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

Abstract

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

CLC Number:

R683.42

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.

Figures/Tables 4

Figure 1

Table 1

Preoperative clinical characteristic of 28 patients with proximal femoral tumor"

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

Table 1

Table 2

Surgical treatment of 28 patients with proximal femoral tumor"

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

Table 2

Table 3

Postoperative recovery of 28 patients with proximal femoral tumor"

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

Table 3

References 29

[1]	Sumathi VP, Jeys L, Legdeur N . Metastatic tumours of bone[J]. Surgery (Oxford), 2012,30(2):80-85.
[2]	Costa L, Badia X, Chow E , et al. Impact of skeletal complications on patients’ quality of life, mobility, and functional independence[J]. Support Care Cancer, 2008,16(10):879-889.
[3]	Harvey N, Ahlmann ER, Allison DC , et al. Endoprostheses last longer than intramedullary devices in proximal femur metastases[J]. Clin Orthop Relat Res, 2012,470(3):684-691.
[4]	杨毅, 郭卫, 尉然 . 两种方式重建股骨近端转移癌患者的围手术期安全性比较[J]. 中国骨与关节外科, 2013,6(3):214-218.
[5]	Steensma M, Boland PJ, Morris CD , et al. Endoprosthetic treatment is more durable for pathologic proximal femur fractures[J]. Clin Orthop Relat Res, 2012,470(3):920-926.
[6]	Wedin R, Bauer HC . Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosjournal or reconstruction nail?[J]. J Bone Joint Surg, 2005,87(12):1653-1657.
[7]	Ratasvuori M, Wedin R, Hansen BH , et al. Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases[J]. J Surg Oncol, 2014,110(4):360-365.
[8]	Hobusch GM, Bollmann J, Puchner SE , et al. What sport activity levels are achieved in patients after resection and endoprosthetic reconstruction for a proximal femur bone sarcoma?[J]. Clin Orthop Relat Res, 2016,475(3):1-10.
[9]	Guzik G . Treatment outcomes and quality of life after the implantation of modular prostheses of the proximal femur in patients with cancer metastases[J]. Ortop Traumatol Rehabil, 2016,18(3):231-238.
[10]	Peterson JR, O’Connor IT, Topfer J, et al. Functional results and complications with long stem hemiarthroplasty in patients with metastases to the proximal femur[J]. J Am Coll Surgeons, 2016,223(4):e150.
[11]	Calabró T, Rooyen RV, Piraino I , et al. Reconstruction of the proximal femur with a modular resection prosjournal[J]. Eur J Orthop Surg Traumatol, 2016,26(4):415-421.
[12]	Peterson JR, Decilveo AP, O’Connor IT, et al. What are the functional results and complications with long stem hemiarthroplasty in patients with metastases to the proximal femur?[J]. Clin Ortho Relat Res, 2017,475(3):745-756.
[13]	Houdek MT, Watts CD, Wyles CC , et al. Functional and oncologic outcome of cemented endoprosjournal for malignant proximal femoral tumors[J]. J Surg Oncol, 2016,114(4):501-506.
[14]	Thambapillary S, Dimitriou R, Makridis KG , et al. Implant longevity, complications and functional outcome following proximal femoral arthroplasty for musculoskeletal tumors: a systematic review[J]. J Arthroplasty, 2013,28(8):1381-1385.
[15]	Janssen SJ, Teunis T, Hornicek FJ , et al. Outcome after fixation of metastatic proximal femoral fractures: A systematic review of 40 studies[J]. J Surg Oncol, 2016,114(4):507-519.
[16]	Houdek MT, Wyles CC, Labott JR , et al. Durability of hemiarthroplasty for pathologic proximal femur fractures[J]. J Arthroplasty, 2017,32(12):3607-3610.
[17]	Zoccali C, Attala D, Uccio ASD , et al. The dual mobility cup in muscular skeletal oncology: rationale and indications[J]. Int Orthop, 2017,41(3):447-453.
[18]	Gross JB . Estimating allowable blood loss: corrected for dilution[J]. Anesthesiology, 1983,58(3):277-280.
[19]	Liu X, Zhang X, Chen Y , et al. Hidden blood loss after total hip arthroplasty[J]. J Arthroplasty, 2011,26(7):1100-1105.
[20]	Kumar A, Torres ML, Cliby WA , et al. Inflammatory and nutritional serum markers as predictors of peri-operative morbidity and survival in ovarian cancer[J]. Anticancer Res, 2017,37(7):3673-3677.
[21]	Goh SL, De Silva RP, Dhital K , et al. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?[J]. Interact Cardiovasc Thorac Surg, 2015,20(1):107-113.
[22]	Musallam KM, Tamim HM, Richards T , et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study[J]. Lancet, 2011,378(9800):1396-1407.
[23]	Fowler AJ, Ahmad T, Phull MK , et al. Meta-analysis of the association between preoperative anaemia and mortality after surgery[J]. Br J Surg, 2015,102(11):1314-1324.
[24]	Rasouli MR, Restrepo C, Maltenfort MG , et al. Risk factors for surgical site infection following total joint arthroplasty[J]. J Bone Joint Surg Am, 2014,96(18):e158.
[25]	周宗科, 翁习生, 向兵 , 等. 中国髋、膝关节置换术加速康复——围术期贫血诊治专家共识[J]. 中华骨与关节外科杂志, 2016,9(1):10-15.
[26]	Mirels H . Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures[J]. Clin Orthop Relat Res, 1989,249:256-264.
[27]	Damron TA, Morgan H, Prakash D , et al. Critical evaluation of Mirels’ rating system for impending pathologic fractures[J]. Clin Orthop Relat Res, 2003(415 Suppl):S201-S207.
[28]	Damron TA, Nazarian A, Entezari V , et al. CT-based structural rigidity analysis is more accurate than Mirels scoring for fracture prediction in metastatic femoral lesions[J]. Clin Orthop Relat Res, 2016,474(3):643-651.
[29]	Ulaner GA, Zindman AM, Zheng J , et al. FDG PET/CT assesses the risk of femoral pathological fractures in patients with metastatic breast cancer[J]. Clin Nucl Med, 2017,42(4):264-270.

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Perioperative clinical characteristics of patients with pathological fracture of proximal femur

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