title: [Surgical managements for bone metastases in tibia of 16 cases].
abstract: OBJECTIVE
  To investigate the different surgical options for tibia metastatic disease and to evaluate the survival prognostic factors, postoperation function and complications.
  
  
  METHODS
  A retrospective evaluation of 16 patients treated for tibia metastatic disease between Jan. 2000 and Feb. 2013 was conducted at our center. The underlying histology of the lesions showed metastatic lung carcinoma (five),breast carcinoma (three), bladder carcinoma (two), unknown (two), renal cell carcinoma, colon carcinoma, hepatic cellular cancer and lymphoma (one each). The locations of these lesions were proximal in 11 patients (with one patient having two synchronous lesions in the proximal metaphysis on both sides), diaphyseal in 4 patients, and distal metaphyseal in two patients. One patient presented with a pathologic fracture,and the risk of impending pathologic fracture of the remainders was evaluated by Mirels scoring system. Of all the 16 patients, 15 were treated surgically (with 16 operations performed). Six of them were reconstructed with proximal tibial replacement, 9 underwent curettage and cementation (with or without inner-fixations), and 1 patient had lower third calf amputation. We employed VAS scoring system to evaluate the pain intensity of the lesions before and after operation.The post-operation function was assessed by MSTS scoring system. The survival rate was described by Kaplan-Meier survival curve.
  
  
  RESULTS
  Fourteen of all the patients were followed-up and enrolled in the research. The median postoperative survival was 7 months (1-72 months).The mean half year survival rate and 2-year survival rate were 57.14% and 8.9% respectively.The mean Mirels score was 9.8 ± 1.0. The mean VAS score before the operation was 7.62 ± 1.03, which turned out to be 1.36 ± 0.86 after the operation. The mean MSTS score for the endoprosthesis and curettage was 21.0 ± 0.63 and 23.1 ± 1.25 respectively.
  
  
  CONCLUSIONS
  The mobidity of tibia metastatic diseases is very low.Surgical intervention, combined with the application of bisphosphonate and postoperative radiotherapy, is absolutely necessary for the treatment of tibial metastatic disease, contributing to an improved quality of life and limb function.
authors.affiliation: Musculoskeletal Tumor Center,Peking University People's Hospital, Beijing 100044, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Rong-Li
authors.initials: RL
authors.lastname: Yang
authors.forename: Tai-Qiang
authors.initials: TQ
authors.lastname: Yan
authors.forename: Ran
authors.initials: R
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D003475:Curettage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013977:Tibia / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000473:pathology
chemical_list: D001843:Bone Cements