肱骨上段恶性肿瘤切除人工假体置换术

目的探讨应用人工假体置换治疗肱骨上段恶性肿瘤的手术疗效及并发症。方法1998年10月~2003年8月,收治肱骨上段恶性肿瘤4例。其中骨肉瘤2例,Enneking分期A期;骨巨细胞瘤2例,Enneking分期分别为A期和B期。根据国际保肢学会评分标准,术前综合评分骨肉瘤2例分别为4分和5分,骨巨细胞瘤2例分别是9分和11分。手术均采用距肿瘤边界以远5~8cm连同周围肌肉切除,行人工假体置换,骨水泥固定。结果4例均获随访24~58个月,平均44个月。术后无肿瘤复发及感染,1例于术后1年5个月出现假体松动,未作特殊处理。假体置换后肩关节伸22~41°(平均25°),屈29~80°(平均35°),外展5~28°,旋转15~22°。4例患者均有不同程度的肩关节不稳,力量减弱。根据国际保肢学会评分标准,术后综合评分骨肉瘤2例分别是19分和22分,较术前平均提高16分;骨巨细胞瘤2例分别是21分和28分,较术前平均提高9.5分。结论人工假体置换治疗肱骨上段恶性肿瘤,效果良好,但并发症较多,临床应用需慎重。

PROSTHESIS REPLACEMENT OF PROXIMAL HUMERUS AFTER RESECTION OF MALIGNANT TUMOR

OBJECTIVE: To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor. METHODS: From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging, I A) and 2 patients with giant cell tumor of the bone (II A, II B). By the International Society of Limb Salvage (ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients' psychological conditions as well as their limb pain, shape, locality, activity, and function were also observed. RESULTS: The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except one patient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22 degrees to 41 degrees (mean, 25 degrees), bending angle from 29 degrees to 80 degrees (mean, 35 degrees), abduction angle from 5 degrees to 28 degrees, and circumgyrate angle from 15 degrees to 22 degrees in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patients with osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points. CONCLUSION: The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.