CAJ | 학술논문

目的探讨经皮骨成形术(POP)联合介入内固定术(IIF)治疗即将发生病理性骨折的股骨上段骨肿瘤的临床价值.方法本研究为回顾性资料分析,将Mirels评分≥8分的40例即将发生病理性骨折的股骨上段骨肿瘤患者纳入观察,根据治疗方法的不同分为2组.POP联合IIF组19例,POP组21例,分别行POP联合IIF、单独POP治疗.术后观察2组患者疼痛缓解、发生骨折、骨水泥渗漏和生存率情况,并对两组的上述指标采用x2检验进行比较.分别于术后1周,1、3、6个月和1年观察患者的视觉模拟评分(VAS)、卡氏生活质量评分(KPS)及四肢肌骨肿瘤术后功能状态评分(EFES)来评价生活质量及功能状态,并对这些指标采用Mann-Whitney U检验比较.结果所有患者均顺利完成手术.POP联合IIF组17例疼痛缓解,6例骨水泥渗漏,无发生骨折者,随访6～18个月14例存活;POP组12例疼痛缓解,9例骨水泥渗漏,5例发生骨折者,随访3～18个月13例存活.2组间疼痛缓解和发生骨折率的差异有统计学意义(P均＜0.05),骨水泥渗漏和生存率差异无统计学意义(x2值分别为0.541和0.761,P均＞0.05).2组患者术后1周VAS、KPS及EFES评分差异无统计学意义(P均＞0.05),术后1、3、6个月和1年评分差异有统计学意义(P均＜0.05).POP联合IIF组1例患者术后15d发生患侧下肢深静脉血栓,经植入腔静脉滤器并抗凝治疗痊愈,其余患者无与手术有关的严重并发症.结论经POP联合IIF治疗即将发生病理性骨折的股骨上段骨肿瘤安全、有效,能更好地缓解疼痛、降低骨折发生率.
목적 탐토경피골성형술(POP)연합개입내고정술(IIF)치료즉장발생병이성골절적고골상단골종류적림상개치.방법 본연구위회고성자료분석,장Mirels평분≥8분적40례즉장발생병이성골절적고골상단골종류환자납입관찰,근거치료방법적불동분위2조.POP연합IIF조19례,POP조21례,분별행POP연합IIF、단독POP치료.술후관찰2조환자동통완해、발생골절、골수니삼루화생존솔정황,병대량조적상술지표채용x2검험진행비교.분별우술후1주,1、3、6개월화1년관찰환자적시각모의평분(VAS)、잡씨생활질량평분(KPS)급사지기골종류술후공능상태평분(EFES)래평개생활질량급공능상태,병대저사지표채용Mann-Whitney U검험비교.결과 소유환자균순리완성수술.POP연합IIF조17례동통완해,6례골수니삼루,무발생골절자,수방6～18개월14례존활;POP조12례동통완해,9례골수니삼루,5례발생골절자,수방3～18개월13례존활.2조간동통완해화발생골절솔적차이유통계학의의(P균＜0.05),골수니삼루화생존솔차이무통계학의의(x2치분별위0.541화0.761,P균＞0.05).2조환자술후1주VAS、KPS급EFES평분차이무통계학의의(P균＞0.05),술후1、3、6개월화1년평분차이유통계학의의(P균＜0.05).POP연합IIF조1례환자술후15d발생환측하지심정맥혈전,경식입강정맥려기병항응치료전유,기여환자무여수술유관적엄중병발증.결론 경POP연합IIF치료즉장발생병이성골절적고골상단골종류안전、유효,능경호지완해동통、강저골절발생솔.
Objective To explore the clinical value of percutaneous osteoplasty (POP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.Methods In this retrospective study,a total of 40 patients with malignant impending pathological fracture of proximal femur were recruited for POP and IIF (n=19) or POP alone (n=21).Pain relief,fracture,bone cement leakage and survival was observed after treatment,of which the difference between two groups were compared by Chi-square test.visual analog scale(VAS),karnofsky performance scale(KPS),ennekingfunction evaluation system(EFES) was used to evaluate the change of pain and quality of life,and the difference of clinical assessment criteria between two groups were compared by Mann-Whitney U test.Results Technical success was achieved in all the patients.In POP and IIF group,pain relief and cement leakage was observed in 17 and 6 of 19 patients respectively.No fracture occurred and 14 patients survived during the follow-up of 6 to 18 months.While in POP group,pain relief and cement leakage was observed in 12 and 9 of 21 patients respectively.Five fractures occurred and 13 patients were still survived during the follow-up of 3 to 18 months.The difference of pain relief and the incidence ratio of fracture between two groups were statistically significant (P＜0.05).However,there is no significant difference in bone cement leakage and survival between two groups (x2 values were 0.541 and 0.761,P＞0.05).The average change of VAS,KPS and EFES in group A were significantly higher than those in group B at 1,3,6 month,1 year(P＜0.05).No serious complications occurred except one experiencing phlebothrombosis at the operative side at 15 days following operation,who was recovered after a filter being placed via femoral vein to the inferior vena cava and anticoagulation therapy taken synchronously.Conclusion POP and IIF were not only a safe and effective procedure,but resulted in greater pain relief,bone consolidation and also reduced the risk of fracture than the currently recommended approach of POP did on malignant proximal femur tumor.