骨骼转移和长骨病理性骨折

Stanislav Rajkovic, Lazar Mičeta, Ljubica Simić, Goran Đuričić, Z. Bascarević, N. Lujić, J. Sopta
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摘要

介绍。病理性骨折最常见的原因是骨骼转移。10%确诊为骨骼转移的患者会发生病理性骨折。骨骼转移瘤可以通过非手术方法治疗,包括止痛剂、双膦酸盐和放疗,主要目的是缓解疼痛和减缓肿瘤生长。手术治疗适用于即将发生或已经发生的骨折。它包括使用各种钉子、钢板和螺钉进行内固定的稳定,并伴有或不伴有骨成形术,以及人工关节内置换术,特别是在主要关节(髋关节、膝关节和肩部)周围的病变。材料和方法。该研究包括在2021年2月至2022年1月期间在“Banjica”骨科研究所接受手术治疗并在贝尔格莱德病理研究所进行病理组织学分析的患者。纳入标准为存在或即将发生的长骨病理性骨折,组织取样手术治疗,以及随后的转移癌病理组织学诊断。除转移性癌外,活检证实病变的患者被排除在研究之外。纳入研究的患者总数为69例。结果。病理性骨折发生时患者平均年龄为67.7岁(42 ~ 88岁)。恶性疾病诊断:乳腺癌36.1%,肺癌24.5%,肾癌14.5%,前列腺癌13.1%,结直肠癌2.9%,其他癌症8.9%。放射学表现为溶解形式(75.4%)和胚性形式(24.6%)。手术治疗包括53.6%的患者关节置换术,46.4%的患者用钉子或钢板固定。结论。病理性骨折是肿瘤在骨骼中活动的最终结果,给患者带来巨大的痛苦,表现为剧烈的疼痛和经常不活动,这加速了所有病理过程并导致死亡。现代化疗、放疗和手术联合方法使这些患者的生活质量得到显著改善和延长。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Skeletal metastases and pathological fractures of long bones
Introduction. The most common cause of pathological fractures are skeletal metastases. Ten percent of patients with diagnosed skeletal metastases will sustain a pathological fracture. Skeletal metastases can be treated by non-surgical methods, including analgesics, bisphosphonates, and radiotherapy, with the primary goal of relieving pain and slowing down tumor growth. Surgical treatment is indicated for impending or existing fractures. It includes stabilization with internal fixation using various nails, plates, and screws with or without osteoplasty, and endoprosthetic joint replacement, especially in lesions around major joints - hip, knee, and shoulder. Material and Methods. The study included patients operatively treated at the Institute of orthopedics "Banjica" and pathohistologically analyzed at the Institute of pathology in Belgrade during the period from February 2021 to January 2022. Inclusion criteria were an existing or impending pathological fracture of long bones, operative treatment with tissue sampling, and the consequent pathohistological diagnosis of metastatic carcinoma. Patients with biopsy-proven processes other than metastatic carcinomas were excluded from the study. The total number of patients included in the study was 69. Results. The mean age of patients at the pathological fracture occurrence was 67.7 (ranging from 42 to 88). Malignant diseases diagnosed were: breast cancer 36.1%, lung cancer 24.5%, kidney cancer 14.5%, prostate cancer 13.1%, colorectal cancer 2.9%, other cancer (8.9%). The radiological presentation was in the form of lysis in 75.4% and in blastic form in 24.6%. Operative treatment included arthroplasty in 53.6% of patients and stabilization with nail or plate in 46.4%. Conclusion. Pathological fractures represent the final outcome of tumor activity in a bone and cause significant suffering in patients expressed through severe pain and often immobility, which accelerates all the pathological processes and leads to death. Joint methods of contemporary chemotherapy, radiotherapy, and surgery enabled a significant life quality improvement and extension in these patients.
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