PDF(Pubmed)
Abstract：
Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.
摘要：
痛苦的骨骼溶骨转移，即将发生病理性骨折,在晚期癌症患者中，非移位骨折是一个破坏性的临床问题。开放式手术方法提供了出色的机械稳定性，但通常伴随着高并发症发生率和缓慢的恢复时间。经皮微创介入治疗已成为晚期癌症患者的务实和合理的治疗选择，晚期癌症患者可能禁忌进行开放手术。这些经皮介入最大限度地减少软组织解剖，允许立即开始或恢复化疗，目前并发症较少。这篇综述为骨转移的微创治疗提供了最新的技术和概念框架，特别关注髋臼周围病变。讨论的基本主题如下：（1）癌症引起的骨丢失的发病机制和局部细胞减少对恢复骨质量的重要性，(2)髋臼作为负重区的解剖学和生物力学,(3)概述消融方案和水泥/螺钉技术，和(4)组合方法。未来的研究应包括更多的长期随访研究，以更好地评估微创干预的机械耐久性。应采用髋臼特定的功能和疼痛评分框架，以进行更好的跨研究比较。
