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Surgery for femoral metastases.

股骨转移瘤的手术。

  • 影响因子:3.58
  • DOI:10.1302/0301-620X.102B3.BJJ-2019-0976.R1
  • 作者列表:"Tanaka A","Katagiri H","Murata H","Wasa J","Miyagi M","Honda Y","Takahashi M
  • 发表时间:2020-03-01
Abstract

AIMS:The aim of this study is to evaluate the clinical results of operative intervention for femoral metastases which were selected based on expected survival and to discuss appropriate surgical strategies. METHODS:From 2002 to 2017, 148 consecutive patients undergoing surgery for femoral metastasis were included in this study. Prognostic risk assessments were performed according to the Katagiri and revised Katagiri scoring system. In general, the low-risk group underwent resection and reconstruction with endoprosthetic replacement (EPR), while the high-risk group underwent internal fixation (IF) and radiation therapy. For the intermediate-risk group, the operative choice depended on the patient's condition, degree of bone destruction, and radio-sensitivity. Overall survival, local failure, walking ability, and systemic complications were evaluated. RESULTS:A total of 83 patients underwent EPR (low-risk, 23%; intermediate-risk, 60%; high-risk, 17%) and 65 patients underwent IF (low-risk, 0%; intermediate-risk, 32%; high-risk, 68%). The one-year survival rate was 71% for EPR and 15% for IF (p < 0.001). The one-year local failure-free survival was 93% for EPR and 67% for IF, and the two-year and five-year local failure-free survival for EPR were both 88% (p = 0.016). Although the ambulatory rate was 99% for EPR and 60% for IF, the median time to ambulation was shorter in the IF (EPR, 28 days, interquartile range (IQR) 25 to 35; IF, 23 days, IQR 18 to 28; p < 0.001) The cause of non ambulation was mainly due to progression of cancer (89%). The rate of systemic complications was comparable between the two groups (EPR, 18%; IF, 22%; p = 0.598). CONCLUSION:Selective use of EPR where survival is expected to be good offers correspondingly good long-term results. IF is less invasive with shorter treatment period, which is beneficial for patients with short-term expected survival. Prognosis is an important indicator in selecting operative procedures for femoral metastasis. Cite this article: Bone Joint J 2020;102-B(3):285-292.

摘要

目的: 本研究的目的是评估根据预期生存率选择的股骨转移瘤手术干预的临床结果,并讨论适当的手术策略。 方法: 2002-2017 年,连续 148 例因股骨转移接受手术的患者纳入本研究。根据Katagiri和修订的Katagiri评分系统进行预后风险评估。一般情况下,低危组行内假体置换 (EPR) 切除重建,高危组行内固定 (IF) 和放射治疗。对于中危组,手术选择取决于患者的病情、骨质破坏程度和放射敏感性。评估总生存期、局部衰竭、行走能力和全身并发症。 结果: 共有 83 例患者接受了EPR (低风险,23%; 中危,60%; 高风险,17%) 和 65 例患者接受了IF (低风险,0%; 中危,32%; 高危,68%)。EPR组 1 年生存率为 71%,IF组为 15% (p <0.001)。EPR的一年局部无失败生存率为 93%,IF为 67%,EPR的 2 年和 5 年局部无失败生存率均为 88% (p = 0.016)。虽然EPR的步行率为 99%,IF为 60%,但IF (EPR,28 天,四分位距 (IQR) 25 至 35 的步行中位时间较短; 如果,23 天,IQR 18 至 28; p <0.001)非下床活动的原因主要是由于癌症的进展 (89%)。两组的全身并发症发生率相当 (EPR,18%; IF,22%; p = 0.598)。 结论: 在预期生存率良好的情况下,选择性使用EPR可提供相应的良好长期结果。IF侵入性更小,治疗周期更短,这对短期预期生存的患者有益。预后是股骨转移癌选择手术方式的重要指标。引用本文: 骨关节J 2020;102-B(3):285-292。

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发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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