人工全肩胛骨置换术治疗肩胛骨肿瘤的疗效研究

目的总结人工全肩胛骨置换术治疗肩胛骨肿瘤患者的疗效。方法回顾分析2010年1月—2017年12月采用全肩胛骨切除联合人工全肩胛骨置换术治疗的17例肩胛骨肿瘤患者临床资料。男9例,女8例;年龄13~64岁,平均34.4岁。软骨肉瘤7例、骨肉瘤3例、尤文肉瘤2例、高级别肉瘤1例、多形性未分化肉瘤1例、纤维肉瘤1例、浆细胞瘤1例、骨巨细胞瘤1例。Enneking外科分期:3期1例,ⅠB期8例,ⅡB期8例。Malawer分型:ⅢB型11例,ⅣB型5例,ⅥB型1例。肿瘤体积11.0 cm×7.5 cm×6.0 cm^18.5 cm×18.0 cm×12.5 cm。病程0.5~8.0个月,平均3.2个月。术后应用1993年美国骨与软组织肿瘤协会上肢功能评分系统(MSTS评分)、肩关节活动度评估肩关节功能,影像学复查肿瘤复发及转移情况。结果术后1例切口愈合不佳,其余患者切口均Ⅰ期愈合。患者均获随访,随访时间20~72个月,平均45.4个月。其中2例因肿瘤转移导致多器官功能衰竭死亡,3例发生肺部转移、荷瘤生存;所有患者均未出现局部复发。总生存率为88.2%(15/17),无瘤生存率为70.6%(12/17)。术后因外伤导致肋骨骨折1例,假体无菌性松动1例,三角肌萎缩变薄1例,其余患者无相关并发症发生。末次随访时,MSTS评分为(26.1±1.4)分,肩关节前屈、后伸、外展活动度分别为(70.0±7.5)、(31.2±11.3)、(54.4±12.5)°。结论肩胛骨肿瘤患者行全肩胛骨切除后,应用人工全肩胛骨置换术可获得较好肩关节外观及功能。

Evaluation of total scapular arthroplasty after total scapulectomy for scapular tumors

Objective To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.Methods A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed.There were 9 males and 8 females with an average age of 34.4 years(range,13-64 years).Seven patients were diagnosed with chondrosarcoma,3 with osteosarcoma,2 with Ewing’s sarcoma,1 with high-grade sarcoma,1 with polymorphic dedifferentiated sarcoma,1 with fibrosarcoma,1 with plasmacytoma,and 1 with bone giant cell tumor.According to the surgical staging system described by Enneking et al,1 patient was rated as stage 3,8 as stageⅠB,8 as stageⅡB.According to the classifications of shoulder girdle resections of Malawer et al,11 patients were typeⅢB,5 were typeⅣB,1 was typeⅥB.The disease duration ranged from 0.5 to 8.0 months(mean,3.2 months)and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm.The 1993 Musculoskeletal Tumor Society(MSTS)upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function.Tumor recurrence and metastases were monitored by radiograph.Results Poor superficial incision healing occurred in 1 patient,the rest incisions achieved healing by first intention.All patients were followed up 20-72 months(mean,45.4 months).Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases;3 patients suffered from pulmonary metastases and were alive with disease.No local recurrence occurred in all patients.The overall survival rate was 88.2%(15/17)and the diseasefree survival rate was 70.6%(12/17).Rib fracture after trauma,aseptic loosening,and atrophy of the deltoid muscle occurred in 1,1,and 1 case,respectively.The other related complication was not observed.At last follow-up,the MSTS score was 26.1±1.4,and the flexion,extension,and abduction range of motion of shoulder joint were(70.0±7.5),(31.2±11.3),and(54.4±12.5)°,respectively.Conclusion Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.