Abstract：Objective To discuss the diagnosis skills, surgical treatment and clinical significance of long bone metastases.Methods Clinical data of 54 patients with long bone metastases of limbs treated from January 2012 to January 2017 in the Department of Orthopaedic Oncology, Honghui Hospital Affiliated Xi'an Jiaotong University College of Medicine were retrospectively analyzed. There were 29 males and 25 females with age of from 48 to 72 years old. The operative sites included the femur 38 patients(70.4%) and the humerus 16 patients (29.6%). Totally 54 patients underwent X-ray, CT, MRI and the whole body bone scan. Preoperative tissue biopsy was performed in 19 patients. The treatment plan was made by using the Tokuhashi score and sites of bone metastases. The Mirls scoring system was used to evaluate treatment decisions for the endangered fractures. Preoperative Tokuhashi scores were ≥12 in 31 patients, 9 to 11 in 8 patients, and ≤8 in 15 patients. The preoperative Mirls score was 9~11 points with an average of 10.3 points. In preoperative and postoperative 3 months, pain levels were assessed by visual analogue scale (VAS), The Karofsky performance score (KPS) was used to assess the physical status of the patients. The Musculoskeletal Tumor Society(MSTS) score was used to evaluate the postoperative functional status of the patients and Kaplan-Meier method was used for survival analysis.Results Thirty-five (64.8%) patients were diagnosed metastases by medical history data and imaging evaluations, the diagnostic consistency made sense between this method and postoperative pathology. Nineteen (35.2%) cases were diagnosed metastases by medical history, imaging assessment, and biopsy. Fifty-four patients were followed up for 4 to 36 months with an average of 18 months. During the follow-up period, 31 patients died of disease, and the average survival time was 10.5 (4.5 to 30) months. Twenty-three patients survived. Kaplan-meier survival analysis showed that the 6-month survival rate was 70.4%(35/54), the 1-year survival rate was 57.4%(31/54), and the 2-year survival rate was 46.2%(25/54). No complications occurred during the perioperative period. No complications such as internal fixation failure or pathological fractures occurred during the follow-up period. In preoperative and postoperative 3 months, the VAS showed statistical significance(t=4.085, P<0.01); The postoperative KPS score showed statistical significance(χ2=21.476, P＜0.01). MSTS score: average score 21.95 after 3 months, upper limb 20.54, lower limbs 23.36. The final good rate was 77.78%.Conclusions Medical history data assessment combined with detailed radiographic analysis can confirm the right diagnosis of most long bone metastases of the extremities. Surgical biopsy is required for difficult cases to diagnose. Appropriate surgical treatment can effectively relieve pain and improve patients' quality of life.
周海振, 杜娟娟, 同志超, 陈博, 邵宇雄, 陈秀锦. 四肢长骨转移瘤诊断和外科治疗分析[J]. 中华解剖与临床杂志, 2019, 24(1): 17-23.
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