四肢長管骨骨幹部転移性骨腫瘍に対するアドリアマイシン混入セメントを併用した髄内釘による治療

Surgical Treatment of Metastatic Lesions in the Shafts of the Long Bones of the Extremities with Intramedullary Nails and Adriamycin-Containing Bone Cement

　抄録：四肢長管骨転移性骨腫瘍に対しアドリアマイシン混入セメント（以下ADMセメント）を併用し髄内釘固定を行った8例を検討した．原発巣は乳癌4例，肺癌，食道癌，卵巣癌，多発性骨髄腫が各1例である．手術時の出血量は平均494ml，輸血量は平均3.25U（MAP）であった．4例が術後1年以内に死亡した．ADLは術前に比し低下した症例はなく，特に術前寝たきり症例において大幅な改善が得られ，終末期まで高いADLが維持できた．またADMセメントを併用することにより局所病変の進行が抑えられ，固定力も増強させることができた．転移性骨腫瘍に対する手術では局所根治性よりも低侵襲で高いQOLの獲得が目標であるが，予想される予後に応じて手術法を決定しなければならない．ADMセメントを併用した髄内釘固定は四肢長管骨骨幹部転移性骨腫瘍に対する外科的治療の一方法として有用である．

　Intramedullary nails and adriamycin-containing bone cement were used in eight patients after resection or curettage of metastatic lesions in the shafts of long bones in their extremities. Breast cancer was the most common primary lesion, having been diagnosed in four patients, and the other primary lesions were lung cancer, esophageal cancer, ovarian cancer, and multiple myeloma, in one patient each. Surgical stress, limb function, and postoperative ADL were retrospectively evaluated in all eight patients. Average intraoperative blood loss was 494ml, and the average blood transfusion volume was 3.25U (MAP). Average operation time was 3 hours 36 minutes. No patients experienced complications, such as pulmonary infarction, surgical wound infection, or side effects of the adriamycin. Four patients died within a year after surgery. None of the patients experienced a decline in ADL after surgery. The patients who were bedridden before surgery learned to move, stand up, or walk by themselves after surgery, and their limb function was maintained until their physical condition deteriorated. No patients experienced local recurrence, nail loosening, or damage by the nail. The goal of treatment for patients with metastatic bone tumors should be to achieve of functional improvement. Surgical treatment with intramedullary nails and adriamycin-containing bone cement is a useful method for treating metastatic lesions in the shafts of long bones in the extremities.