Surgical Management Of Metastasis In Mroximal Femur

Background:The proximal femur is one of the predilection sites for metastatic cancers,and the risk of pathologic fractures is high here because of its structural specificity(cantilever structure)and high-intensity biomechanical load in this area.The traditional view that bone metastases are advanced disease,due to the limited survival of patients advocate the application of as simple as possible surgery to solve patient pain and function problems.However,due to the complex condition of patients with bone metastases and the uncertain timing of survival,the choice of the best therapeutic strategy is affected.Objective:We conducted this retrospective study to evaluate the efficacy of tumor resection + endoprosthetic replacement(EPR)and proximal femoral lesions curettage of bone cement placement + intramedullary nailing(IMN)in the treatment of proximal femoral metastatic carcinoma.To provide some reference for the treatment of proximal femoral metastases.Materials and Methods:This article retrospectively analyzed 68 cases of proximal femur bone metastases from September 2015 to November 2018 in the Chinese-JapaneseUnite Hospital of Jilin University from which 30 patients were eligible.18 patients underwent EPR treatment and 12 patients underwent IMN treatment.Among them,10 cases of lung cancer,8 cases of breast cancer,liver cancer in 2 cases,thyroid cancer in 4 cases,2 cases of renal cancer,4cases of prostate cancer,pathological fracture occurred in 22 cases,the verge of fracture in 8 cases.Statistical methods:Statistical analysis SPSS21.00 software was used to analyze.Preoperative Karnofsky performance score(KPS),preoperative and postoperative pain score(VAS score),surgical incision length,operation time,surgical bleeding volume,Time,postoperative functional score(MSTS score)and perioperative complications,P <0.05 was considered statistically significant.Result:The operation was stable in 30 patients with an average follow-up of16.4 months(range 9-24 months).The same pain control effect(p=0.862)was achieved in both surgical regiments..The length of incision,operation time and bleeding amount in IMN group were all less than EPR group(P =0.001,P = 0.002,P = 0.001).The average postoperative IM time was lower in the IMN group than in the EPR group(P = 0.000).At 3 months,the hip score was better in the IMN group than in the EPR group(p = 0.002).There was nosignificant difference in IMN and EPR at 6 months and 12 months(p = 0.21,p = 0.169).Conclusion:Both EPR and IMN are important repair and reconstruction methods for proximal femoral metastasis.In the same condition of preoperative functional status and pain score,the same pain control effect was achieved in both surgical approaches.EPR group was larger than IMN group in surgical trauma.Early postoperative functional IMN group was superior to EPR group.Therefore,the appropriate surgical procedure depends on the patient's state of health.IMN is recommended for patients with short-lived proximal femur metastases,and EPR should be a better choice for patients with longer estimated survival.