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Abstract：
As managing pathological fractures of the extremities can be difficult, the present study aimed to present a treatment algorithm for lower extremity bone malignancies. A total of 38 patients with impending and pathological fractures were treated at the Department of Orthopedic Surgery in Kindai University Hospital. Age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcomes, follow-up period and the MSTS scores and ECOG-PS were compared in cases of primary malignant tumors and those cases of metastatic malignant tumors were retrospectively surveyed. Post-treatment MSTS scores in cases of impending and pathological fractures were compared between intramedullary nail fixation and non-intramedullary nail fixation procedures. Disease sites included the sub-trochanteric femur in 10 patients, trochanteric femur in 8, femoral diaphysis in 7, femoral neck in 5, bilateral trochanteric femur in 3, proximal tibia in 3 and distal femur in 2 patients. A total of 10 patients had metastases between 3-20 sites. The median pre-fracture ECOG-PS score was 1. Adjuvant radiotherapy was administered to 5, chemotherapy to 8 and radiotherapy with chemotherapy to 10 patients. Surgical procedures included intramedullary nails in 18 patients, tumor arthroplasty in 4, plate fixation in 3, artificial head replacement in three, compression hip screw (CHS) in 3, conservative treatment in 2, bilateral intramedullary nail fixation in 2 and artificial bone stem with combined intramedullary nail and plate fixation, right-sided artificial head replacement and left-sided CHS in 1 patient each. The MSTS score was 19.9±8.95 for intramedullary nail fixation and 24.3±7.45 for other procedures, with a negative association between the MSTS score and pre-fracture ECOG-PS. The median follow-up period was 8 months. The outcomes were as follows: Alive with disease, 23 patients; continued disease-free, 1 patient; and dead due to disease, 14 patients. The 1-year postoperative overall survival rate was 60.5%. Moreover, the group with metastatic malignant tumors, which had significantly worse ECOG-PS, had significantly lower MSTS scores than the group with primary malignant tumors. The authors\' treatment algorithm for malignant bone tumors of the lower extremity was shown to be useful.
摘要：
由于处理四肢的病理性骨折可能很困难，本研究旨在提出一种治疗下肢骨恶性肿瘤的方法。在金台大学医院骨科共治疗了38例即将发生和病理性骨折的患者。年龄,性别,骨折部位,原发性恶性肿瘤的类型，转移的数量，东部肿瘤协作组骨折前表现状态（ECOG-PS）评分，辅助治疗,治疗方式，手术时间,失血,术后并发症,肌肉骨骼肿瘤协会（MSTS）评分，结果，对原发性恶性肿瘤病例和转移性恶性肿瘤病例的随访时间以及MSTS评分和ECOG-PS进行了比较。比较了髓内钉固定和非髓内钉固定手术中即将发生和病理性骨折的治疗后MSTS评分。疾病部位包括10例患者的股骨转子下，股骨转子8例，股骨干7例，股骨颈5例，双侧股骨转子3例，胫骨近端3例，股骨远端2例。共有10名患者在3-20个部位之间发生转移。骨折前ECOG-PS评分中位数为1.辅助放疗5例，化疗8例，放疗加化疗10例。手术包括18例患者的髓内钉，肿瘤关节置换术4例，钢板固定3例，人工头部置换3例，加压髋螺钉（CHS）3，保守治疗2，双侧髓内钉固定2和人工骨干联合髓内钉和钢板固定，右侧人工头置换和左侧CHS各1例。髓内钉固定的MSTS评分为19.9±8.95,其他术式为24.3±7.45,MSTS评分与骨折前ECOG-PS之间呈负相关。中位随访期为8个月。结果如下：患有疾病，23名患者；持续无病，1名患者；因疾病死亡，14名患者术后1年总生存率为60.5%。此外，转移性恶性肿瘤组，ECOG-PS明显更差，MSTS评分明显低于原发性恶性肿瘤组。作者对下肢恶性骨肿瘤的治疗算法被证明是有用的。
