肩胛带S2区恶性肿瘤保肢术的疗效评价

Limb salvage strategies for malignant scapular bone tumors in region S2

目的评估肩胛带S2区恶性肿瘤保肢术后的疗效。方法2005年1月至2009年1月，17例肩胛带S2区恶性骨肿瘤患者行保肢术，男13例，女4例；年龄14-55岁，平均32．6岁；软骨肉瘤6例，骨肉瘤4例，纤维肉瘤、骨髓瘤、Ewing肉瘤、横纹肌肉瘤、非霍奇金淋巴瘤、恶性骨巨细胞瘤、复发的软骨肉瘤各1例。Enneking分期：ⅠB期4例，ⅡB期13例。按国际骨与软组织肿瘤协会（MSTS）肩胛带分区标准，11例累及S2区和外1／3 S1区，6例累及S2区和S1区。肩袖均不同程度受累，肩关节囊受累8例。14例行新辅助化疗。8例瘤体范围较广或肩关节囊受累者行人工全肩胛骨置换术，9例瘤体范围较小或肩关节囊可保留者行肩胛骨次全切除、异体肩胛骨重建、肩关节囊及肩袖修复术。结果随访16-62个月，平均35．1个月。9例患者出现并发症，其中发生异体骨排斥反应和异体骨吸收1例，异体骨排斥反应1例，假体肩峰外露3例，异体骨吸收4例。局部复发1例，死亡3例，死亡原因均为术后肿瘤广泛转移。MSTS功能评分53．3％-93.3％，平均74．1％。结论在肩胛带S2区保肢手术中，将肿瘤完整切除与功能重建行个体化平衡，可获得较满意的肿瘤学疗效及稳定、美观、功能良好的肩关节。

Objective To investigate and discuss the limb salvage strategies of malignant bone tumors in region S2 of shoulder girdle. Methods The data of 17 patients （13 males and 4 females） were retrospectively analyzed. All of them had malignant scapular tumor at least in region S2, and underwent limb salvage between January 2005 and January 2009. They aged from 14 to 55 years old （mean, 32.6 years）. The histologic types of them were chondrosarcoma in 6 patients, osteosarcoma in 4, fibrosarcoma in 1, myeloma in 1, Ewing＇s sarcoma in 1, rhabdomyosarcoma in 1, non-Hodgkin lymphoma in 1, malignant giant cell tumor of bone in 1 and recurrent chondrosarcoma in 1. The tumors were staged according to Enneking surgical staging system： IB in 4 and IIB in 13. According to the MSTS classification system, the region S2 and lateral 1/3 of region S1 were effected in 11 cases, the region S2 and large part of region S, were effected in 6 cases. The rotator cuff was involved to some extent in all patients, and the articular capsule were involved in 8 cases. Neo-adjuvant chemotherapy was given to 14 patients. The surgical strategies were depended on the range of tumor and preservation of articular capsule. The scapular prosthetic replacement was done in 8 cases with a relatively large range of tumor or resection of articular capsule, otherwise the scapular allograft replacement was done. Among the 11 cases with region S2 and lateral 1/3 of region S1 effected, the scapular allograft replacement was done in 9 cases with articular capsule preserved and the prosthetic replacement was done in 2 cases with articular capsule resected. And the prosthetic replacement was done in the other 6 cases. The articular capsule and partial rotator cuff were preserved and reconstructed preferentially. Results All patients were followed up 16-62 months （mean, 35.1 months）. Postoperative complications were noted in 9 patients, including mild allografi rejection and mild allograft resorption in 1 patient, allograft rejection in 1, prosthetic acromion exposure in 3, allograft resorption in 4. Local recurrence were noted in 1 patients. Three patients were dead because of extensive metastasis. The average function scores were 74.1% （range, 53.3%-93.3%）. Conclusion During the limb salvage surgery, it＇s very important to guarantee the en bloc resection of the tumor. In the meanwhile, the en bloc resection and functional reconstruction should be well balanced.