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April 24, 2026Orthopedics & Traumatology0 citationsOpen Access

骨硬化のため髄内釘手術に難渋した大腿骨近位部転移性骨腫瘍の2症例

俊福俊 福島信横信彦 横山宇薛宇孝 薛

Key Points

  • To report two cases of difficult intramedullary nailing in femoral metastatic tumors due to bone sclerosis.
  • Presented two cases involving patients with bone metastasis from breast cancer.
  • Described surgical approaches, including direct reaming and wire fixation, due to challenges with bone sclerosis.
  • Monitored surgical time and blood loss during procedures.
  • Both cases involved significant bone sclerosis complicating intramedullary nail insertion.
  • Surgical times were 224 minutes and 279 minutes, with blood loss of 210ml and 200ml respectively.
  • The addition of wire fixation was needed in one case due to fracture during nail insertion.

Abstract

【はじめに】骨硬化のため髄内釘手術に難渋した大腿骨近位部病的骨折の2症例を報告する．【症例1】79歳女性．乳癌，多発骨転移．右大腿骨転移性骨腫瘍，右大腿骨転子下病的骨折．骨折受傷までに，6年6か月の骨修飾薬投与歴あり．著明な骨硬化で玉付きガイドワイヤーが骨折部を通過せず，骨折部を展開し直接髄腔を削開して髄内釘を留置した．手術時間224分，出血210ml．【症例2】60歳女性．乳癌，多発骨転移．右大腿骨転移性骨腫瘍，右大腿骨転子下病的骨折．骨折受傷までに，3年9か月の骨修飾薬投与歴あり．著明な骨硬化のため髄腔のリーミングに難渋し，また髄内釘挿入時に遠位骨片前方に骨折をきたしたため，ワイヤー固定を追加した．手術時間279分，出血200ml．【考察】病的骨折の骨接合術においては，髄内釘の挿入が困難な症例がある．術前の画像評価や，内固定材料の選択には細心の注意を払う必要がある．

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Cite This Study

福島 et al. (2026) studied this question.

synapsesocial.com/papers/69eb0803553a5433e34b3413https://doi.org/10.5035/nishiseisai.75.337
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