摘要
目的 探讨肱骨近端恶性肿瘤切除术后的重建方法。方法 36例肱骨近端恶性肿瘤，其中骨肉瘤 11例、软骨肉瘤 6例、皮质旁骨肉瘤及纤维肉瘤各 3例、原始神经外胚层瘤及恶性纤维组织细胞瘤各 2例、转移性骨肿瘤 5例、恶性骨巨细胞瘤 4例。骨肉瘤、原始神经外胚层瘤与恶性纤维组织细胞瘤患者均接受了新辅助化疗。肿瘤关节内切除 33例，关节外切除 3例。 21例采用异体半关节移植， 4例采用人工假体置换， 6例行游离锁骨移植， 5例行带骨膜血管蒂锁骨移植。结果 随访 6～ 118个月，平均 62.7个月。死亡 11例，局部复发 3例。按 Enneking功能评价标准， 21例采用异体半关节移植的患者，平均得分 24分； 4例人工假体置换的患者，平均得分 26分； 11例采用同侧锁骨重建肱骨近端的患者，平均得分 23分。结论 肱骨近端恶性肿瘤保肢手术的重建以人工假体置换和异体半关节移植为首选，儿童的保肢可选用同侧锁骨移植。保肢术后的功能与肩袖和肩外展肌的修复密切相关。
Objective To investigate limb salvage methods in reconstructing post operative defects after malignant tumor resection of proximal humerus. Methods Thirty six patients had limb salvage procedures for treatment of malignant tumors of the proximal humerus from 1989 through 1999. There were 12 osteosarcomas, 6 chondrosarcomas, 2 primitive neuroectodermal tumors, 2 malignant fibrous histiocytomas, 5 metastatic carcinomas in bone, and 4 malignant giant cell tumors of bone. The patients with osteosarcoma or primitive neuroectodermal tumor or malignant fibrous histiocytoma received neo adjuvant chemotherapy. 33 cases of malignancies underwent intra articular resection and 3 cases extra articular resection, in which 21 underwent reconstruction with osteoarticular allograft, 4 cases underwent reconstruction with endoprosthesis, 6 cases with free periosteum vascularized clavicle; and 5 cases underwent claviculoplasty with peri osteolar vascular pedicle. Results The patients were followed up from 6 to 118 months postoperatively. 11 cases died and 3 cases recurred. According to Enneking Function Evaluation Standard, the mean post operative function score of the upper extremity was 23 points (total 30 points) in group of reconstructing proximal humerus with collateral clavicle, 24 points in patients underwent reconstruction with osteoarticular allograft, and 26 points in patients underwent reconstruction with endoprosthetic. Conclusion The reconstructive method with osteoarticular allograft or endoprosthesis is the first choice after malignant tumor resection of proximal humerus. Limb salvage with collateral clavicle in reconstructing proximal humerus is suitable for children. The function following reconstructive procedures is closely related with the reconstruction of the rotator cuff and the abductor mechanism.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2000年第7期416-420,共5页
Chinese Journal of Orthopaedics
关键词
肱骨近端恶性肿瘤
保肢手术
辅助化疗
Bone neoplasms
Humerus
Chemotherapy, adjuvant
Salvage therapy
Treatment outcome
