the incidence of femur is next only to spine and pelvis. Pain, activity obstacle and pathologic fractures caused by bone metastases seriously affect the patients’ quality of life, and bring great pain to the patient. With the development of metastases limb-salvage surgery, more and more patients and their families have accepted operative fixation. Local lesions curettage and deactivation combined with internal fixation of bone cement were commonly used in clinical to treat femoral shaft metastasis carcinoma. Along with the development of the artificial prosthesis, segmental tumor prosthesis replacement has been gradually applied in the treatment of femoral metastatic carcinoma and has obtained the good curative effect. This study aims at evaluating the postoperative curative effects of different operation methods through analysis of clinical data, and discussing complications, indications, advantages and disadvantages of different surgical modes combined with literature review.Methods:The research data from2004January to2014May in Yangzhou No.l People’s Hospital were reviewed in16cases of femoral shaft in cancer patients with femoral shaft metastases carcinoma.13cases of femoral metastatic cancer surgical operation treatment, of which10cases were treated with local lesions curettage and deactivation combined with internal fixation of bone cement therapy,3cases used is wide resection of femoral shaft metastases lesions combined with segmental artificial prosthesis replacement.The patients were observed for the postoperative healing of the incision, postoperative recovery of limb function, postoperative complications, and postoperative life quality. Their follow-up situations were recorded including when the patient was lost and why. Whether the patient was dead and the causes of death were counted. The MSTS scores and the pain scores of the patients need to be recorded at different times The score was statistically analyzed by using SPSS17.0statistical software.Results:To May01,2014, Among patients treated with the use of curettage and internal fixation of bone cement strengthened,75%patients died for the treatment of patients, the mean survival time was8.5months, including2cases of postoperative bone resorption, complications occurred in5cases after operation, an average of2weeks after operation, MSTS score was8, postoperative average3months of MSTS score of7.5points. The average preoperative VAS pain score was9points, after2weeks in VAS pain score, the average score was5. After1months the average score is3points. Patients treated with the use of The wide excision femur metastasis focus+segmental artificial prosthesis replacement were no deaths, the average follow-up period of4months, an average of2weeks after operation, MSTS score was27points, an average of3months after surgery, MSTS score of28points. The average preoperative VAS pain score was9points, after2weeks in VAS pain score, the average score was3. After1months the average score is1points. SPSS17.0statistical analysis software t test for paired data to the data, using P<0.05as a significant statistical difference, results showed that treatment of two kinds of operation method of metastatic cancer on femoral shaft, after operation in both pain and living treatment significantly improved, the latter is better than the former.Conclusion:Femoral shaft metastases carcinoma types that need surgical treatment and reconstruction were showed in this study, through the treatment for patients with femoral shaft metastases carcinoma. Combined with domestic and foreign literature analysis, it was thought that wide resection of femoral shaft metastases lesions combined with segmental artificial prosthesis replacement had obvious advantages than the local lesions curettage and deactivation combined with internal fixation of bone cement. The advantages were as follow:simple operation and relatively larger resection sites; isolated metastases lesions can be complete removed; lower recurrence rate, small trauma; postoperative pain can be obviously reduced, the patient can perform limb function exercise and weight-bearing exercise earlier, and the limb function was recovered faster; to further improve the quality of life of patients.This technique has better clinical practical value.