Although intramedullary nail (IMN) fixation is the standard of care for most impending and/or complete pathologic fractures of the femur, the optimal timing/sequence of the IMN in cases of synchronous bilateral femoral disease in advanced cancer is not well established. Thus, we compared the outcomes of single-stage (SS) vs. two-stage (TS) IMN of the bilateral femur with a systematic review of the literature on this topic. Bilateral SS and TS IMN cases were identified from 14 studies extracted from four databases according to PRISMA guidelines. Safety (complications, reoperations, mortality, survival, blood loss, and transfusion) and efficacy (length of stay [LOS], time to start rehabilitation and adjuvant therapy, functional scores, and cost) were compared between the groups. A total of 156 IMNs in 78 patients (36 SS and 42 TS) were analyzed. There were one surgical (infection in TS requiring reoperation;p= 0.860) and fifteen medical complications (five in SS, ten in TS;p= 0.045), with SS being associated with lower rates of total and medical complications. Survival, intraoperative mortality, and postoperative same-admission mortality were similar. No cases of implant failure were reported. Data on LOS, rehabilitation, and adjuvant therapy were scarcely reported, although one study favored SS over TS. No study compared cost or functional scores. Our study is the largest and most comprehensive of its kind in supporting the safety and efficacy of a SS bilateral femur IMN approach in these select patients. Further investigations with higher levels of evidence are warranted to optimize treatment protocols for this clinical scenario.
尽管髓内钉（IMN）固定是治疗大多数股骨即将发生和/或完全病理性骨折的标准方法，但在晚期癌症患者出现双侧股骨同步病变时，IMN的最佳手术时机与顺序尚未明确。为此，我们通过系统性文献回顾，比较了双侧股骨单阶段（SS）与两阶段（TS）IMN手术的临床结果。根据PRISMA指南，我们从四个数据库中提取了14项研究，识别出双侧SS与TS IMN病例。研究比较了两组在安全性（并发症、再次手术、死亡率、生存率、失血量及输血情况）和有效性（住院时长、开始康复及辅助治疗时间、功能评分及治疗成本）方面的差异。共分析了78例患者（36例SS，42例TS）的156次IMN手术。记录到1例手术并发症（TS组感染需再次手术；p=0.860）和15例内科并发症（SS组5例，TS组10例；p=0.045），SS组的总并发症及内科并发症发生率更低。两组在生存率、术中死亡率及术后同次住院期间死亡率方面无显著差异。未报告内固定失败病例。关于住院时长、康复及辅助治疗的数据报道较少，但有一项研究显示SS方案优于TS。尚无研究比较治疗成本或功能评分。本研究是目前同类研究中规模最大、最全面的，支持在特定患者中采用SS双侧股骨IMN方案的安全性与有效性。未来需要更高级别的证据进一步研究，以优化此类临床情况的治疗方案。
肿瘤(癌症)患者之家