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2017 г. №2 Том 25

ТРАВМАТОЛОГИЯ И ОРТОПЕДИЯ

A.I. RADCHENKO, A.G. ZHUKOVEC, Y.M. BOGDAEV

Osteosynthesis in surgical treatment of metastatic lesions of long tubular bones

SE “Republican Scientific and Practical Center of Oncology
and Medical Radiology Named after N.N.Alexandrov”, Minsk,
The Republic of Belarus

Objectives. This study was designed to investigate the causes and risk factors of complications requiring revision surgeries after intramedullary and plate osteosynthesis of the long tubular bones affected by metastases.
Methods. Surgical treatment outcomes of patients with long tubular bones metastases (n=44) were analyzed retrospectively. Twelve patients had solitary skeletal metastasis, eleven – multiple, twenty one – bone metastases combined with visceral metastases. The pathological fracture was diagnosed in 35 patients and the threat of the pathological fracture – in 9. Intramedullary osteosynthesis was carried out in 34 cases, plate osteosynthesis – in 3 cases, intramedullary osteosynthesis with alloplasty – in 12 cases.
Results. Application of OS in the metastatic treatment of malignant tumors in long tubular bones have allowed saving the extremity function in 75% cases; the revision organ-saving surgery was carried out in 14,6% observations; restoration of the extremity function was failed in 10,4% cases. Thirteen complications caused by bone metastases required the revision surgery. Median time was 6 months (range of 1-12 months). The causes of complications included local tumor progression, the absence of osseous consolidation and violation of the structural integrity. Risk factors of complications development which require the revision surgeries were the following: pathologic fracture (p=0,046), progressive renal cell carcinoma (p=0,013) and radiation therapy before surgery (p=0,029). In patients with the best life prognosis the complications related with violation of the metal construction integrity or bone fixation failure have developed in longer and active load on the extremity.
Conclusion. Osteosynthesis appears to be an efficient method in the treatment of metastatic bone disease in the specific clinical cases. Radical surgical removal of the metastases with the elimination of the bone defect by allograft or endoprosthesis is more reasonable in case of solitary metastases of radio-resistant tumors and controlled tumor process.

Ключевые слова: metastases, long tubular bones, osteosynthesis, radical surgical removal, bone fixation failure, complications, mortality
с. 155-162 оригинального издания
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Адрес для корреспонденции:
223040, Republic of Belarus, Minsk
region, Lesnoy settl.,
EE «N.N. Alexandrov National Cancer Centre
of Belarus for Oncology and Medical Radiology».
Laboratory of oncological pathology
of the central nervous system with a group
of oncological pathology of the head and neck,
Tel.: 375447724255
e-mail: Aradchenko@mail.ru
Artem I. Radchenko
Cведения об авторах:
Радченко А.И., научный сотрудник лаборатории онкопатологии центральной нервной системы с группой онкопатологии головы и шеи ГУ «Республиканский научно-практический центр онкологии и медицинской радиологии им. Н.Н. Александрова».
Жуковец А.Г., к.м.н., руководитель лаборатории онкопатологии центральной нервной системы с группой онкопатологии головы и шеи ГУ «Республиканский научно-практический центр онкологии и медицинской радиологии им. Н.Н. Александрова».
Богдаев Ю.М., к.м.н., заведующий отделением реконструктивно-восстановительной хирургии ГУ «Республиканский научно-практический центр онкологии и медицинской радиологии им. Н.Н. Александрова».
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