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首页> 外文期刊>Acta orthopaedica Scandinavica. Supplementum >Surgical treatment for pathologic fracture.
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Surgical treatment for pathologic fracture.

机译：病理性骨折的外科治疗。

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AIM: To evaluate epidemiology, prognosis and diagnostics in metastatic bone disease and identify risk factors for failure after operation for pathologic fracture. PATIENTS: The study was based on patients treated for skeletal metastases, myeloma or lymphoma between 1986 and 1998 at the Oncology Service, Department of Orthopedics, Karolinska Hospital and on patients diagnosed with symptomatic skeletal metastases 1989-1994 in the Stockholm Region. EPIDEMIOLOGY: 641 breast cancer patients were diagnosed with symptomatic skeletal metastases 1989-1994. Based upon 1100 new primary breast cancer cases yearly, the overall risk of developing symptomatic skeletal metastases was 10-15%. One out of 5 patients with skeletal metastases required surgical treatment for skeletal complications. PROGNOSIS: The survival rate after surgical treatment for skeletal complications was 0.3 at 1 year and 0.008 at 3 years. Multivariate analysis based on 619 patients showed that complete pathologic fracture and soft tissue metastases were negative prognostic variables for 1-year survival after operation. Solitary skeletal metastasis, breast, prostate, kidney cancer, myeloma, and lymphoma were positive variables. DIAGNOSIS: Fine Needle Aspiration Biopsy (FNAB) was assessed in 110 patients for diagnostic accuracy and to which extent information about primary site of the metastatic carcinoma could be gained. There were 80 patients with metastatic carcinoma, 14 with lymphoma, and 16 with myeloma. FNAB offered correct diagnosis in 9 of 10 patients and also provided guidance in the search for the primary lesions. Hence, 27 of 30 myeloma or lymphomas were diagnosed by FNAB and in half of the patients with metastatic carcinoma the site of the primary tumor could be ascertained. For patients with a suspected skeletal metastasis the search for the primary tumor may preferably start with FNAB. SURGICAL TREATMENT: Risk factors for failure after operation for pathologic fractures were identified in 192 patients treated for 228 metastatic lesions of the long bones. 26 out of 228 procedures (11%) lead to failures necessitating reoperation. Long survival after surgery was the most important risk factor for failure of the reconstruction. Kidney cancer was the primary tumor associated with the highest rate of reoperations. Reoperations were more common in the femur than in the humerus. Reconstructions based on prosthetic as opposed to osteosynthetic devices appeared safer. There was a tendency for a high reoperation rate in hospitals with few treated patients. CONCLUSION: To decrease the risk of reoperation, it is important to identify patients with a long expected survival. Patients with a good prognosis should be considered for wide resection and reconstruction as applied in primary malignant bone tumors.
机译：目的：评估转移性骨病的流行病学，预后和诊断，并确定病理性骨折术后失败的危险因素。患者：该研究基于1986年至1998年间在Karolinska医院骨科的肿瘤科接受过骨骼转移，骨髓瘤或淋巴瘤治疗的患者，以及1989-1994年在斯德哥尔摩地区被诊断为有症状的骨骼转移的患者。流行病学：1989-1994年诊断为641例有症状的骨骼转移的乳腺癌患者。根据每年1100例新发的原发性乳腺癌病例，出现症状性骨骼转移的总风险为10％至15％。五分之一的骨骼转移患者因骨骼并发症需要手术治疗。预后：骨骼并发症手术治疗后的生存率为1年时为0.3，3年时为0.008。基于619例患者的多变量分析显示，完整的病理性骨折和软组织转移是术后1年生存的阴性预后变量。孤立性骨骼转移，乳腺癌，前列腺癌，肾癌，骨髓瘤和淋巴瘤是阳性变量。诊断：评估了110例患者的细针穿刺活检（FNAB）的诊断准确性，并在此程度上可以获取有关转移癌原发部位的信息。有转移癌80例，淋巴瘤14例，骨髓瘤16例。 FNAB在10例患者中有9例提供了正确的诊断，并为寻找原发灶提供了指导。因此，通过FNAB诊断出30例骨髓瘤或淋巴瘤中的27例，在转移性癌患者中，有一半可以确定原发灶的位置。对于怀疑有骨骼转移的患者，寻找原发性肿瘤最好从FNAB开始。手术治疗：在192名接受228例长骨转移性病变治疗的患者中，发现了病理性骨折术后失败的危险因素。 228个步骤中有26个（11％）导致失败，需要重新操作。术后长期存活是重建失败的最重要的危险因素。肾癌是与再次手术率最高相关的原发肿瘤。股骨再手术比肱骨更常见。基于假肢而不是骨合成装置的重建似乎更安全。在接受治疗的病人很少的医院中，有较高的再手术率。结论：为了降低再次手术的风险，重要的是确定预期存活时间长的患者。预后良好的患者应考虑用于原发性恶性骨肿瘤的广泛切除和重建。

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