背景:肱骨病理性骨折引起严重疼痛,手的有限使用,生活质量下降。本研究旨在比较髓内钉和锁定钢板治疗肱骨近端转移性病理性骨折的疗效。
方法:这项回顾性比较研究包括45例患者(22例男性,23名女性)患有肱骨近端转移性病理性骨折,在2011年至2022年之间接受了手术治疗。所有数据均从病历中收集并进行回顾性分析。17例接受了髓内钉加骨水泥增强术,28例行锁定钢板加水泥强化术。主要结果是疼痛缓解,函数得分,和并发症。
结果:在45名平均年龄为61.7±9.7岁的患者中,23例(51.1%)有多发骨转移,28例(62.2%)被诊断为即将发生的骨折。钉组的失血量明显减少[100(60-200)对500(350-600)ml,p<0.001]和更短的住院时间(8.4±2.6对12.3±4.3天,p<0.001)比电镀组。钉组平均随访时间为12个月,平板组平均随访时间为16.5个月。钉组视觉模拟量表(VAS)评分高于平板组,表明钉钉[7(6-8)对6(5-7)的疼痛缓解更大,p=0.01]。肌肉骨骼肿瘤学会功能评分[28(27-29)与27(26.5-28.5),p=0.23]组间具有可比性。无并发症,局部复发,或翻修手术均报告至最后一次随访.然而,钢板组1例肱骨头塌陷和碎裂,无需翻修手术.
结论:髓内钉联合骨水泥强化是治疗肱骨近端转移性病理性骨折的可行选择,提供刚性固定和更好的疼痛缓解,从而实现更早的活动,以优化功能结果。具有更少失血和更短住院时间的微创手术也有利于患者。证据水平II级。试用注册声明不适用。
BACKGROUND: Pathological fracture of the humerus causes severe pain, limited use of the hand, and decreased quality of life. This study aimed to compare the outcomes of intramedullary nailing and locking plate in treating metastatic pathological fractures of the proximal humerus.
METHODS: This retrospective comparison study included 45 patients (22 male, 23 female) with proximal humerus metastatic pathological fractures who underwent surgical treatment between 2011 and 2022. All data were collected from medical records and were analyzed retrospectively. Seventeen cases underwent intramedullary nailing plus cement augmentation, and 28 cases underwent locking plate plus cement augmentation. The main outcomes were pain relief, function scores, and complications.
RESULTS: Among 45 patients with mean age 61.7 ± 9.7 years, 23 (51.1%) had multiple bone metastases, and 28 (62.2%) were diagnosed with impending fractures. The nailing group had significantly lower blood loss [100 (60-200) versus 500 (350-600) ml, p < 0.001] and shorter hospital stay (8.4 ± 2.6 versus 12.3 ± 4.3 days, p < 0.001) than the plating group. Average follow-up time of the nailing group was 12 months and 16.5 months for the plating group. The nailing group had higher visual analog scale (VAS) scores than the plating group, indicating greater pain relief with nailing [7 (6-8) versus 6 (5-7), p = 0.01]. Musculoskeletal Tumor Society functional scores [28 (27-29) versus 27 (26.5-28.5), p = 0.23] were comparable between groups. No complications, local recurrence, or revision surgery were reported until the last follow-up in either group. However, one case in the plating group had a humeral head collapse and fragmentation without needing revision surgery.
CONCLUSIONS: Intramedullary nailing with cement augmentation is a viable option for treating proximal humerus metastatic pathological fracture, providing rigid fixation and better pain relief resulting in earlier mobility to optimize functional outcomes. Less invasive procedure with less blood loss and shorter hospital stay also benefits patients. Level of evidence Level II. Trial registration statement Not applicable.