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股骨上段转移癌的外科分型与治疗策略

Surgical classification and therapeutic strategy for metastases of proximal femur

摘要:

目的 探讨股骨上段转移癌的外科分型及治疗策略.方法 回顾性分析2003年1月至2011年12月接受手术治疗的99例(102侧)股骨上段转移癌患者的临床资料,其中男性50例,女性49例,中位年龄56岁(15 ~ 87岁),肿瘤来源以肺癌最为常见(30例),其次为乳腺癌(17例).根据解剖部位及生物力学特点将股骨上段转移灶分为4型(Ⅰ~Ⅳ型),记录各型患者的手术重建方式及术后随访情况.结果 99例(102侧)患者中,广泛或边缘切除65侧、囊内切除37侧.重建方式包括:双动半髋关节置换3侧、全髋关节置换10侧、股骨上端肿瘤型双动半髋关节置换48侧、股骨上端肿瘤型全髋关节置换8侧,髓内针固定21侧、螺钉钢板固定12侧.不同外科分型患者所应用的治疗策略有所差异.患者术后平均随访8.4个月(1~44个月),预期生存期10.3个月.Ⅰ、Ⅱ、Ⅲ、Ⅳ型患者术后美国骨与软组织肿瘤学会-93评分分别为86.5%、77.3%、81.3%、69.1%,Ⅳ型患者较其他3组患者差(t=4.763,P=0.031).10例患者出现术后并发症,Ⅳ型患者术后并发症发生率(3/12)显著高于其他3组患者(x2 =4.018,P =0.045).结论 股骨上段转移瘤根据解剖部位及生物力学特点进行外科分型并采用相应策略进行治疗可以最大限度地改善患者生活质量,降低并发症率.

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abstracts:

Objective To establish a surgical classification system for metastases of proximal femur and discuss the therapeutic strategy with retrospective analysis and literature review.Methods The data of 99 patients who underwent a total of 102 operations for femoral metastatic lesions from January 2003 to December 2011 was analyzed.There were 50 males and 49 females,and the median age was 56 years (range 15-87 years).The most common diagnosis was lung cancer (30 cases),followed by breast cancer (17 cases).All femoral lesions were divided into 4 types (Ⅰ-Ⅳ) with different anatomic site and biomechanic characteristic.The patients with various surgical reconstruction mode and postoperative follow-up data were recorded.Results There were 65 side who received widely or marginal resection and 37 side who received intralesional resection.The patients were operated with bipolar hip prosthesis (n =3),ordinary total hip replacement (THR) (n =10),bipolar tumor prosthesis (n =48),THR with tumor prosthesis (n =8),intramedullary nailing (n =21),and plate/screw (n =12).The estimated survival for the 99 patients was 10.3 months.Type Ⅰ,Ⅱ,Ⅲ and Ⅳ patients with postoperative American Society of bone and soft tissue tumors-93 rating were 86.5%,77.3%,81.3% and 69.1%.Patients with type Ⅳ were worse compared with the other 3 groups (t =4.763,P =0.031).The 10 operations were followed by complications of any kind.Complication rate of patients with type Ⅳ were 3/12,and it was significantly higher than the other 3 groups of patients (x2 =4.018,P =0.045).Conclusions The classifications and corresponsive surgical methods for upper femur metastases had some superiority in hinting prognosis and guiding treatment.

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