Background

Most benign active and latent lesions of proximal femur do not predispose a patient to a pathologic fracture. Nonetheless, there is a tendency to perform internal fixation due to the lack of accurate clinical tools that may reliably confirm low risk of pathologic fracture. As many as 30% of these surgeries may be unnecessary. A patient-specific CT-based finite element analysis may quantify bone strength and risk of fracture under normal weight-bearing conditions.

Methods

The clinical relevance of such finite element analysis was investigated in a retrospective study on a cohort of 17 patients. Finite element analysis results (high risk = indication for surgery, low or moderate risk = follow-up) were compared to actual clinical decisions (surgery vs follow-up). All patients predicted by the finite element analysis as high risk underwent internal fixation and had good outcomes (n = 6).

Findings

Four of the 11 low- and moderate-risk finite element analysis patients (36%) were operated immediately, and seven (64%) were either operated after a delay of at least 6 months or were never operated. None sustained a pathologic fracture. Patients who were predicted as low fracture risk by finite element analysis remained fracture-free for a minimal period of 6 months. Prediction of high risk of pathologic fracture by finite element analysis was in complete agreement with the conventional clinical evaluation.

Interpretation

We consider finite element analysis a promising decision support system for the management of patients with benign tumors of femur, and that it may reliably endorse the decision to withhold surgery for patients at low fracture-risk.

中文翻译：

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基于患者的基于计算机断层扫描的有限元分析：一种评估股骨良性骨病变中骨折风险的新工具。

背景

股骨近端的大多数良性活动性和潜在性病变不会使患者容易发生病理性骨折。然而，由于缺乏可以可靠地确认低病理性骨折风险的精确临床工具，存在进行内固定的趋势。这些手术中多达30％可能是不必要的。基于患者的基于CT的有限元分析可以量化正常体重情况下的骨强度和骨折风险。

方法

在一项针对17名患者的回顾性研究中研究了这种有限元分析的临床相关性。将有限元分析结果（高风险=手术指征，低或中度风险=随访）与实际临床决策（手术vs随访）进行比较。所有通过有限元分析预测为高风险的患者均接受了内固定术，并具有良好的预后（n  = 6）。

发现

11名低风险和中风险有限元分析患者中有4名（36％）立即进行手术，而至少延迟6个月后才进行手术的7名（64％）或从未进行过手术。没有人发生病理性骨折。通过有限元分析预测为低骨折风险的患者至少6个月内无骨折。通过有限元分析预测病理性骨折的高风险与常规临床评估完全一致。

解释

我们认为有限元分析是治疗股骨良性肿瘤患者的有前途的决策支持系统，它可以可靠地支持低骨折风险患者不接受手术的决策。