A Comprehensive Analysis of Percutaneous Screw Fixation for Metastatic Lesion of the Pelvis: Outcomes of 107 Cases.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-04-02 Epub Date: 2025-02-20 DOI:10.2106/JBJS.24.00908

Barlas Goker, Jichuan Wang, D'Arcy Marsh, Ranxin Zhang, Yungtai Lo, Jana Fox, Beverly A Thornhill, Milan Sen, Bang H Hoang, David S Geller, Rui Yang

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引用次数: 0

Abstract

Background: Minimally invasive techniques such as percutaneous screw fixation have previously been shown to be mostly successful for pain relief and functional improvement in patients with pelvic metastases. In this study, we retrospectively reviewed the largest single-center cohort to date to further characterize the impact of this treatment on pain palliation, ambulation, and function; the predictors of suboptimal outcomes; and complications.

Methods: Electronic medical records were reviewed. The primary outcome measures were pain, as assessed with use of the visual analog scale (VAS) score; functional status, as assessed with use of the Eastern Cooperative Oncology Group (ECOG) score; and ambulation, as assessed with use of the Combined Pain and Ambulatory Function Score (CPAFS), including preoperatively and postoperatively. Secondary outcome measures included radiographic evidence of fracture healing and the need for narcotics.

Results: The study included 103 consecutive patients (42 men, 61 women) with a mean age of 64.1 years (range, 34 to 93 years) and a median follow-up of 14.4 months (range, 3 to 64 months) who underwent 107 procedures (bilateral in 4 patients). Sixty-nine had periacetabular lesions, whereas 38 had non-periacetabular lesions. VAS, ECOG, and CPAFS values improved from preoperatively at all time points (p < 0.001). Fifty-seven (85.1%) of the 67 patients presenting with a pathologic fracture demonstrated radiographic healing. A lack of radiographic healing was associated with a prolonged need for narcotics (p < 0.001). Six hips were converted to total hip arthroplasties, and 1 underwent a Girdlestone procedure. Complications were observed in 3 cases (2.8%).

Conclusions: Percutaneous screw fixation provided sustained benefits of pain relief and functional improvement in the treatment of metastatic pelvic lesions, with a low rate of complications. Bone healing after fixation was common. The risk of prolonged narcotic usage was higher in patients without evidence of bone healing.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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经皮螺钉内固定治疗骨盆转移性病变107例疗效分析。

背景：微创技术，如经皮螺钉固定，在骨盆转移患者的疼痛缓解和功能改善方面已被证明是最成功的。在这项研究中，我们回顾性地回顾了迄今为止最大的单中心队列，以进一步表征这种治疗对疼痛缓解、活动和功能的影响；次优结果的预测因子；和并发症。方法：对电子病历进行回顾性分析。主要结局指标为疼痛，使用视觉模拟量表（VAS）评分进行评估；使用东部肿瘤合作组织（ECOG）评分评估功能状态；使用疼痛和活动功能综合评分（CPAFS）评估患者的活动能力，包括术前和术后。次要结局指标包括骨折愈合的影像学证据和麻醉的需要。结果：该研究包括103例连续患者（42名男性，61名女性），平均年龄为64.1岁（范围，34至93岁），中位随访14.4个月（范围，3至64个月），接受了107次手术（4例双侧）。69例髋臼周围病变，38例非髋臼周围病变。VAS、ECOG和CPAFS评分在所有时间点均较术前改善（p < 0.001）。67例病理性骨折患者中57例（85.1%）表现出x线片愈合。放射治疗缺乏与麻醉需求延长相关（p < 0.001）。6个髋关节进行了全髋关节置换术，1个髋关节进行了Girdlestone手术。并发症3例（2.8%）。结论：经皮螺钉内固定治疗转移性盆腔病变提供了持续的疼痛缓解和功能改善，并发症发生率低。固定后骨愈合是常见的。在没有骨愈合迹象的患者中，长期使用麻醉剂的风险更高。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.