Die chirurgisch-orthopädische Behandlung von Knochenmetastasen

Zusammenfassung

Osteolytische Zerstörungen des Knochens aufgrund von Metastasen verursachen bei den Patienten signifikante Morbidität und Mortalität. Mit einem verbesserten Überleben durch die gegenwärtigen onkologischen Behandlungen wird eine frühzeitige Intervention zur effektiven Rekonstruktion von skelettalen Zerstörungen immer wichtiger. Neben der Versorgung mit Tumorendoprothesen spielt die Rekonstruktion des Knochens mit Zement eine wichtige Rolle. In Verbindung mit Osteosytheseverfahren können am Becken und an peripheren Knochen stabile Situationen erreicht werden, die durchaus eine Langzeitfunktionalität gewährleisten. Die Augmentation mit Zement an der Wirbelsäule hat als ein minimalinvasives Verfahren zunehmend an Akzeptanz bei der Behandlung von osteoporotischen und tumorbedingten Frakturen gewonnen. An der Wirbelsäule werden immer mehr thermische Ablationsverfahren zur Bekämpfung der Schmerzen und lokalen Tumorkontrolle eingesetzt. Die perkutane vertebrale Augmentation durch Zement, mit und ohne Ablation, wie auch die Verbund osteosynthese von Knochendefekten erbringen gute Erfolge in der palliativen Situation dieser schwerkranken Patienten und verbessern ihre Lebensqualität deutlich. Der Einsatz von modernen chirurgischen Verfahren zur Rekonstruktion von Knochendefekten entspricht den Zielen, die von einer palliativen Therapie gefordert werden müssen. Unkomplizierte Durchführung, schneller Wirkungs - eintritt, lang anhaltende Wirkung, geringe Morbidität.

Summary

Skeletal metastases are the most frequent complication of malignant tumours, and are associated with severe pain and pathologic fractures. Although treatment for metastatic bone lesions does not alter life expectancy, preventing fractures can improve the quality of life of the cancer patient. Patients with metastatic disease to the bone are a clinical challenge. There are multiple therapeutic options available for treatment, including systemic therapy with antiosteoclastic compound, radiation, and surgery. Treatment should reflect the patient’s biology of the underlying tumour, overall prognosis and life expectancy. Maintenance of function and quality of life are the predominant goals in treating these patients. The most devastating complications in those patients with metastatic bone disease are impending or pathologic fractures and neurologic compromise secondary to cord compression. The surgical intervention aims for removal of the tumour and subsequently reconstruction of the defect. The ability to bear weight immediately following surgery is important, because these patients have a shorter life expectancy. Therefore the procedure should be “save, short, and simple”. The interdisciplinary approach of appropriate surgical intervention, systemic therapy and radiation therapy achieves the best results of pain relief and control, and functional preservation in patients with metastatic bone disease of nonosseous primary cancers. Many patients do not receive an optimal treatment for their metastatic bone lesions. Clinician awareness of the various therapeutic options and their indications, and aggressive advocacy of quality of life for these patients, can improve the care delivered to people with metastatic bone disease.

Schlüsselwörter

Knochenmetastasen - Osteosynthese - Augmentation - Tumorablation

Keywords

Skeletal metastases - osteosynthesis - augmentation - tumour ablation

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