Abstract
To evaluate the functional outcome and pain control in patients after resection of humeral metastases. A prospective randomized study of 24 cases of metastatic disease of the humerus with an associated pathologic fracture was carried out. The selected cases were divided into two groups based on the using methylmethacrylate cement for fracture fixation. Group 1 (n=12) included all cases in which the fracture was treated with bone cement augmentation. Group 2 (n=12) included all cases in which the fracture was treated without bone cement augmentation. Functional outcome was evaluated according to the American Musculoskeletal Tumor Society system. Good and excellent pain control was achieved in 95% of cases in both groups. Functional outcome after resection of humeral metastases and pathological fracture fixation was significantly better in Group 1. Total function in five patients (45%) accounted for 86% and in three patients (25%) for 83% of full normal upper extremity function, whereas in Group 2, total function in six patients (50%) accounted for 70% and in three patients (25%) for 83% of full normal upper extremity function. The rate of fixation failure was significantly greater in Group 2, where fixation instability was observed in 50% (n=6) of cases (P=0.03). There were no significant differences in complication rate (in 50% of cases, mechanical instability occurred after fixation with intramedullary nail and in 50% of cases after fixation with plates). The introduction of bone cement as an adjunct to fixation of pathologic fracture improved clinical results and reduced the rate of fixation failure.
Highlights
The selected cases were divided into two groups based on the using methylmethacrylate cement for fracture fixation
Group 1 (n=12) included all cases in which the fracture was treated with bone cement augmentation
Good and excellent pain control was achieved in 95% of cases in both groups
Summary
Įvertinti operuotos rankos funkcijos atsikūrimo visavertiškumą ir skausminio sindromo kontrolę po žastikaulio metastazinio židinio pašalinimo ir fiksacijos. Pirmosios grupės tiriamiesiems patologinio žastikaulio lūžio fiksacijai naudotas kaulų cementas. Kurioje osteosintezė atlikta be kaulų cemento, 50 proc. Kaulų cemento panaudojimas patologinių žastikaulio lūžių fiksacijai užtikrina geresnį operuotos galūnės funkcijos atsikūrimo visavertiškumą ir efektyvesnę skausminio sindromo kontrolę, sumažina pakartotinių operacijų dažnį. Perspektyviosios atsitiktinių imčių studijos metu įvertinti kaulų cemento įtaką skausmo kontrolei ir operuotos rankos funkcijos atsikūrimui pacientams, kuriems nustatyta metastazinė žastikaulio pažaida ir patologinis lūžis. Pirmosios grupės tiriamiesiems patologinio žastikaulio lūžio fiksacija atlikta naudojant implantus ir kaulinį cementą su metastazinio židinio pašalinimu ar išvalymu. Antrosios grupės tiriamiesiems patologinio žastikaulio lūžio fiksacija atlikta naudojant tik implantus su metastazinio židinio pašalinimu. Iki operacijos visiems tiriamiesiems buvo vertintas hemoglobino kiekis kraujyje, metastazinio židinio dydis pažeistame kaule, Karnovskio indeksas, diagnozuotų lėtinių ligų skaičius, priklausomumas klinikinei grupei. Po trijų ir po šešių mėnesių vertinant skausminio sindromo, savirūpos, emocinio atsako į atliktą
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