肩关节肿瘤切除和重建后的患肢功能观察

Functional outcome following shoulder tumor resection and reconstruction

目的肩关节肿瘤切除后,探讨不同重建方式的患肢长期功能。方法回顾性分析32例肩关节肿瘤保肢患者的临床资料。重建方式包括:8例一期肩关节融合,7例假体异体骨复合物,6例功能性间隔物,5例未行重建或悬吊术,3例假体,2例带血管蒂腓骨和1例异体骨。结果23例生存患者平均随访81个月。不同重建方式的功能评分分别为:一期肩关节融合为87%,主动运动优良,肩部有力;假体异体骨复合物为79%,间隔物为66%,未重建为85%,假体为60%和带血管蒂腓骨为73%。结论肩关节肿瘤的重建方式是根据切除范围和患者的实际需要来选择。如外展肌群无法重建,肩关节融合的功能良好,肩部有力;如果外展肌群可以重建,假体异体骨复合物功能较好。

Objective To analyze the long-term limb sparing outcomes of various reconstructive procedures and complications associated with extensive excision in bone tumours of the shoulder girdle. Methods Shoulder reconstruction following resection of bone tumors of the shoulder girdle was reviewed retrospectively for 32 patients at the Wesley Hospital or Princess Alexandra Hospital. The reconstructions were including arthrodesis （ 8 cases） , allograft-prosthetic composite （7 cases） , spacer （ 6 cases）, no bone reconstruction （5 cases）, prosthesis （3 cases）, vascular fibular graft （2 cases） and allograft （ 1 case）. Results The average duration of follow-up was 81 months for the 23 patients who were still alive at the time of the latest follow-up examination. Functional results were related to the type of resection and the method of shoulder reconstruction. After intra-articular resection of the proximal humerus with loss of the abductor mechanism, arthrodesis resulted in 87% functional score and more strength was found after reconstruction with prosthesis or allograft-prosthetic composite. Allograft-prosthetic composite had better function （ Score 79% ） than prosthesis alone after intra-articular resection of the humerus because reconstruction of the deltoid and the rotator cuff could be performed without increased prevalence of complication related to the allograft. After extra-articular resection of the glenoid cavity and the proximal humerus with abductor mechanism, reconstruction with a functional spacer frequently resulted in superior subluxation of the implant and only fair function （ Score 66% ） of the shoulder. With two teen-aged patients, a free fibular graft inserted after intra-articular resection of the proximal humerus led to fair function （ Score 73% ） , to be followed by secondary arthrodesis when growth was complete. Conclusions Indications for the method of reconstruction depend on type of resection, age, gender, occupation, the expected functional level and restriction of activity. After resection of the abductor mechanism, arthrodesis results in more strength and is the preferred option for the young active demanding patients. If the abductor mechanism is preserved, allograft-prosthetic composite gives good results.