摘要
目的:分析肱骨转移癌的外科治疗策略、术后功能、并发症及生存率。方法:自2000年至2009年,59例肱骨转移癌患者(62例手术)在北京大学人民医院骨与软组织肿瘤治疗中心接受外科治疗,其中肺癌19例,骨髓瘤10例,乳腺癌8例,肾癌5例,胃肠道2例,甲状腺癌2例,前列腺癌1例,鼻咽癌1例,胆管癌1例,卵巢癌1例,黑色素瘤1例,来源不明8例。溶骨破坏严重、软组织侵犯明显的病例(n=32)多采用瘤段切除、假体置换术,其中肱骨上段肩关节假体25例,肱骨下段肘关节假体7例,其余病例接受肿瘤刮除、骨水泥填充、髓内针(n=17)或钢板(n=11)固定,另有2例因病理性骨折后肿瘤巨大且周围组织广泛受累行肩胛带离断术。发生病理性骨折43例,未发生病理性骨折的16例,以Mirels’评分判断骨折风险。术后功能依据肌肉骨骼肿瘤学会(MusculoskeletalTumor Society,MSTS)评分,回顾性分析患者生存率。结果:患者术后生存期平均为9.6个月,半年总体生存率45.1%,一年生存率27.4%,两年生存率11.6%,预期生存期11.6个月。未发生病理性骨折患者Mirels’评分平均9.3分。瘤段截除假体置换组中,术后2例复发,1例出现排异反应。髓内针和钢板固定组中1例钢板折断,2例复发,1例桡神经功能障碍。MSTS评分,假体置换组71%,髓内针和钢板组75.1%。结论:外科手术治疗肱骨转移癌的主要目的是缓解疼痛和改善生活质量,外科手术能够为患者提供坚强固定,这一优势是单纯放疗无法比拟的,包括化疗、激素治疗以及二膦酸盐类药物在内的全身系统治疗是延长骨转移癌患者生存期的决定因素。
Objective：To evaluate different operative treatment options for patients with metastases of the humerus focusing on surgical procedures,complications,function,and survival rate.Methods：From 2000 to 2009,62 bone metastases of the humerus in 59 patients were surgically treated in our institutions.Histological types were of lung（n= 19）,myeloma（n= 10）,breast（n= 8）,kidney（n= 5）,gastrointestinal tract（n= 2）,thyroid（n= 2）,prostate（n= 1）,bile duct（n= 1）,larynx（n= 1）,ovarian（n= 1）,melanoma（n= 1） and unknown tumors（n= 8）.Severe osteolytic lesions close to the shoulder and elbow joint were treated with resection and endoprosthetic replacement（n= 32）.Twenty-eight metasteses were stabilized by intramedullary locked nailing（17 cases） or plate/screws（11cases） with polymethylmethacrylate-assisted reconstruction.The remaining 2 lesions were treated with amputation because of wide tumor contaminations after pathological fracture.Mirels＇ rating system was used to predict the risk of pathological fracture.The function of the upper limb was assessed using the Musculoskeletal Tumor Society（MSTS） rating scale and survival rate was retrospectively analyzed.Results：The mean survival time of patients after surgery was 9.6 months.The mean Mirels＇ score for impending pathologic fractures was 9.3.Complications of endoprosthetic replacement recorded included di-sease relapse（n= 2） and soft tissue infection（n= 1）,whereas,for intramedullary locked nailing and plate/screws fixation,there were two cases of local recurrence,one case of plate/screw break and one case of radial nerve palsy.The mean MSTS score for the follow-up was 71% for endoprosthesis and 75.1% for locked intramedullary nailing or plate/screws fixation.Conclusion：Immediate stability and pain relief were the main purpose of surgical procedures to treat humerus metastases.Radiotherapy was only a local treatment;however systemic therapies,such as chemotherapy,hormonotherapy and bisphophonate play a cr
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期681-685,共5页
Journal of Peking University:Health Sciences
关键词
肱骨
肿瘤转移
外科手术
骨折
自发性
Humerus
Neoplasm metastasis
Surgical procedures
operative
Fractures
spontaneous
