Curettage of lesion combined with reconstruction of intramedullary nail and bone cement for the treatment of subtrochanteric metastatic tumors of the femur.

ABSTRACT

This study investigated subtrochanteric femoral metastases using a retrospective approach by analyzing data from 109 patients with bone metastases (2015-2019). Surgical methods were compared curettage with intramedullary nail and bone cement versus prosthetic reconstruction. Post-surgical assessments included joint function, bone metastasis-related serum markers, and complications. Univariate and multivariate logistic regression analysis was used to screen independent risk factors affecting patients' prognosis. R language was used to construct a nomogram model for predicting patients' 1- and 2-year survival, which was validated through ROC curves and the calibration chart. Patients treated with curettage showed superior postoperative outcomes, exhibiting significantly higher Karnofsky Performance Status (KPS) scores (80.00 vs. 70.00, P < 0.001) and Musculoskeletal Tumor Society Scores (MSTS) (23.86 ± 2.57 vs. 21.67 ± 3.24, P < 0.001). Both methods demonstrated comparable efficacy in pain control (VAS 3.00 vs. 3.00, P > 0.05) and bone metabolism impact (ALP 85.93 ± 14.44 vs. 83.19 ± 21.19; CTX-I 3.03 ± 1.56 vs. 3.15 ± 1.75; PINP 10.30 ± 4.41 vs. 11.57 ± 3.90; all P > 0.05). Cox regression identified treatment regimen, age, diabetes, and pre-treatment KPS score as significant survival factors (all P < 0.05). The nomogram model demonstrated high accuracy in predicting one-year and two-year survival (AUC 0.821 and 0.790, respectively). In conclusion, curettage with intramedullary nail and bone cement enhances postoperative functional recovery and quality of life for subtrochanteric femoral metastases patients, representing a promising treatment method.