特制型人工假体在肱骨近端恶性肿瘤保肢治疗中的应用

目的肱骨近端恶性骨肿瘤的保肢治疗方法很多,但都面临同样的难题,即满足安全外科边界切除肿瘤的前提下尽量保留肢体功能,同时降低并发症的发生率.本研究探讨特制型人工假体置换在肱骨近段恶性骨肿瘤保肢治疗中的临床疗效.方法应用自行设计的定制型人工假体对2000年2月至2009年2月间的16例肱骨近端恶性肿瘤患者行保肢术.男性10例,女性6例.年龄14～56岁,平均（27±3）岁.病理证实：骨肉瘤10例,恶性纤维组织细胞瘤1例,尤文肉瘤1例,骨巨细胞瘤4例.骨巨细胞瘤按Campanicci分级：4例为Ⅲ级.其它12例患者以Enneking分期：Ⅱa期2例,Ⅱb期10例.除骨巨细胞瘤外均辅予术前、术后化疗.结果平均随访32个月（6～84个月）,置入假体无感染、松动及断裂等并发症.人工肩关节不完全脱位2例（12.5%,2/16）.术后肩关节功能按国际保肢学会（ISOLS）标准评分,优良率81.3%（13/16,评分≥24分）.结论应用特殊定制的人工假体置换能够降低术后并发症,获得较为满意的肩关节功能.

Application of Prosthesis Replacement in Limb Salvage Treatment of Malignant Bone Tumors in Proximal Humerus

Objective To evaluate the curative effect of prosthetic replacement in limb salvage treatment of malignant bone tumors in proximal humerus.Methods From February 2000 to February 2009,16 patients with malignant tumors in the proximal humerus underwent limb salvage with prosthetic replacement.There were 10 male patients and 6 female patients.The age of patientd ranged from 14～56 years old（average age is 27.3）.The pathological diagnosis results confirmed that 10 patients with osteosarcoma,1 patient with malignant fibrous histiocytoma,1 patient with Ewing＇s sarcoma,and 4 patients with giant cell tumor.According to Campanicci grading system,4 patients were in Ⅲ grade.According to Enneking grading system,2 patients were in Ⅱa stage and 10 patients were in Ⅱb stage.All patients except patients with bone giant cell tumor were given neo-adjuvant chemotherapy and postoperative adjuvant chemotherapy.Results The average follow-up time of patients were 32 months（6months to 84 months）.No complications including infection,loosening and fracture happened in patients with prosthetic replacement.The incomplete dislocation of artificial should joint happened in 2 patients（12.5%,2/16）.The function were assessed by International Society of Limb Salvage System（ISOLS）,the functional scores of reconstructed shoulder joint were at least 24 in 13 cases.It was 81.3% that superior rate of the function of the afffected limb.Conclusion It is an efficacious method for treatment of malignant tumors in proximal humerus by using prosthetic replacement which can reduce complication after operation,and the function of reconstructed shoulder joint is satisfied.