人工肩关节假体置换治疗肱骨近端恶性骨肿瘤

Treatment of Malignant Bone Tumors of Proximal Humerus by Prosthetic Replacement of Shoulder Joint

目的:探讨人工肩关节假体置换治疗肱骨近端恶性骨肿瘤的疗效。方法:1985年8月至2003年8月我院共对35例肱骨近端恶性骨肿瘤患者行肿瘤瘤段切除,人工肩关节假体置换保肢术。其中骨肉瘤9例,骨巨细胞瘤9例,软骨肉瘤5例,尤文氏肉瘤2例,恶性纤维组织细胞瘤3例,非霍奇金淋巴瘤2例,纤维肉瘤2例,转移癌3例。结果:35例患者中,5例失访,2例因肺部原发肿瘤死亡,6例因原发恶性骨肿瘤转移死亡,2例因局部复发而行前四分之一截肢术,1例因感染行假体翻修术;重建成功的20例患者无瘤生存,最长18年,最短6个月,平均6年,所有患者未发现假体松动或断裂。按Enneking骨骼肌肉肿瘤术后评估标准,平均评分24.6分,评分在24分以上者占65%。结论:人工肩关节假体置换在治疗肱骨近端恶性肿瘤方面,不仅能保留患肢完整的外观形态,而且能在很大程度上保留上肢的功能,是一种值得肯定的治疗方法。

Objective:To discuss the treatment of malignant bone tumors of proximal humerus by the replacement of artificial shoulder joint.Methods:From August 1985 to August 2003,35 patients with malignant bone tumors of proximal humerus were treated with segmental resection and prosthetic replacement of shoulder joint.The tumors involved in these patients were osteosarcoma(9 cases),giant cell tumor(9 cases),chondrosarcoma(5 cases),Ewing sarcoma(2 cases),malignant fibrohistiocytoma(3 cases),non-Hodgkin lymphoma(2 cases),fibrosarcoma(2 case)and metastatic malignant tumor(3 cases).Reusults:Of the 35 patients,5 was lost from follow-up and 8 cases died after operation,of which 2 died from primary tumor of lung and 6 died from metastesis of primary malignant tumors;2cases because of local recurrence undergoing forequarter amputations in 1 case endoprothethesis was removed and revised because of deep infection and the other 20 patents were survived for 6 months to 18 years(mean 6 years).There was no loosening or fracture of the endoprostheses.Function was evaluated with Enneking's system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.The mean score was 24.6,13 patients(65%)attained the scores more than 24.Conclusion:It can be evident that prosthetic replarement of shoulder joint for the treatment of malignant tumors of proximal humerus would not only keep the integrated appearance,but also preserve the function of the upper extremity to a greater extent.