| Objective To explore the method and clinical effect of surgical treatment of the pathological fracture of limb bone metastasis.Methods 32 patients from Liaoning Provincial People's Hospital and Liaoning Provincial Tumor Hospital were retrospectively analyzed,they were all patients with bone metastases that met the criteria for inclusion,there were 19 males and 13 females,with an average age of 61(45-73).Most of the symptoms before admission to patients with pain and limb dysfunction,some patients before the fracture there are also varying degrees of pain symptoms.There were 17 cases of primary lung cancer,8 cases of breast cancer,3 cases of kidney cancer,2 cases of liver cancer and 2 cases of thyroid carcinoma.Fracture site:22 cases of femur and 10 cases of humerus.Operation method:All the 14 patients with proximal femoral fractures were treated with artificial joint prosthesis,of the 8patients with fractures of the femoral shaft,4 underwent modular intercalary endoprosthesis reconstruction,2 cases of tumor resection of massive allograft bone combined with internal fixation.A total of 10 patients with pathological fractures of humeral metastases,among them,5 cases of proximal humerus fracture were treated with artificial shoulder prosthesis.In the 5 cases of humeral shaft fracture,2 routine tumor resection segmental prosthesis reconstruction,3 routine tumor resection of intramedullary bone cement reconstruction.Follow-up by means of outpatient review,surgical treatment of patients and before and after treatment of pain,limb function,quality of life,recurrence and metastasis,survival and other aspects of a comprehensive assessment,comparison of preoperative and postoperative evaluation indicators of changes.Results All patients had a smooth operation.postoperative complications occurred in 4 patients,2 patients were infected with incisions,the incision was healed after treatment.2 patients underwent deep venous thrombosis after operation,thrombolysis after anticoagulant therapy.All patients were followed up,the follow-up duration was 3-54 months,median follow-up was 9 months.The preoperative VAS score was(6.8±1.2);the postoperative VAS score(2.1±1.5)was lower than that before the operation(6.8±1.2)(t=7.934,P < 0.05);The postoperative Kanofsky score(65.5±8.4)was higher than that before the operation(35.5±11.8)(t=-16.340,P <0.05);MSTS score(23.1±3.8)3 months after surgery,the Enneking function score(24.5±1.5)was significantly higher than preoperative(8.5±1.5)(t=-19.327,P <0.05),excellent function 62.5%(20/32),fair 25%(8/32),and poor 12.5%(4/32),the excellent and fair rate was 87.5%.One-year survival rate of 17 lung cancer patients was11.8%,of which 4 cases of local recurrence,9 cases of metastasis,The survival rate of 8patients with breast cancer was 87.5%,and the 3-year survival rate was 50%,there were2 cases of local recurrence and 3 cases of metastasis.Two cases of thyroid cancer patients with 1-year survival rate was 100%,3-year survival rate was 50%,1 case of metastasis,no local recurrence.All patients with hepatocellular carcinoma metastasized and died within 1 year without local recurrence.The 1-year survival rate of 3 patients with renal cancer was 33.3%,and 3 cases showed metastasis,of which 1 showed local recurrence.Conclusions For patients with physical bone metastasis,the patient should be treated with active surgery.Choose a reasonable surgical treatment can significantly reduce patient pain,improve limb function,make life better for patients.Fracture risk assessment is necessary for patients with established bone metastases,patients at high risk of fracture require preventive surgery to reduce the risk of fracture. |
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