中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4139-4143.doi: 10.3969/j.issn.1673-8225.2010.22.038

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

肿瘤致四肢长骨病理性骨折的治疗选择：异体骨重建、内植物重建还是假体置换？

刘艳成，胡永成，夏  群，苗  军，张继东，徐宝山，吉  宁   

  1. 天津医科大学骨科临床学院，天津市天津医院，天津市  300211
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 通讯作者: 胡永成，博士，主任，教授，天津市天津医院，天津市 300211 yongchenghu@yahoo.com.cn
  • 作者简介:刘艳成★，男，天津市人，汉族，天津医科大学在读硕士，主治医师，主要从事骨科方面的研究。 liutj2001@163.com

Management of tumorous long bone pathological fractures: Allogeneic bone reconstruction, graft reconstruction or prosthesis replacement?

Liu Yan-cheng, Hu Yong-cheng, Xia Qun, Miao Jun, Zhang Ji-dong, Xu Bao-shan, Ji Ning   

  1. Clinical College of Orthopedics, Tianjin Medical University, Tianjin Hospital, Tianjin  300211, China
  • Online:2010-05-28 Published:2010-05-28
  • Contact: Hu Yong-cheng, Doctor, Professor, Clinical College of Orthopedics, Tiianjin Medical University, Tianjin Hospital, Tianjin 300211, China yongchenghu@yahoo.com.cn
  • About author:Liu Yan-cheng★, Studying for master’s degree, Attending physician, Clinical College of Orthopedics, Tianjin Medical University, Tianjin Hospital, Tianjin 300211, China liutj2001@163.com

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摘要：

背景：病理性骨折的国内外文献报道虽然较多，但大宗病例随访极少，诊治方法各异，尚缺乏规范的原则。
目的：探讨肿瘤致四肢长骨病理骨折的诊断和治疗方案。
方法：2002-08/2009-08收治143例四肢病理性骨折患者，将其中明确肿瘤来源的100例长骨骨折患者纳入分析，其中单发96例，多发部位4例；转移癌32例，原发恶性肿瘤24例，良性肿瘤29例，骨巨细胞瘤15例。通过回顾性分析，对其诊治特点进行总结分析。
结果与结论：随访6~56个月，平均26.5个月。骨折致伤暴力：自发性18例，功能性29例，轻微暴力46例，严重暴力7例。76例受伤前骨折局部有疼痛等先驱症状。转移癌中局部广泛切除，肿瘤假体置换13例，无局部复发；切除大段异体骨移植，髓内钉固定11例，其中死亡1例；病灶刮除、骨水泥或颗粒骨填充，髓内钉固定5例，其中2例复发，2例死亡；未手术3例。骨肉瘤根据化疗的敏感性选择是否保肢，其中7例行肿瘤切除、假体置换，未见局部复发，功能良好，2例切除大段异体骨重建，4例截肢治疗，共3例肺转移。恶性纤维组织细胞瘤3例行切除后假体置换，2例截肢，其中1例早期误诊，随访死亡。提示致伤暴力轻微和具有先驱症状的骨折应高度怀疑为病理性骨折。应结合局部肿瘤性质及骨折部位等因素选择合适的病理性骨折治疗方案，假体置换对于重建临近关节病变是较好的方法。

关键词: 骨肿瘤, 骨转移, 病理性骨折, 保肢, 假体置换

Abstract:

BACKGROUND: There are many reports regarding pathological fractures, but follow-up of large samples are few and the diagnosis methods vary, leading to lacks of uniform rule.
OBJECTIVE: To discuss the diagnosis and treatment of tumorous long bone pathological fractures.
METHODS: From August 2002 to August 2009, 143 consecutive hospitalized pathological patients were enrolled, including 100 long bone fractures involving 96 tumorous fractures, 4 multiple site, 32 metastases, 24 primary malignant tumors, 29 benign tumors, and 15 giant cell tumors. The diagnosis and treatments of pathological fractures were retrospectively analyzed.
RESULTS AND CONCLUSION: All the patients were followed up for 6 to 56 months with an average of 26.5 months. Violence-induced fractures were classified into four groups: 18 cases of spontaneous, 29 cases of functional activities, 46 cases of minor injuries, and 7 cases of severe injuries. A total of 76 patients complained discomforts such like pain at fracture cites. In 13 cases with metastases, resection of mass was followed by construction prosthesis with no local recurrences; 11 patients with metastases were treated with intramedullary nail, with 2 cases recurrences, and 2 cases died. Operation was not accepted in 3 cases. Of patients with osteosarcoma accepting limb sparing operation, 4 cases accepted amputation, all of which had no relapses but with lung metastases in 3 patients; 3 cases with malignant fibrous hisfiocytoma were resected and followed by construction prosthesis; 2 cases accepted amputation, one of which was misdiagnosed and died at last follow-up. Pathological fractures should be highly suspected in minor injury patients. Treatment of pathological fractures should consider multiple factors such as specific tumor character and fracture locations. It is a better way to choose arthroplasty for fractures adjacent to joints.

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