吻合血管的腓骨上段重建肩关节行肱骨肿瘤保肢术

The repair of proximal humeral defect after the ectomy of tumor using fibula grafting with wascular anastomosis

目的研究分析肱骨上段骨肿瘤切除术后大段骨缺损,应用吻合血管的腓骨上段移植重建肩关节的技术与疗效。方法1997-07～2003-12对9例肱骨上段的骨肿瘤行瘤段切除术后应用吻合血管的腓骨上段移植重建肩关节。本组所有骨肿瘤均侵及肩关节,按Enneking分期,广泛性边缘性切除肱骨肿瘤,取同侧腓骨上段带完整的腓骨头与腓动脉移植于瘤段切除之骨缺损处,将腓动脉与肱深动脉吻合,腓骨头与肩关节盂形成关节,并重建肩关节之功能肌,移植腓骨长18～23cm,平均20cm。结果所有患者均获随访,中位随访时间为2年,移植骨均愈合良好,均于术后3～6个月与宿主骨牢固连接。重建肩关节的功能评分均在25分以上。结论吻合血管的腓骨上段移植能够修复肱骨骨肿瘤瘤段切除术后约15cm以上的骨缺损,进行肩关节周围肌肉重建后可以保留大部分肩关节功能。

Objective To analyze the method and efficacy of reconstructing the shoulder joint by proximal fibula grafting with vascular anastomosis,so as to repair massive bonedefect and the lost function of shoulder joint after the ectomy of proximal humeral tumor.Methods From July,1997 to Dec.,2003 the 9 patients with bone tumor of proximal humerus were treated with proximal fibula grafting with vascular anastomosis to reconstruct shoulder joint after the ectomy of the bone tumor. In these cases, the tumor had invaded the shoulder joint according to the Enneking staging,amputated the humeral tumor extensively and marginally, transplanted proximal fibula of the same lateral with fibular-head and fibular artery to the defect site after the removal of the tumor anastomose fibular artery with deep branchial artery, fibular-head and glenoid cavity constituted the joint, and the reconstructed functional muscle of shoulder joint reserved most function of the joint. The length of the tansplanted fibula was 18-23 cm, the average length was 20 cm.Results All the cases was followed up, the met follow up time was 2 years. The union grafted bones all healed well, connected with the host bones within 3 to 6 months after the surgery. The functional scores of reconstructed shoulder joint were at least 25.Conclusions Transplantation of proximal humerus with vascular anastomosis could repair the bone defect at least 15 cm after the ectomy of bone tumor in proximal humerus. Reconstruction of the muscles arouned the shoulder joint could reserve most function of the shoulder joint.[