Bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur
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摘要:
目的 探讨骨水泥型人工双极股骨头置换治疗股骨近段转移瘤的临床疗效。 方法 回顾性分析2012年1月至2019年6月华中科技大学同济医学院附属协和医院收治的54例行骨水泥型人工双极股骨头置换的股骨近段转移瘤患者的资料。采用疼痛视觉模拟评分（visual analogue scale，VAS）、国际骨肿瘤协会（musculoskeletal tumor society system，MSTS）功能评分、国际保肢学会（international society of limb salvage，ISOLS）影像评分、Harris髋关节功能评分量表（Harris hip score）、Karnofsky功能状态（Karnof?sky performance status，KPS）评分和诺丁汉健康调查问卷（Nottingham health profile，NHP）评分评定患者疼痛、肢体功能和生存质量。Kaplan-Meier法分析生存情况。 结果 患者随访时间为10~99个月，平均42.17个月。患者手术时间（79.68±6.17）min，术中出血量（524.00±39.25）mL。术后3、6和12个月，VAS评分和NHP评分分别较术前降低，MSTS评分、ISOLS评分、Harris评分和KPS评分分别较术前提高，差异均具有统计学意义（P < 0.05）。术后3、6和12个月，每个随访点之间的VAS评分、相关功能评分和生存质量评分差异均无统计学意义（P>0.05）。随访期内6例发生并发症。患者平均生存时间19.46个月，6个月、1年和3年生存率分别为88.89%、70.37%和11.11%。 结论 股骨近段骨转移瘤患者行骨水泥型人工双极股骨头置换可减轻患者疼痛，提高肢体功能，延长生存时间，提高生存质量。 Abstract:Objective To investigate the clinical efficacy of bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur. Methods Medical records of 54 patients who underwent bone cement type artificial bipolar femoral head replacement at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to June 2019 were retrospectively analyzed. Scoring for pain by visual analogue scale (VAS), musculoskeletal tumor society (MSTS) function score, international society of limb salvage (ISOLS) score, Harris function score, Karnofsky performance status (KPS) scale, and Nottingham health profile (NHP) score were used to evaluate patients' pain, limb function and the overall quality of life after surgery, and the Kaplan-Meier estimate was used for computing the survival over time. Results Patients were followed up for (10-99) months, with an average of 42.17 months. The average operative time and the intraoperative blood loss were (79.68±6.17) min and (524±39.25) mL, respectively. The VAS score and the NHP score decreased significantly whereas the MSTS score, ISOLS score, Harris score, and KPS score improved significantly at 3, 6 and 12 months after surgery than the pre-surgery scores (P < 0.05); however the differences in VAS score, limb function scores and quality of life score at all post-surgical follow-up visits at 3, 6 and 12 months were comparable (P>0.05). Six cases of complications were reported during the follow-up period. The mean survival time of the patients was 19.46 months, and the 6-month, 1-year and 3-year survival rates were found to be 88.89%, 70.37% and 11.11%, respectively. Conclusions Bone cement type artificial bipolar femoral head replacement used in patients with bone metastases in the proximal femurcan effectively relieve pain, improve limb function and quality of life, and prolong survival. -
Key words:
- bone tumors /
- tumor metastasis /
- proximal femur /
- surgical treatment /
- femoral head replacement
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图 1 50岁患者，男性左侧股骨近段转移性肺腺癌
A：臀中肌前缘间隙入路手术切口；B，C：T1、T2加权像示股骨近段髓腔内较长范围信号异常，骨髓腔内形成团片致密阴影，邻近骨皮质及软组织受累；D：经臀中肌前缘间隙入路分离暴露股骨近段肿瘤病灶；E：根据术前计划截骨并切除瘤段；F：术后正位X线检查示假体位置良好，无脱位、松动和假体周围骨折等并发症
图 2 51岁患者，女性右侧股骨近段转移性肺腺癌
A：右侧股骨头颈部及转子间骨质密度不均，见斑点状低密度影和絮状高密度影；B：髋关节磁共振平扫示右侧股骨头颈部及大小转子骨质破坏，T2WI呈非均匀高信号，股骨头保持外形，未见明显塌陷，关节间隙未见增宽变窄，周围未见明显软组织肿块形成；C：根据术前计划进行截骨并切除瘤段；D：根据瘤段骨截除长度，选择合适的双极股骨头假体进行安置固定；E：术后正位X线检查示假体位置良好，无脱位、松动和假体周围骨折等并发症
表 1 患者术前术后疼痛、功能情况和生存质量的比较
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