肱骨近端肿瘤切除组配式肿瘤型反肩关节假体重建的早期功能效果

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目的:分析组配式肿瘤型反肩关节假体在肱骨近端肿瘤行MalawerⅠ型切除后重建中的适应证、早期临床疗效、并发症情况及注意事项。方法:收集2018年9月至2019年10月7例行肱骨近端肿瘤大段切除组配式肿瘤型反肩关节假体置换的患者资料,其中男6例,女1例;年龄(32.4±16.2)岁(范围:14~59岁)。7例的肿瘤类型:骨巨细胞瘤3例,骨肉瘤2例,骨髓瘤1例,肾癌转移瘤1例。采用肱骨近端MalawerⅠ型肿瘤切除后采用组配式肿瘤型反肩关节假体重建。随访摄肩关节X线片观察手术部位情况及假体情况,并测量肩关节活动度,末次随访使用Constant-Murley功能评分及国际骨肿瘤协会(Musculoskeletal Tumor Society,MSTS)功能评分进行功能评价。结果:7例均顺利完成手术,手术时间125~215 min,平均158 min;术中出血量100~500 ml,平均257 ml;切除肱骨近端10~16 cm,平均12 cm。所有患者均获得随访,随访时间4~17个月,平均8个月。至末次随访7例肩关节主动外展平均108°(范围:80°~175°),主动前屈平均124° (范围:90°~175°)。3例诉肩部轻度不适,余患者无肩部疼痛;所有患者睡眠均无影响,7例手均可过顶。7例患者的肩关节内、外旋受限,肩关节外展力量下降,Constant-Murley功能评分72%(范围:59%~78%),MSTS功能评分为84%(范围:67%~93%)。7例均未发生切口感染等相关并发症。1例三角肌止点切除重建患者术后1个月出现脱位,经切开复位采用更大关节盂球,并收紧三角肌张力后未再脱位。结论:组配式肿瘤假体具有安装简便,手术要求相对复合异体骨反肩低,容易控制假体长度的优点,同样可以取得理想的效果。“,”Objective:To summarize the indications, early functional outcome, complications and precautions of modular reverse shoulder tumor prosthesis in the treatment of proximal humerus tumor.Methods:From September 2018 to October 2019, there were 7 patients with proximal humeral tumor underwent tumor resection and modular reverse shoulder tumor prosthesis replacement in our hospital, including 6 males and 1 female. The average age of the patients was 32 years (14-59 years), including 3 cases of giant cell tumors, 2 cases of osteosarcomas, one case of myeloma and one case of renal cancer metastasis. The prosthesis reconstruction was performed after the removal of the proximal humerus tumor according to malawer type I. Postoperative outpatient follow-up included X-ray of shoulder joint, measurement of shoulder joint activity, functional evaluation using Constant-Murley function score and Musculoskeletal Tumor Society (MSTS) function score.Results:All the 7 patients successfully completed the operation, the operation times were ranged from 125 to 215 min, averaged 158 min; the intraoperative hemorrhage were ranged from 100 to 500 ml, the averaged 257 ml; the length of resected proximal humerus were ranged from 10 to 16 cm, averaged 12 cm. All patients were followed up for 4-17 months, with an average of 8 months. At the last follow-up, the average active abduction of shoulder was 108° (80°-175°), and the average active flexion was 124° (90°-175°). Three patients complained of mild discomfort in the shoulder, the rest of the patients had no pain in the shoulder. Sleep was not affected in all patients, and the hands of seven patients could go over the top of head, and they could live and work normally. In 7 patients, the rotation of shoulder joint was limited, the abduction force of shoulder joint was decreased, the Constant-Murley function score was 72% (59%-78%), and the MSTS function score was 84% (67%-93%). None of the 7 patients had incision infection, hematoma and other related complications. There was one dislocation occurred one month after the operation because the humeral adhesion of deltoid was resected. After open reduction, a larger glenoid ball was used and tension of deltoid muscle was tightened, and no dislocation was found.Conclusion:The combined tumor prosthesis of reverse shoulder has the advantages of simple installation, lower operative requirements compared with the common reverse shoulder prosthesis compounded with allograft, easy to control the length of the prosthesis, and also can achieve satisfactory results.
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