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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效果。方法:自1998年10月～2007年11月,收治肱骨上段恶性肿瘤6例。其中骨肉瘤3例,Enneking分期IIA期;骨巨细胞瘤2例,Enneking分期分别为IA期和IB期,成纤维性纤维瘤并肉瘤变1例。手术均采用距肿瘤边界以远5cm肱骨连同周围肌肉切除,行人工肱骨假体置换,骨水泥固定,术后对患者假体位置、疼痛、功能、患者心理承受等进行观察。结果:6例均获随访4～61个月,平均40个月。术后1例骨肉瘤患者于2个月后出现肺转移多器官衰竭死亡,1例于术后1年出现感染行假体去除,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6例患者均有不同程度的肩关节活动受限,力量减弱。根据国际保肢学会评分标准,术后综合评分较术前均有提高。结论:人工假体置换治疗肱骨上段恶性肿瘤效果良好,是保全肢体、提高生活质量的一种可靠治疗方法,但应慎重采用。
Objective: To investigate the surgical effect of artificial prosthesis replacement on the upper humerus malignant tumor. Methods: From October 1998 to November 2007, 6 cases of malignant tumor of the upper humerus were treated. There were 3 cases of osteosarcoma, Enneking staging IIA, 2 cases of giant cell tumor of bone, Enneking stage IA and IB stage, fibroblastic fibrosarcoma and 1 case of sarcoma. Surgical operations were performed with the humerus and the surrounding muscles removed 5 cm farther than the border of the tumor. The artificial humerus prosthesis was replaced and the cement was fixed. Postoperative patient prosthesis position, pain, function and patient’s psychological endurance were observed. Results: All 6 cases were followed up for 4 to 61 months with an average of 40 months. One patient with osteosarcoma died of lung metastasis and multiple organ failure after 2 months. One patient underwent infection removal one year after operation. One patient had loosening of prosthesis at 1 year and 5 months after operation. For special treatment. 6 patients after prosthesis replacement have varying degrees of shoulder joint activity is limited, the strength weakened. According to the International Association of limb salvage standards, postoperative comprehensive score increased compared with preoperative. CONCLUSION: The artificial prosthesis replacement has a good effect on malignant tumors of the upper humerus. It is a reliable treatment for preserving limbs and improving the quality of life, but should be used with caution.