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目的对儿童肱骨近端成骨肉瘤的患者,切除肱骨肿瘤后,实施了锁骨代肱骨的重建手术。探讨该重建方法的效果。方法患者仰卧,皮肤切口自锁骨内侧端通过喙突至上臂前方。整块切除肿瘤。重建的第一步为松解锁骨,保留锁骨骨膜及其周围部分软组织。切开胸锁关节,去除锁骨近端的软骨。以肩锁关节为轴,旋转整根锁骨,使锁骨近端能够较容易的下垂。将残留肱骨及被旋转后的锁骨近端应用窄的AO动力加压钢板作内固定。将原来附着于肱骨近端的残留肌肉缝合在锁骨上,使之尽量符合原来的解剖结构。在恰当张力下将肱二头肌长头腱性部分固定在肱二头肌短头的腱性部分上。结果患儿在手术后3个月即拥有良好的患肢功能。患儿术后肩关节前屈达80°,外展平均达到75°。术后随访1~4年,3例患儿均无肿瘤局部复发。结论对于儿童患者,肱骨近端肿瘤切除术后会出现肢体短缩等相关问题。接受锁骨代替肱骨手术的患者,术后锁骨出现纵向生长。如果锁骨骨膜未受到破坏,术后还会出现锁骨骨质增生肥厚。保留锁骨的骨膜是保证术后锁骨生长的最重要的因素。实施锁骨重建肱骨近端手术后,除重建后的肩锁关节外,肩胛骨-胸廓之间的连接在外展、内旋及外旋方面也提供了相当的活动度。对于肱骨近端恶性骨肿瘤的青少年患者来讲,锁骨代替肱骨是一种值得推?
Objective To reconstruct the humerus of the clavicle after the resection of the humeral tumor in children with proximal osteosarcoma of the humerus. Discuss the effect of this reconstruction method. Methods Patients supine, skin incision from the medial clavicle to the front of the upper arm through the coracoid. The whole excision of the tumor. The first step in reconstruction is to release the clavicle and keep the clavicle periosteal and its surrounding soft tissues. Cut the sternoclavicular joint and remove the proximal clavicular cartilage. Acromioclavicular joint axis, rotate the entire collarbone, so that the proximal clavicle can be more easily sagged. The remaining humerus and the proximal rotation of the clavicle after narrow AO dynamic compression plate for internal fixation. The original attached to the proximal humerus muscle suture in the clavicle, so as to meet the original anatomical structure. Fix the long biceps tendon part of the biceps to the tendinous part of the biceps brachii under proper tension. Results The children had good limb function 3 months after operation. Children with anterior flexion of 80 ° after surgery, abduction reached an average of 75 °. Follow-up 1 to 4 years after surgery, 3 patients had no local tumor recurrence. Conclusion In pediatric patients, related problems such as limb shortening may occur after proximal humerus tumor resection. Patients who underwent clavicular replacement for humerus surgery developed a longitudinal growth of the clavicle. If the clavicle periosteum is not damaged, there will be postoperative clavicular hyperplasia hypertrophy. The preservation of the periosteum of the clavicle is the most important factor for ensuring the growth of the clavicle after surgery. In addition to the reconstructed acromioclavicular joint, the connection between the scapula and the thorax also provides considerable mobility in terms of abduction, pronation and external rotation after performing proximal clavicular reconstruction of the proximal humerus. For young patients with proximal humerus malignant bone tumors, the replacement of the humerus is a worthwhile push?