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Metastasen der Extremitäten

Übersicht über operative Versorgungsstrategien

Metastatic disease in long bones

Review of surgical treatment options

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Zusammenfassung

Die operative Versorgung von ossären Metastasen ist heute die häufigste onkologische Operation in der Orthopädie bzw. Unfallchirurgie. Aufgrund einer längeren Überlebenswahrscheinlichkeit und einer steigenden Inzidenz von ossären Metastasen kommt es zu einem vermehrten Auftreten von durch Metastasen verursachten Komplikationen wie pathologischen Frakturen oder Implantatversagen nach bereits operativ versorgter Metastase. Zwar ist die Metastasenchirurgie weiterhin meist Bestandteil eines palliativen Therapiekonzepts; dank einer suffizienten Therapie der Primärtumoren, tumorspezifisch orientierter Nachsorgeprotokolle und der Varianz in der Prognose der einzelnen Entitäten muss jedoch eine individuelle, prognoseadaptierte Therapiestrategie verfolgt werden. Abhängig von der Lebenserwartung des Patienten treten aggressivere Operationsverfahren mit dem Ziel einer adäquaten, lokalen Tumorkontrolle in den Vordergrund. Die prognoseadaptierte Versorgung erfordert Erfahrung und sollte daher an einem interdisziplinären Tumorzentrum erfolgen. Dieser Beitrag stellt einen Überblick über die heutigen Therapiekonzepte der operativen Versorgung von Extremitätenmetastasen zusammen. Verfahren zur Knochen- und Weichteilüberbrückung wie winkelstabile Verbundosteosynthesen, Marknagelosteosynthesen, Endoprothesen sowie modulare Tumorprothesen werden vorgestellt.

Abstract

Surgery in metastatic bone disease is currently the most frequent type of surgery in orthopedic oncology. Improved survival rates and an increasing incidence of bone metastasis have led to an increase in complications caused by metastatic disease, such as pathological fractures or hardware failure after operative treatment. Although surgery of metastatic lesions remains a palliative therapy concept, because of sufficient therapy for the primary carcinomas, tumor-specific-oriented follow-up protocols and a variation in the prognosis for the individual entities, an individually adapted treatment strategy is necessary. Depending on the life expectancy, more aggressive surgical procedures with the goal of adequate local tumor control have come into focus. Therefore, prognosis-tailored treatment requires an experienced team and should be performed in a multidisciplinary tumor center. The current article provides an overview of recent therapy concepts for the surgical treatment including endoprosthetic reconstruction, internal fixation with either intramedullary nailing or plate fixation devices, often augmented with bone cement.

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Authors and Affiliations

  1. Klinik für Orthopädie und Sportorthopädie, Technische Universität München, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland

    Franz Liska, Norbert Harrasser, Peter Prodinger, Hans Rechl & Rüdiger von Eisenhart-Rothe

  2. Abteilung Orthopädie und Unfallchirurgie, Klinikum Fürstenfeldbruck, Dachauer Str. 33, 82256, Fürstenfeldbruck, Deutschland

    Philipp Schmitz

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  1. Franz Liska
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Correspondence to Franz Liska.

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Franz Liska, Philipp Schmitz, Norbert Harrasser, Peter Prodinger, Hans Rechl und Rüdiger von Eisenhart-Rothe geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Liska, F., Schmitz, P., Harrasser, N. et al. Metastasen der Extremitäten. Unfallchirurg 121, 37–46 (2018). https://doi.org/10.1007/s00113-016-0282-1

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