肱骨近端肿瘤行人工肩关节假体置换术后的肩关节功能临床观察

Clinical observation of shoulder function after prosthesis shoulder arthroplasty replacement for tumor of proximal humerus

目的分析肱骨近端骨肿瘤切除术后,行肿瘤型人工肩关节置换的治疗效果。方法选取2007年3月~2019年3月,我院骨外科诊治的25例行瘤段切除加人工肩关节置换治疗肱骨近端肿瘤的患者。其中男16例,女9例;年龄9~62岁间,平均年龄(35.6±14.93)岁;其中左肱骨14例,右肱骨11例。骨巨细胞瘤病例10例,骨肉瘤病例6例,转移瘤病例3例,恶性纤维细胞瘤、郎格罕斯细胞增生症、恶性周围神经细胞瘤、上皮样血管肉瘤、未分化软骨肉瘤、肱骨平滑肌肉瘤各1例,对这些病例进行功能评分及并发症情况分析。结果所有患者术后均为一期愈合,无法评估12例(8例失访,3例因转移瘤死亡,1例因原发肿瘤死亡),9例无术后并发症、死亡、失访等情况,术后复发4例(行肩关节离断术3例,行肿瘤扩大切除术1例)。结合美国肌肉骨骼肿瘤学会(Musculo Skeletal Tumor Society,MSTS)评分,其均值为20.89。结论肱骨近端肿瘤行肿瘤型人工假体置换术能够不同程度地重建肩关节的部分功能,改善患者的术后部分生活质量。

Objective To analyze the therapeutic effect of prosthesis shoulder arthroplasty after resection of proximal humerus bone tumor.Methods From March 2007 to March 2019,25 cases undergoing tumor segment resection and prosthesis shoulder arthroplasty for treatment of proximal humerus bone tumors in the Department of Orthopedic Surgery of our hospital were involved.Among them,16 males and 9 females,ranging in age from 9 to 62 years,with a mean age of(35.6±14.93)years.There were 14 cases of left humerus and 11 cases of right humerus.There were 10 cases of giant cell tumor of bone,6 cases of osteosarcoma,3 cases of metastatic tumor,and 1 case each of malignant fibrocytoma,Langerhans cell hyperplasia,malignant peripheral neurocytoma,epithelioid angiosarcoma,poorly differentiated chondrosarcoma,and humeral leiomyosarcoma.Function scores and complications of these cases were analyzed.Results All patients and primary postoperative healing,and 12 cases could not be evaluated(8 cases were lost to follow-up,3 cases died of metastatic tumor,and 1 case died of primary tumor),9 cases had no postoperative complications,death,loss of follew-up etc.And 4 cases had postoperative recurrence(3 cases underwent shoulder joint dissociation and 1 case underwent expansion surgery).Combined with the American of Musculo Skeletal Tumor Society(MSTS)score,the mean score was 20.89.Conclusion Tumor prosthesis replacement for proximal humeral tumor can reconstruct part of the function of shoulder joint and improve the quality of life of patients after operation.