| Objective:To explore the choice,clinical efficacy,and prognosis of surgical approaches for proximal femoral metastases.Comparing the effect of intramedullary nail and joint replacement after operation.Method:Through propensity matching study,60 patients with proximal femoral metastases who underwent surgical treatment from June 2006 to June 2016 were analyzed.Among them,34 patients used intramedullary nail surgery and 26 patients used joint replacement surgery.Thirty-four patients who underwent intramedullary nail surgery were treated as treatment groups;26 patients who underwent joint surgery were used as control groups and propensity matching analysis was performed with matching capacity of 0.03.Thirty-four patients with intramedullary nail surgery were compared by propensity scores.20 of them were paired with 20 patients in the joint replacement group.The intraoperative blood loss,operation time,VAS score,MSTS score,ECOG score,postoperative complications,and overall survival time were recorded before and after operation in January,March,June and December.Statistical methods were used to compare the changes of each index in the two groups of patients and the differences between groups.The single factor Kaplan-Meier analysis of Log-Rank method was used to compare the ECOG score,VAS score,primary tumor and other factors with the survival time.Cox regression model was used to analyze the factors affecting the survival time of patients with proximal femoral metastases.Results:Intraoperative bleeding:joint replacement group 450 ml-2200 ml.average(1047.5±519.2)ml,intramedullary nail fixation group 150 ml-1250 ml,average(705.0±347.1)ml,intraoperative bleeding The difference was statistically significant(P<0.05);operation time:joint replacement group was 2h-4.5h,mean(3.15±0.86)h.intramedullary nail fixation group was 1.5h-4.0h,average(2.55±0.63))h.The difference in operation time between the two groups was statistically significant(P<0.05).VAS score:There was no significant difference in preoperative VAS scores.The mean VAS score was 4.95±0.5 in the joint replacement group and 3.45±0.5 in the intramedullary nail fixation group(P<0.05).There was a statistically significant difference in VAS scores between the two groups after one month.The mean VAS score was 2.42±0.5 in the joint replacement group and 1.75±0.8 in the intramedullary nail fixation group(P<0.05).The mean VAS score was 0.94±0.2 in the joint replacement group and 1.31±0.9 in the intramedullary nail fixation group(P>0.05).There was no significant difference in VAS scores between the two groups after 6 months of surgery.The mean VAS score was 0.56±0.5 in the joint replacement group and 3.70±2.2 in the intramedullary nail fixation group(P<0.05).The difference was statistically significant.MSTS scores:There was no significant difference in preoperative MSTS scores.In the joint replacement group,the MSTS score was 4.42±10.7 at 1 month after operation and 8.55±1.4 in the intramedullary nail fixation group(P<0.05).The difference was statistically significant.The MSTS score was 14.05±1.7 in the joint replacement group and 15.75±1.7 in the intramedullary nail fixation group(P<0.05).The difference was statistically significant.There was no significant difference in the MSTS scores between the two groups after 6 months.The MSTS score in the joint replacement group was 21.33±0.9 in the joint replacement group and 11.70±6.3 in the intramedullary nail fixation group(P<0.05).The difference was statistically significant.ECOG score:There was no significant difference in preoperative ECOG scores.In the joint replacement group,ECOG was 2.79±0.6 at 1 month and 2.40±0.5 in the intramedullary nail fixation group(P<0.05).There was a statistically significant difference in ECOG scores between the two groups at 1 month after surgery.Joint replacement was performed at 3 months after surgery.The group ECOG score was 2.26±0.6,and the intramedullary nail fixation group was 1.75±0.6(P<0.05).The difference was statistically significant.There was no significant difference in ECOG scores after 6 months of surgery.The ECOG score in the joint replacement group was 1.89±0.9 in the joint replacement group and 3.00±1.1 in the intramedullary nail fixation group(P<0.05).The difference was statistically significant.Complications:There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Survival analysis:There was no significant difference in the gender,age,preoperative ECOG score,whether the primary tumor was operated,and the surgical method on the survival time of patients with proximal femoral metastases.There was a statistically significant difference in the number of pathological fractures and the number of metastatic lesions on the survival time of patients.COX multivariate analysis showed that the pathological types of primary tumors,the number of metastatic lesions,and pathological fractures were risk factors for the survival time of patients with metastatic proximal femoral metastases.Conclusion:1.After surgical treatment of patients with proximal femoral metastases,the patient's pain symptoms are relieved,limb function is improved,and quality of life is significantly improved.2.For patients with metastatic proximal femoral cancer,individualized surgical procedures are required.3.Patients with short-term survival expectant intramedullary nail fixation are more appropriate and achieve better quality of life early in the patient's limited survival time.Joint replacement is more appropriate for patients who are expected to have a long survival time. |
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