PDF(Pubmed)
Abstract：
UNASSIGNED: Treatment of metastatic lesions to the humerus is dependent on patient\'s pain, lesion size and location, and post-operative functional goals. Surgical options include plate or nail fixation [open reduction internal fixation (ORIF)], or endoprosthetic replacement (EPR), with cement augmentation. The objective of this study was to perform a single institution retrospective analysis of outcomes by method of reconstruction, tumor volume, and pathologic diagnosis.
UNASSIGNED: The records of 229 consecutive patients treated surgically for appendicular metastatic disease from 2005-2018 at our musculoskeletal oncology center were retrospectively reviewed following institutional review board (IRB) approval. Indications for surgical treatment at the humerus included patients who presented with impending and displaced pathologic fractures.
UNASSIGNED: Sixty patients (34 male, 26 female) with a mean age of 62.9±12.2 were identified who were treated surgically at the proximal (n=21), diaphyseal (n=29), or distal (n=10) humerus. Forty-nine (82%) patients presented with displaced pathologic fractures. The remaining eleven patients had a mean Mirels score of 9.5. There was no difference in overall complication rate between EPR or ORIF [4/36 (11%) versus 2/24 (8%); P=0.725]. Mean Musculoskeletal Tumor Society (MSTS) scores were 83% for both EPR and ORIF, with no differences in subgroup analyses at the proximal, diaphyseal, or distal humerus. Patients with cortical destruction on anterior posterior (AP) and lateral imaging were at increased risk for mechanical failure [2/6 (33%) versus 0/18 (0%), P=0.015].
UNASSIGNED: In conclusion, when pathologic pattern permits, cement-augmented fixation allows for stabilization of pathologic bone, while minimizing risk of soft-tissue detachment, while EPR resulted in similar outcomes in patients with more extensive bone destruction. Increased tumor volume was associated with lower MSTS scores.
UNASSIGNED: The records of 229 consecutive patients treated surgically for appendicular metastatic disease from 2005-2018 at our musculoskeletal oncology center were retrospectively reviewed following institutional review board (IRB) approval. Indications for surgical treatment at the humerus included patients who presented with impending and displaced pathologic fractures.
UNASSIGNED: Sixty patients (34 male, 26 female) with a mean age of 62.9±12.2 were identified who were treated surgically at the proximal (n=21), diaphyseal (n=29), or distal (n=10) humerus. Forty-nine (82%) patients presented with displaced pathologic fractures. The remaining eleven patients had a mean Mirels score of 9.5. There was no difference in overall complication rate between EPR or ORIF [4/36 (11%) versus 2/24 (8%); P=0.725]. Mean Musculoskeletal Tumor Society (MSTS) scores were 83% for both EPR and ORIF, with no differences in subgroup analyses at the proximal, diaphyseal, or distal humerus. Patients with cortical destruction on anterior posterior (AP) and lateral imaging were at increased risk for mechanical failure [2/6 (33%) versus 0/18 (0%), P=0.015].
UNASSIGNED: In conclusion, when pathologic pattern permits, cement-augmented fixation allows for stabilization of pathologic bone, while minimizing risk of soft-tissue detachment, while EPR resulted in similar outcomes in patients with more extensive bone destruction. Increased tumor volume was associated with lower MSTS scores.
摘要：
■肱骨转移性病变的治疗取决于患者的疼痛，病变大小和位置，和术后功能目标。手术选择包括钢板或钉固定[切开复位内固定（ORIF）]，或假体置换（EPR），水泥增强。本研究的目的是通过重建方法对结果进行单机构回顾性分析，肿瘤体积,和病理诊断。
在机构审查委员会（IRB）批准后，回顾性审查了2005-2018年在我们的肌肉骨骼肿瘤中心接受手术治疗的229例连续患者的记录。肱骨手术治疗的适应症包括即将发生和移位的病理性骨折的患者。
■60名患者（34名男性，26名女性），平均年龄为62.9±12.2岁，在近端接受手术治疗（n=21），骨干（n=29），或肱骨远端（n=10）。49例（82％）患者出现移位的病理性骨折。其余11名患者的平均Mirels评分为9.5。EPR或ORIF之间的总并发症发生率无差异[4/36（11％）与2/24（8％）；P=0.725]。EPR和ORIF的平均肌肉骨骼肿瘤协会（MSTS）评分为83％，在近端亚组分析中没有差异，骨干,或者肱骨远端.前路（AP）和外侧成像皮质破坏的患者发生机械故障的风险增加[2/6（33％）与0/18（0％），P=0.015]。
■总而言之，当病理模式允许时，骨水泥增强固定可以稳定病理性骨，同时将软组织脱离的风险降至最低，而EPR在骨破坏更广泛的患者中导致相似的结局。肿瘤体积增加与较低的MSTS评分相关。
在机构审查委员会（IRB）批准后，回顾性审查了2005-2018年在我们的肌肉骨骼肿瘤中心接受手术治疗的229例连续患者的记录。肱骨手术治疗的适应症包括即将发生和移位的病理性骨折的患者。
■60名患者（34名男性，26名女性），平均年龄为62.9±12.2岁，在近端接受手术治疗（n=21），骨干（n=29），或肱骨远端（n=10）。49例（82％）患者出现移位的病理性骨折。其余11名患者的平均Mirels评分为9.5。EPR或ORIF之间的总并发症发生率无差异[4/36（11％）与2/24（8％）；P=0.725]。EPR和ORIF的平均肌肉骨骼肿瘤协会（MSTS）评分为83％，在近端亚组分析中没有差异，骨干,或者肱骨远端.前路（AP）和外侧成像皮质破坏的患者发生机械故障的风险增加[2/6（33％）与0/18（0％），P=0.015]。
■总而言之，当病理模式允许时，骨水泥增强固定可以稳定病理性骨，同时将软组织脱离的风险降至最低，而EPR在骨破坏更广泛的患者中导致相似的结局。肿瘤体积增加与较低的MSTS评分相关。
