Levent ERALP, Harzem ÖZGER, Adnan KARAOĞLU, Eray BOZAN

Kalça bölgesi metastatik kemik lezyonlarının cerrahi tedavi sonuçları

Amaç: Kliniğimizde kalça çevresi kemik metastazları na bağlı kırık tehdidi veya patolojik kırık olan hastaların, çeşitli internal fiksasyon ve artroplasti yöntemleriyle yapılan cerrahi tedavileri ve tedavi sonuçları de- ğerlendirildi. Çalışma planı: Kalça bölgesinde metastatik patolojiye bağlı kırık tehdidi veya patolojik kırık nedeniyle cerrahi olarak tedavi edilen 34 hastanın (36 kalça) raporlar› retrospektif olarak incelendi. Hasta grubunun (21 kadın, 13 erkek) yaş ortalaması 53.2 (dağılım 18-80) idi. Tanıların büyük çoğunluğunu meme karsinomu ve renal karsinom metastazları oluşturuyordu. İstisnalar dışında, subtrokanterik bölge yerleflimli lezyonlar ikinci kuflak statik kilitli intramedüller çivileme, diğer hastalar çeşitli formlarda endoprostetik rekonstrüksiyonlar ile tedavi edildi. Sonuçlar: Tüm hastalarda ameliyat öncesine göre ağrı tedavisi ve ambulasyon seviyesi parametrelerinde çeşitli oranlarda düzelme sağlandı. Perioperatif mortalite ve mekanik implant komplikasyonuna rastlanmadı. Dört hastada ortaya çıkan derin ven trombozu veya yüzeyel enfeksiyon tarzındaki komplikasyonlar medikal tedavi ile geriledi. Çıkarımlar: Metastatik femur lezyonu ile baflvuran hastalarda yapılacak cerrahi tedaviler bu hastaların sağkalım- larını artırmasa da, hastanın ağrısını azaltacak, ambulasyon yeteneğini artıracak, dolayısıyla kısıtlı sağkalım süresi dahilinde hayat kalitesini yükseltecektir.

Anahtar Kelimeler:

Kemik çivileri, Yük verme, Kalça kırıkları, Femur boynu kırıkları, Asetabulum, Protezler ve implantlar, Kemik neoplazmları, Kırık tespiti, Metilmetakrilat

Results of surgical management in patients with metastasis to the hip

Objectives: We evaluated surgical methods and results in patients who were treated by various internal fixation and arthroplastic methods for impending or pathological fractures around the hip joint due to symptomatic bone metastasis. Methods: The study included 34 patients (36 hips) who were treated with surgical therapy for metastatic hip pathologies. Twenty-one patients were males, and 13 patients were females. Their mean age was 53.2 years (range 18 to 80 years). Most of the lesions were metastases of breast or kidney carcinomas. Apart from some exceptions, subtrochanteric lesions were fixed by second generation, statically locked intramedullary rods; other lesions were reconstructed by endoprosthetic replacement. Results: Postoperatively, alleviation of pain and improvement in ambulation levels were achieved in all patients. No perioperative mortality and implant failure were encountered. Complications included deep venous thrombosis (n=2) and superficial infection (n=2) and were treated with appropriate medical treatment. Conclusion: Although the operative interventions to reconstruct metastatic lesions around the hip will not contribute directly to the patients' survival, they may decrease their pain, improve both their ambulation and quality of life.

Keywords:

Bone Nails, Weight-Bearing, Hip Fractures, Femoral Neck Fractures, Acetabulum, Prostheses and Implants, Bone Neoplasms, Fracture Fixation, Methylmethacrylate,

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