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目的探讨改良根治性切除重建术治疗肱骨近端恶性肿瘤的可行性及近期疗效。方法以30例正常成人肩关节MRI为研究对象,测量相关解剖数据,分析改良根治性切除重建术治疗肱骨近端恶性肿瘤的可行性。2012年3月-2016年1月应用改良根治性切除重建术治疗5例肱骨近端恶性肿瘤患者。男1例,女4例;年龄9~69岁,中位年龄46岁。骨肉瘤4例(EnnekingⅡA期2例、ⅡB期2例),转移癌(中分化腺癌)1例。病程7~12个月,平均9个月。术后观察肿瘤有无复发,根据Enneking骨骼肌肉肿瘤功能评分系统评估肩关节功能。结果影像学测量结果显示改良根治性切除重建术可行,均在允许最大纵径(<29.8 mm)及深度(<4 mm)范围内。5例手术均顺利完成,病理检查提示达到根治性切除目的。患者均获随访,随访时间3~49个月,平均15.6个月。1例术后12个月局部复发,行肩关节离断术;余4例患者携带假体生存良好。末次随访时患者肩关节功能较术前明显恢复,根据Enneking骨骼肌肉肿瘤功能评分系统对4例患者(排除行肩关节离断术1例)进行评估,评分24~27分,平均25.8分。结论改良根治性切除重建术治疗肱骨近端恶性肿瘤可行,术后可保持良好早期肩关节功能。
Objective To investigate the feasibility and short-term curative effect of modified radical resection and reconstruction in the treatment of proximal humeral malignancies. Methods Thirty normal adult patients with shoulder MRI were studied. Relevant anatomical data were measured and the feasibility of modified radical resection and reconstruction for the treatment of proximal humeral malignancy was analyzed. March 2012-January 2016 Five patients with proximal humerus malignancies were treated with modified radical resection and reconstruction. 1 males and 4 females; aged 9 to 69 years old, the median age of 46 years old. 4 cases of osteosarcoma (EnnekingⅡA in 2 cases, ⅡB in 2 cases), metastatic carcinoma (in differentiated adenocarcinoma) in 1 case. Duration of 7 to 12 months, an average of 9 months. Postoperative tumor recurrence was observed, according to Enneking skeletal muscle tumor function scoring system to assess the function of the shoulder. Results Imaging results showed that the modified radical resection and reconstruction feasible, both in the maximum longitudinal diameter (<29.8 mm) and depth (<4 mm) range. Five cases of surgery were successfully completed, pathological examination showed that the purpose of radical resection. All patients were followed up for 3 ~ 49 months with an average of 15.6 months. One case had local recurrence 12 months after operation, and the shoulder joint was cut off. The remaining 4 cases had good survival. At the final follow-up, shoulder function recovered significantly compared with that before operation. According to Enneking Skeletal Muscle Tumor Function Score System, 4 patients (excluding shoulder shunt) were assessed with a score of 24 to 27 with an average of 25.8 points. Conclusion Modified radical resection and reconstruction of proximal humerus malignant tumor feasible, after surgery to maintain good early shoulder function.