股骨近端病理性骨折患者围手术期的临床特征分析

doi:10.19723/j.issn.1671-167X.2019.05.014

摘要/Abstract

摘要：

目的:分析股骨近端恶性肿瘤导致病理性骨折患者的围手术期临床特征,探讨病理性骨折对患者股骨近端假体置换围手术期治疗的影响。方法:回顾性分析北京大学第一医院骨科2011年1月至2017年2月期间收治的因股骨近端恶性肿瘤行股骨近端扩大切除、肿瘤半髋关节置换手术的患者共28例。根据骨折情况将患者分为骨折组和非骨折组,对比两组患者围手术期临床特征。结果:骨折患者占50.0%,两组间不同年龄、性别、受累肢体以及肿瘤病理类型间的差异无统计学意义。术前两组患者血红蛋白浓度、红细胞压积、下肢血栓间的差异无统计学意义(P>0.05),骨折组患者白蛋白低于非骨折组,差异有统计学意义(P=0.031)。两组患者术中出血、手术时间的差异无统计学意义(P>0.05)。两组患者术后第1天患者血红蛋白浓度、红细胞压积、白蛋白下降程度,以及术后引流管留置时间、术后引流总量、术后下地时间、术后住院日的差异无统计学意义(P>0.05)。术后第7天,骨折组患者血红蛋白浓度(P=0.025)、红细胞压积(P=0.039)低于非骨折组,差异有统计学意义。术中、术后7天内骨折组患者需输血的人数均多于非骨折组患者(术中:7/14 vs. 1/14,P=0.033;术后7天内:8/14 vs. 1/14,P=0.013)。以Gross公式计算围手术期总失血量(术后7天内),骨折组患者高于非骨折组患者[(2 066.3±419.8) mL vs. (786.0±152.6) mL, P=0.039]。骨折组患者术前Barthel日常生活能力评分低于非骨折组(P=0.009),视觉模拟评分(visual analogue scale,VAS)高于非骨折组(P<0.001),出院前两组患者上述评分间差异无统计学意义(P>0.05)。结论:股骨近端病理性骨折的患者围手术期白蛋白低,病理性骨折不增加患者手术时间、术中出血量以及围手术期功能恢复情况,但是骨折组患者围手术期的总失血量多于非骨折组患者,术后血红蛋白浓度、红细胞压积低于非骨折组,骨折组患者术中、术后需输血治疗的人数多于非骨折组。

关键词: 骨折, 自发性, 骨肿瘤, 股骨骨折, 围手术期

Abstract:

Objective: To investigate the perioperative clinical characteristics of patients with patholo-gical fracture of proximal femur. Methods: A retrospective study reviewed 28 patients who received proximal resection and tumor hemiarthroplasty for malignant proximal femoral tumor in Peking University First Hospital from January 2011 to February 2017. According to the fracture, the patients were divided into two groups: pathological fracture group and non-pathological fracture group. We investigated the clinical characteristics during perioperative period between the two groups. Results: Of the 28 patients, 14 (50.0%) patients suffered pathological fracture, and there was no significant difference between the two groups in the patient’s age, gender, limb involvement, and tumor source (P>0.05). There was no significant difference between the two groups in hemoglobin (HGB), hematocrit (Hct), and lower extremity thrombosis. The albumin (ALB) of pathological fracture group were lower in contrast to non-pathological fracture group (P=0.031). There was no significant difference between the two groups in decline of HGB and Hct on postoperation day 1, operative time, bleeding during operation, time for walking with help of ambulation aid postoperative, and postoperative hospital stay (P>0.05). On post-operation day 7, HGB (P=0.025) and Hct (P=0.039) of pathological fracture group were significant lower in contrast to non-pathological fracture group. Whereas, the total blood loss calculated by Gross equation of pathological fracture group was significant higher in contrast to non-pathological fracture group [(2 066.3±419.8) mL vs. (786.0±152.6) mL, P=0.039]. The patient needed blood transfusion during operation (7/14 vs. 1/14, P=0.033) and postoperative (8/14 vs. 1/14, P=0.013) in pathological fracture group were more than in non-pathological fracture group. At last, Barthel daily life ability score (P=0.009) of pathological fracture group was lower in contrast to non-pathological fracture group, and visual analogue scale (VAS) score was higher (P<0.001). They were almost equal when the patients were discharged (P>0.05). Conclusion: Patients with pathological fracture had lower ALB during perioperative period. Pathological fracture had no effect on operative time, bleeding during operation and function outcomes. However, the patients with pathological fracture had more total blood loss and lower HGB, Hct in contrast to the patients without pathological fracture. Blood transfusion was more needed in pathological fracture patients.

Key words: Fractures, spontaneous, Bone neoplasms, Femoral fractures, Perioperative period

中图分类号:

R683.42

崔云鹏,米川,王冰,潘元星,林云飞,施学东. 股骨近端病理性骨折患者围手术期的临床特征分析[J]. 北京大学学报（医学版）, 2019, 51(5): 875-880.

Yun-peng CUI,Chuan MI,Bing WANG,Yuan-xing PAN,Yun-fei LIN,Xue-dong SHI. Perioperative clinical characteristics of patients with pathological fracture of proximal femur[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 875-880.

图/表 4

图1

表1

28例股骨近端肿瘤患者术前临床特征"

Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Age/years, $x ?$ ±s	63.6±3.5	59.6±2.9	0.210^b
Female, n (%)	7 (50.0)	4 (28.6)	0.440^c
Left limb involvement, n (%)	5 (35.7)	10 (71.4)	0.128^c
Lower extremity thrombosis, n (%)			>0.999^c
Deep venous thrombosis	0	0
Inter-muscular venous thrombosis	2 (14.3)	1 (7.1)
Tumor source, n			0.678^c
Primary tumor	5	3
Metastatic tumor	9	11
VAS score, $x ?$ ±s	8.2±0.2	4.0±0.3	<0.001^b
Barthel daily life ability score, $x ?$ ±s	33.2±4.5	60.6±9.1	0.009^a
HGB/(g/L), $x ?$ ±s	113.0±6.2	127.4±5.1	0.087^a
Hct/%, $x ?$ ±s	33.1±1.8	37.0±1.5	0.103^a
ALB/(g/L), $x ?$ ±s	35.6±1.5	40.1±1.2	0.031^a
Pre-ALB/(mg/L), $x ?$ ±s	186.5±22.5	244.0±18.1	0.056^a

表1

表2

28例股骨近端肿瘤患者手术治疗情况"

Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Operative time/min, $x ?$ ±s	214.3±20.8	188.6±9.9	0.194^b
Bleeding during operation/mL, $x ?$ ±s	953.4±332.9	414.3±66.0	0.246^b
Blood transfusion during operation, n (%)	7 (50.0)	1 (7.1)	0.033^c

表2

表3

28例股骨近端肿瘤患者术后恢复情况"

Items	Pathological fracture (n=14)	Non-pathological fracture (n=14)	P value
Short-term prognosis
Time for walking with help of ambulation aid/d, $x ?$ ±s	15.8±1.2	14.3±0.9	0.333^a
Postoperative hospital stay/d, $x ?$ ±s	18.5±1.8	18.8±1.8	0.910^a
VAS score-discharge, $x ?$ ±s	2.9±0.2	2.6±0.1	0.482^b
VAS score decline, $x ?$ ±s	5.4±0.3	1.4±0.2	<0.001^b
Barthel daily life ability score-discharge, $x ?$ ±s	38.8±2.9	42.9±5.5	0.477^a
Drainage
Time/d, $x ?$ ±s	6.3±0.8	4.1±0.3	0.069^b
Volume/mL, $x ?$ ±s	759.8±158.2	380.3±60.4	0.085^b
Laboratory examination of postoperation day 1
HGB/(g/L), $x ?$ ±s	93.8±4.2	106.5±4.7	0.055^a
HGB decline/(g/L), $x ?$ ±s	19.2±3.9	20.9±3.2	0.745^a
Hct/%, $x ?$ ±s	27.2±1.2	30.9±1.2	0.042^a
Hct decline/%, $x ?$ ±s	5.9±1.1	6.1±1.2	0.893^a
ALB/(g/L), $x ?$ ±s	27.8±1.0	31.8±1.2	0.018^a
ALB decline/(g/L), $x ?$ ±s	7.6±1.1	8.5±1.0	0.594^a
Laboratory examination of postoperation day 7
HGB/(g/L), $x ?$ ±s	90.0±5.3	107.6±5.0	0.025^a
Hct/%, $x ?$ ±s	26.3±1.7	30.9±1.2	0.039^a
Total perioperative blood loss/mL, $x ?$ ±s			0.164^b
Postoperation day 1	1 219.0±203.6	781.4±118.4	0.164^b
Postoperation day 7	2 066.3±419.8	786.0±152.6	0.030^b
Blood transfusion postoperation within 7 days, n (%)	8 (57.1)	1 (7.1)	0.013^c

表3

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