PURPOSE OF THE STUDY The paper focuses on the potential use of nail osteosynthesis in diaphyseal metastases of long bones. The purpose of the paper is to assess the outcomes of intramedullary osteosynthesis in pathologic and impending pathologic fractures, to evaluate patient survival and potential complications. MATERIAL AND METHODS The retrospective study evaluated a cohort of 42 patients (19 men and 23 women) in whom intramedullary osteosynthesis was performed for complete pathologic fracture (28 patients) or impending pathologic fracture (14 patients) between 2010 and 2019. Of the total number of 42 patients, 31 patients' lower limbs were affected, namely by 17 pathologic fractures and 14 impending fractures. There were 11 humerus fractures. The mean age was 61.8 years (range 41-84 years). In the followed-up cohort, the patient survival after osteosynthesis with intramedullary nails, complications occurred and post-operative mobility of the patient were assessed. The functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system. The unpaired Mann-Whitney test was used to test the significance of the difference in functional outcomes and survival between the followed-up groups. Survival longer than 6 months was evaluated using Fisher's exact test. The level of statistical significance used for the test was p 0.05. RESULTS The investigated indicator was patient survival, which was 11.3 months (range 1-50 months) on average. In the group of impending fractures, the mean survival was 13.5 months. In the group of pathologic fractures, the survival was 10 months. The functional outcome in 16 followed-up patients at three months after intramedullary osteosynthesis according to the MSTS score was 46.9% (30-66.7%). At the level of significance of p 0.05, the statistically significant difference in the functional outcomes between the group with preventive intramedullary osteosynthesis and the group with nail osteosynthesis of the pathologic fracture was not confirmed (p=0.952). When comparing the patient survival after nail osteosynthesis with impending pathologic fracture and the survival of patients with pathologic fracture, a statistically significant difference in survival between these two groups (p=0.520) was not confirmed. The patient survival of longer than 6 months was 71% in the group of impending fractures and 40% in the group of pathologic fractures. DISCUSSION The occurrence of pathologic fracture is associated with increased pain, loss of function, and according to some authors, a higher risk of death. Surgical treatment options include intramedullary osteosynthesis, plate osteosynthesis with cement filling, implantation of an intercalary spacer, and implantation of tumor endoprostheses. When deciding on a surgical procedure, an account is taken of the expected survival of the patient. In patients with an expected survival of up to 6 months, intramedullary osteosynthesis is indicated as a palliative surgical intervention. The most common complications include implant failure and metastatic progression. CONCLUSIONS Intramedullary osteosynthesis is the method of choice in treating pathologic fractures or impending pathologic diaphyseal fractures of long bones in patients with an expected predicted survival of up to 6 months. Intramedullary osteosynthesis aims to reduce pain and enable early verticalization. The study confirmed the importance of preventive intramedullary osteosynthesis and its effect on survival compared to the survival of patients with a pathologic fracture. Key words: skeletal metastases, diaphyseal metastases, intramedullary osteosynthesis, pathologic fracture, impending fracture.
- MeSH
- dospělí MeSH
- fraktury humeru * chirurgie MeSH
- fraktury spontánní * etiologie patologie chirurgie MeSH
- intramedulární fixace fraktury * škodlivé účinky metody MeSH
- kostní hřeby škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory * komplikace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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x
- Klíčová slova
- distální jištění,
- MeSH
- chirurgie s pomocí počítače metody MeSH
- diafýzy * chirurgie zranění MeSH
- fraktury kostí * chirurgie MeSH
- intramedulární fixace fraktury MeSH
- lidé MeSH
- vnitřní fixace fraktury metody MeSH
- výzkum MeSH
- Check Tag
- lidé MeSH
Úvod: Cílem naší studie bylo porovnání funkčního výsledku a radiografického postavení unikompartmentální náhrady kolenního kloubu (UKA) s využitím konvenčního nenavigovaného operačního postupu a pomocí počítačem asistované navigace. Metoda a materiál: Na našem pracovišti jsme od roku 2005 do roku 2012 implantovali 106 UKA. K implantaci bylo využito dvou typů UKA, 67 náhrad The PRESERVATION (DePuy) s využitím navigace a 39 náhrad Oxford Partial Knee (Biomet) bylo implantováno konvenční operační technikou. Bylo hodnoceno 104 mediálních UKA rozdělených do dvou skupin: konvenční operační technika a počítačem asistovaná operační technika. Hodnoty získané z pooperačního radiografického měření byly spárovány s funkčním výsledkem, který byl hodnocen podle The Knee Society Clinical Rating System (Knee score). Výsledky: Knee score skupiny operované pomocí navigace se zlepšilo z 58 předoperačně na 93 pooperačně. Knee score skupiny s konvenčním postupem se zlepšilo z 56 předoperačně na 91 pooperačně. Závěr: Počítačem asistovaná navigace umožňuje přesnější implantaci femorální i tibiální komponenty než konvenční operační technika. Přesto jsou pooperační funkční výsledky srovnatelné.
Introduction: The aim of our study was to compare the clinical outcome and radiographic alignment of unicompartmental knee arthroplasty (UKA) performed either with the use of conventional non-navigation technique or using computer-assisted navigation technique. Materials and Methods: At our department, we have performed 106 UKAs between 2005 and 2012. Two types of UKA transplants were used, 67 of UKAs were performed using The PRESERVATION (DePuy) with navigation and 39 UKAs used Oxford Partial Knee (Biomet.) and were performed using the conventional technique. We have evaluated 104 medial UKAs, divided into groups: conventional non-navigation technique and computer-assisted navigation technique. Postoperative radiographic measurement was performed and results were matched with clinical outcome postoperatively. This assessment was performed using The Knee Society Clinical Rating System (Knee score). Results: The group in whose cases navigation technique was used marked an improved Knee score from mean 58 preoperatively to 93 postoperatively. The "conventional" group's UKA Knee mean score improved from 56 preoperatively to 91 postoperatively. Conclusion: Computer-assisted navigation enables more exact alignment of the femoral and tibial component than conventional technique. In spite of this fact, the clinical outcome is comparable.
- Klíčová slova
- unikompartmentální náhrada,
- MeSH
- artróza kolenních kloubů chirurgie MeSH
- biomechanika MeSH
- chirurgie s pomocí počítače MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- protézy kolene klasifikace statistika a číselné údaje MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene metody statistika a číselné údaje MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
