逆置型人工全肩胛骨肩关节置换术在肩部恶性肿瘤治疗中的应用

目的探讨人工全肩胛骨肩关节置换及保肢功能重建技术治疗肩部恶性肿瘤的临床疗效。方法2001年2月-2004年11月，采用肿瘤广泛切除术、制约式逆置型人工全肩胛骨肩关节置换及功能重建治疗肩部恶性肿瘤5例。其中男4例，女1例；年龄19～26岁，平均23．6岁。肿瘤包括骨肉瘤2例、软骨肉瘤1例以及尤文氏肉瘤2例。术后患肢均用三角巾悬吊3周。术后第3天开始被动肩关节功能锻炼，3周后行主动肩关节功能锻炼。结果手术时间380～530min，平均425min；术中出血量1250～1900ml，平均1540ml。术后出现气胸1例，肩部切口皮瓣局部缺血坏死1例，锁骨残端翘起顶破皮肤合并局部感染1例；分别经短期胸腔闭式引流、中药生肌膏换药及再次手术清理病灶、二次截骨等处理后治愈。术后获随访7～52个月，平均24．6个月。患者均无深部感染、假体外露、松动或脱位以及神经损伤等并发症发生。术后屈、伸肘功能均恢复正常；肩部前屈功能部分保留，外展与后伸功能丧失；手部持物及精细动作良好。按照肩关节JOA（Japan orthopaedics association）评分系统进行疗效评价，得分60～72分，平均65分。结论逆置型人工全肩胛骨肩关节置换术是治疗肩部恶性肿瘤的有效方法，此类假体具有适应证广、活动范围大及稳定性强等优点，同时术式既保留肢体又重建功能，术后恢复快，能减轻肩关节疼痛，患者满意率高。

REPLACEMENT OF INVERT-TYPE ARTIFICIAL TOTAL SCAPULA AND SHOULDER JOINT PROSTHESIS FOR MALIGNANT TUMOR

OBJECTIVE: To estimate the clinical curative effect of replacement of invert-type artificial total scapula and shoulder joint prosthesis and reserving arm with rehabilitation of function in the treatment of.malignant tumor in shoulder. METHODS: From February 2001 and November 2004, five youth patients with primary malignant shoulder tumors were treated operatively by resection of neoplasms thoroughly, replacement of invert-type artificial total shoulder blade and joint prosthesis, the functional reconstruction. Of them, there were 4 males and 1 female, aging from 19 to 26 years with an average of 23.6 years. Two cases were diagnosed as having osteosarcoma, one as having chondrosarcoma, and 2 as having Ewing sarcoma. After operation, the upper limbs was immobilized for 3 weeks. The rehabilitation training including passive exercise and initiative exercise. RESULTS: The average operative time was 425 min (380 to 530 min), and the blood loss ranged from 1250 ml to 1900 ml (1540 ml on average). The follow-up ranged from 7 to 52 months, with an average of 24.6 months. Postoperative complication included 1 case of pneumothorax, one case of shoulder incision skin part necrosis and 1 case of clavicle stump raising and pierce skin with shallow infection. No complication of postoperative incision deeply infection, nerve damage and prosthesis exposure or dislocation occurred. According to the scoring system of JOA (Japan orthopaedics association), the average score was 65 (60 to 72). The flexion and extension function of elbow joint recovered to normal. CONCLUSION: The replacement of invert-type artificial total scapula and shoulder joint prosthesis is an efficacious method for the treatment of malignant tumor in shoulder. There are advantages of numerous adaption, wide range of motion and good stability. It can not only reserve arm but also rehabilitate function.