无内固定自体腓骨移植修复肱骨近端肿瘤性骨缺损

目的 探讨无内固定自体腓骨对肱骨近端肿瘤切除后骨缺损的修复重建方法。方法 1991年6月～2003年12月对26例肱骨近端骨肿瘤患者行病灶囊内刮除或瘤段切除，患者年龄6～41岁。其中骨巨细胞瘤5例，骨囊肿9例，骨纤维结构不良8例，内生软骨瘤4例。采用肱骨近端肿瘤病灶刮除自体腓骨支撑内固定15例，肱骨近端瘤段切除自体腓骨重建肩关节11例。根据手术类型和肿瘤切除后骨缺损的大小，用不带血管蒂的自体近端腓骨3～10cm（平均6cm），移植重建肩关节或联合异体骨填充骨缺损。结果 26例术后经1～12年，平均3．4年随访，2例术后2年内出现肿瘤原位复发，二期行截肢术，其中1例肺转移死亡。15例保留肱骨肩关节面，腓骨支撑填充骨缺损，术后肩关节外观及功能恢复良好，其中3例患儿术后3周肩关节恢复正常活动。11例瘤段切除后近段腓骨修复重建肩关节，术后肩关节保留部分功能。结论 无内固定不带血管的自体腓骨移植对肱骨近端肿瘤切除后的骨缺损是一种有效的修复方法。

TREATMENT OF PROXIMAL HUMERAL DEFECT DUE TO BONE TUMOR BY USE OF NON-INTERNAL FIXATION FIBULAR AUTOGRAFT

Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with non-internal fixation non-vascularised fibular autografts.Methods From June 1991 to December 2003,26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus.Fifteen cases were given curettage and fibular supporting internal fixation,the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft.The age ranged from 6 to 41 years.Out of 26 patients,5 had giant cell tumor,9 had bone cysts,8 had fibrous dysplasia and 4 had enchondroma.Results Twenty-six patients were followed up from 1 to 12 years(3.4 years on average).Local recurrence was found in 2 cases,and 1 of them died of lung metastasis.Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases.Of them,3 children gained normal shoulder function 3 weeks after operation.Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect.Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.