대한골관절종양학회지 (The Journal of the Korean bone and joint tumor society)

  • 제16권2호
  • /
  • Pages.80-86
  • /
  • 2010
  • /
  • 1226-4962(pISSN)
  • /
  • 2233-9841(eISSN)
대한근골격종양학회 (The Korean Musculoskeletal Tumor Society)
권호 표지
DOI QR코드

DOI QR Code

잠김 금속판을 이용한 하지의 전이성 병적 골절에 대한 치료

Metastatic Pathologic Fractures in Lower Extremities Treated with the Locking Plate

  • 서창영 (전남대학교 의과대학 정형외과학교실) ;
  • 정성택 (전남대학교 의과대학 정형외과학교실)
  • Seo, Chang-Young (Department of Orthopedic Surgery, Chonnam National University Medical School) ;
  • Jung, Sung-Taek (Department of Orthopedic Surgery, Chonnam National University Medical School)
  • 투고 : 2010.09.07
  • 심사 : 2010.11.07
  • 발행 : 2010.12.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 골격계는 전이성 암에 의해 흔히 영향을 받는 부위이다. 본 연구를 통해 하지에서 발생한 전이성 병적 골절에 대한 치료로서 잠김 금속판을 이용한 치료 결과에 대해 알아보고자 한다. 대상 및 방법: 2004년부터 2010년까지 하지에 발생한 전이성 암에 의한 병적 골절에 대하여 잠김 금속판을 이용하여 치료받은 12명(13예)의 환자를 대상으로 평가를 시행하였다. 평균 환자 나이는 62.2세(50-81세)였으며, 골절은 각각 근위 대퇴골 2예, 대퇴골 간부 3예, 원위 대퇴골 3예, 근위 경골 4예, 원위 대퇴골 1예에서 발생하였다. 치료 결과로서 휠체어 보행 가능 시기, 통증 완화 정도 및 합병증을 평가하였으며, 또한 수술 시간 및 술 후 실혈량에 대하여 평가하였다. 결과: 수술 후부터 휠체어 보행까지는 평균 3.2일(1-6일)이 소요되었다. 평균 시각 통증 척도는 수술 전 8.1점(7-9점)에서 술 후 1주일째 2.7점(2-4점)으로 호전되었으며, 수술과 연관된 조기 합병증은 발생하지 않았다. 평균 수술 시간은 88.4분(70-105분)이었으며, 술후 평균 실혈량은 246.5 ml (130-320 ml)이었다. 결론: 하지의 전이성 병적 골절에 대한 치료로서, 잠김 금속판을 이용한 내고정술은 심한 골 파괴나 골 결손을 보이는 장골의 골간단부 혹은 골간부 병변에 효과적인 치료 방법이며, 또한 조기 보행을 가능하게 하고, 통증 및 술후 합병증 감소에 도움을 줄 수 있을 것이다.

Purpose: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. Materials and Methods: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. Results: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). Conclusion: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.

키워드

참고문헌

  1. Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80:1588-94. https://doi.org/10.1002/(SICI)1097-0142(19971015)80:8+<1588::AID-CNCR9>3.0.CO;2-G
  2. Dahlin DC, Unni KK. Bone tumours. 4th ed. Springfield, Illinois: Thomas; 1986.
  3. Varadhachary GR, Abbruzzese JL, Lenzi R. Diagnostic strategies for unknown primary cancer. Cancer. 2004;100:1776-85. https://doi.org/10.1002/cncr.20202
  4. Biermann JS, Holt GE, Lewis VO, Schwartz HS, Yaszemski MJ. Metastatic bone disease: diagnosis, evaluation, and treatment. Instr Course Lect. 2010;59:593-606.
  5. Siegel HJ, Lopez-Ben R, Mann JP, Ponce BA. Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement. J Bone Joint Surg Br. 2010;92:707-12. https://doi.org/10.1302/0301-620X.92B5.23246
  6. Bashore CJ, Temple HT. Management of metastatic lesions of the humerus. Orthop Clin North Am. 2000;31:597-609. https://doi.org/10.1016/S0030-5898(05)70178-4
  7. Bauer HC. Controversies in the surgical management of skeletal metastases. J Bone Joint Surg Br. 2005;87:608-17. https://doi.org/10.1302/0301-620X.87B5.16021
  8. Frassica FJ, Frassica DA. Evaluation and treatment of metastases to the humerus. Clin Orthop Relat Res. 2003;415:S212-8. https://doi.org/10.1097/01.blo.0000093052.96273.a7
  9. Ward WG, Holsenbeck S, Dorey FJ, et al. Metastatic disease of the femur: surgical treatment. Clin Orthop. 2003;415:S230-44. https://doi.org/10.1097/01.blo.0000093849.72468.82
  10. Bickels J, Kollender Y, Wittig JC, et al. Function after resection of humeral metastases: analysis of 59 consecutive patients. Clin Orthop. 2005;437:201-8.
  11. Harrington KD. Impending pathologic fractures from metastatic malignancy: evaluation and management. Instr Course Lect. 1986;35:357-81.
  12. Jung ST, Ghert MA, Harrelson JM, et al. Treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop. 2003;409:223-31. https://doi.org/10.1097/01.blo.0000059580.08469.3e
  13. Kay PR. Cement augmentation of pathological fracture fixation. J Bone Joint Surg Br. 1989;71:702.
  14. Mercadante S. Malignant bone pain: pathophysiology and treatment. Pain. 1997;69:1-18. https://doi.org/10.1016/S0304-3959(96)03267-8
  15. Mundy GR. Mechanisms of bone metastasis. Cancer. 1997;80:1546-56. https://doi.org/10.1002/(SICI)1097-0142(19971015)80:8+<1546::AID-CNCR4>3.0.CO;2-I
  16. Friedl W. Indication, management and results of surgical therapy for pathological fractures in patients with bone metastases. Eur J Surg Oncol. 1990;16:380-96.
  17. Friedl W, Mieck U, Fritz T. Surgical therapy of bone metastases of the upper and lower extremity. Chirurg. 1992;63:897-911.
  18. Graupe F, Heitmann C, Becker M, et al. Palliative surgical treatment of bone metastases. Improved quality of life by early intervention? Dtsch Med Wochenschr. 1996;121:393-7. https://doi.org/10.1055/s-2008-1043017
  19. Hardy DC, Descamps PY, Krallis P, et al. Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg Am. 1998;80:618-30. https://doi.org/10.2106/00004623-199805000-00002
  20. Brumback RJ, Toal TR Jr, Murphy-Zane MS, et al. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999;81:1538-44. https://doi.org/10.2106/00004623-199911000-00005
  21. Anglen J, Kyle RF, Marsh JL, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg. 2009;17:465-72. https://doi.org/10.5435/00124635-200907000-00007
  22. Hage WD, Aboulafia AJ, Aboulafia DM. Incidence, location, and diagnostic evaluation of metastatic bone disease. Orthop Clin North Am. 2000;31:515-28. https://doi.org/10.1016/S0030-5898(05)70171-1
  23. Heinz T, Stoik W, Vecsei V. Treatment and results of pathologic fractures. A collaborative study from 1965 to 1985 of 16 Austrian hospitals. Unfallchirurg. 1989;92:477-85.
  24. Barwood SA, Wilson JL, Molnar RR, et al. The incidence of acute cardiorespiratory and vascular dysfunction following intramedullary nail fixation of femoral metastasis. Acta Orthop Scand. 2000;71:147-52. https://doi.org/10.1080/000164700317413111
  25. Cole AS, Hill GA, Theologis TN, et al. Femoral nailing for metastatic disease of the femur: a comparison of reamed and unreamed femoral nailing. Injury. 2000;31:25-31. https://doi.org/10.1016/S0020-1383(99)00195-3
  26. Sharma H, Bhagat S, McCaul J, Macdonald D, Rana B, Naik M. Intramedullary nailing for pathological femoral fractures. J Orthop Surg (Hong Kong). 2007;15:291-4. https://doi.org/10.1177/230949900701500309
  27. Moholkar K, Mohan R, Grigoris P. The Long Gamma Nail for stabilization of existing and impending pathological fractures of the femur: an analysis of 48 cases. Acta Orthop Belg. 2004;70:429-34.

피인용 문헌

  1. Distribution of Femoral Metastases; Potential Role for Extended FDG PET/CT Scanning vol.38, pp.4, 2010, https://doi.org/10.1080/07357907.2020.1735407