新型人工全肩胛骨肩关节置换治疗肩胛部肿瘤

Replacement of New Scapula-shoulder Prosthesis for Treatment of Scapular Tumor

应用研制的羟基磷灰石喷涂钛合金全肩胛骨、肩关节置换治疗２例肩胛部肿瘤，随访１～１．５年，假体无松动，重建的肩关节功能恢复满意。作者认为，这种新型人工关节具有以下优点：（ｌ）盂肱关节连动采用倒置球臼型结构，肱骨头柄用绞链型连接，增加了关节的稳定性和提供关节更大的活动度；（２）人工关节金属部分应用人工骨羟基磷灰石喷涂，假体能让周围的组织长入，产生较好的生物固定，避免假体的松动、下沉和折断等并发症；（３）此人工肩胛骨为板状、多孔结构设计和假体上羟基磷灰石涂层，有利于肩胛骨周围组织长入，粘连，确保重建的肩关节的功能良好。应用这种新型人工全肩胛骨肩关节置换治疗肩胛部肿瘤，既可彻底切除肿瘤，又能保留肩部和上肢的功能，在不断提高生存率基础上使患者的生活质量得到进一步的改善。本文还强调要严格掌握手术适应证，术中对肿瘤应实施广泛切除边缘，术后注意化疗和功能康复，以提高治疗效果。

AbstractReplacement of hydroxyapatite-coated titanium al-loy prosthesis of total scapul a and shoulder joint hasbeen perfor1ned for the treatment of tumor in the scapu-lar area in 2 patients. They had been followed up for l～1. 5 years,The prosthesis had not loosened and the reconst ructed shoulder joint recoverred satisfact ory fu nc-tion. The authors considered that this new scapula-shou lder joint prost hesis has the following advantages:(1) The joint of the glenoid cavity and the humerus wasconnected with the structure of reverse hall-socket and the head and diaphysis of the humerus hinge type com-bined, thus increased the stability and sufficient range ofmotion of the joint;(2 ) The titanium alloy prosthesiswas coated with artificial bone hydroxyapatite. It allowsto be ingrown by the surrounding tissue, which pro-duced biological fixation of the joint and avoided thecomplications, such as lcosening, sinking and breakageof the prosthesis;(3 ) The strueture of the scapularprot hesis vvas mult iporous and the plat e coated w1th hy-droxyapatite,which resulted in solid flxation of the sur-rou nding tissue with the shoulder joint prothesis. It ispossible to resect the tumor completely as well as to pre-serve the func tion of the shoulder and the upper limbwith the replacement of this new prosthesis。The livingquality of the patient was improved while the survivalrate was also increased. The authors emphasized the im-portance of strict indications of surgical treatment,wideresection of the lesion and postoperative chemotherapy.