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目的 探讨髓内钉联合辅助钢板骨水泥在四肢长骨转移性肿瘤所致病理性骨折姑息性治疗中的应用.方法 2015年4月-2016年10月,应用髓内钉联合辅助钢板骨水泥治疗四肢长骨转移性肿瘤导致的病理性骨折11例.其中,男6例,女5例;年龄54～ 72岁,平均62.9岁.肿瘤转移至肱骨4例,股骨6例,胫骨1例;肿瘤浸润长度3.3 ～ 5.6 cm,平均4.6 cm,深度可达患肢骨质全层.术前均有患肢疼痛并日常活动能力丧失.病程1.0～1.5个月.术前疼痛视觉模拟评分(VAS)为(6.36±1.03)分,Karnofsky功能状态评分(KPS)为(42.73±10.09)分.记录患者手术时间、术中失血量、术后并发症发生情况.术后3个月通过VAS评分、KPS评分及国际肌肉骨骼肿瘤学会(MSTS)评分评定临床疗效.结果 手术时间1.1 ～ 1.8h,平均1.5 h;术中失血量102.5～ 211.3 mL,平均135.6 mL.术后患肢切口均Ⅰ期愈合,无感染、坏死、延迟愈合等并发症发生.11例患者术后均获随访,随访时间7～ 10个月,平均8.2个月.术后3个月,患肢全部恢复日常活动功能.VAS评分降至(0.82±0.75)分、KPS评分升高至(85.45±5.22)分,与术前比较差异均有统计学意义(t=35.218,P=0.000;t=-18.470,P=0.000);MSTS评分为(23.91±2.47)分.末次随访时,患肢正侧位X线片示无髓内钉及钢板断裂,无骨水泥松动、肢体短缩及对线不良等并发症发生.结论 采用髓内钉联合辅助钢板骨水泥内固定治疗四肢长骨转移性肿瘤导致的病理性骨折,能在保证患肢长度及对线不变的前提下,清除病灶并恢复患肢骨生物力学稳定性,减轻患者疼痛,提高其生存质量.“,”Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors.Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed.All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement.There were 6 males and 5 females with an age of 54-72 years (mean,62.9 years).The disease duration was 1.0-1.5 months.Of the 11 patients,4 metastatic tumors were diagnosed at humerus,6 at femur,and 1 at tibia,respectively.And the tumor infdtration length ranged from 3.3 to 5.6 cm (mean,4.6 cm),the depth could reach the bilayer of limb bones.All the patients had suffered the limbs pain and incapability of physical movement.The preoperative visual analogue scale (VAS) score was 6.36±1.03,and the Karnofsky Performance Status (KPS) score was 42.73±10.09.The operation time,intraoperative blood loss,and postoperative complications were recorded.The VAS score,KPS score,and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation.Results The operation time was 1.1-1.8 hours (mean,1.5 hours),the intraoperative blood loss was 102.5-211.3 mL (mean,135.6 mL).Postoperative limb incisions healed well without infection,necrosis,and delayed healing or other complications.All the patients were followed up 7-10 months (mean,8.2 months).At 3 months after operation,the functions of limbs recovered.The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22,both showing significant difference when compared with preoperative ones (t=35.218,P=0.000;t=-18.470,P=0.000);and the MSTS score was 23.91±2.47.At last follow-up,the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate,or loosening in bone cement,limb shortening,malalignment,or other complications occurred.Conclusion In treating metastatic tumors of extremities,the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs,resulting in biomechanical stability for skeleton.Under this premise,the tumor lesions can be eliminated and pathological pains be relieved,so as to improve patients' life quality.