定制型肱骨近端假体结合人工补片重建肩关节的疗效分析

Proximal humerus reconstruction with endoprostheses and polypropylene mesh

目的探讨肱骨近端骨肿瘤保肢术中使用人工补片重建盂肱关节囊的手术方法及其对稳定肩关节、预防术后肱骨头脱位的效果。方法2006年2月至2009年1月，回顾性分析接受定制型肱骨近端假体结合聚丙烯非降解性人工补片重建肩关节的患者12例，男7例，女5例；年龄21～55岁，平均38岁。肿瘤类型：骨巨细胞瘤9例，骨肉瘤1例，软骨肉瘤2例。9例骨巨细胞瘤患者中3例为CampanacciⅡ期，6例为CampanacciⅢ期；1例骨肉瘤患者为EnnekingⅡB期；2例软骨肉瘤患者均为EnnekingⅡA期。采用国际骨与软组织肿瘤协会（MSTS）功能评估标准评价术后肩关节功能。结果患者均获得随访，随访时间24～52个月，平均35个月。手术出血量150～500ml，平均254ml；手术时间150-200min，平均172min。术后患者肩关节前屈20°-60°，平均41°；外展20°～70°，平均42°。MSTS评分为53％～77％，平均66％。术后无一例患者出现臂丛损伤、切口感染及假体脱位；随访期间无一例患者出现局部复发、远处转移或死亡。结论使用聚丙烯非降解性人工补片重建盂肱关节囊可显著减少肱骨近端骨肿瘤保肢术后肱骨头假体脱位的发生，便于周围软组织的附着和长入。

Objective To investigate the surgical technique, postoperative function and dislocation incidence of proximal humerus reconstruction with metallic endoprostheses and polypropylene knitted nonabsorbable mesh after proximal humeral tumor resection. Methods Twenty patients with proximal humeral tumor were retrospectively reviewed. They were performed proximal humerus reconstruction with proximal humeral prosthesis and polypropylene knitted non-absorbable mesh from February 2006 to January 2009. There were 5 women and 7 men with a mean age of 38 years （range, 21-55 years） at the time of surgery, and giant cell tumor in 9 patients （including Campanacci Ⅱ for 3, Campanacci Ⅲ for 6）, osteosarcoma in 1 （Enneking ⅡB）, and chondrosarcoma in 2 （Enneking ⅡA）. The operative time, blood loss, and shoulder movement postoperation were analysed. According to the assessment system by MSTS, the function of limb after surgery was assessed. Results Patients were followed clinically and radiographically for a minimum of 24 months （mean, 35 months; range, 24-52 months）. The mean operative time was 172 min （range, 150-200 min）. The mean blood loss was 254 ml （range, 150-500 ml）. There were no shoulder dislocations at final follow-up. The mean shoulder flexion was 41°（range, 200-60°） and mean shoulder abduction was 42° （range, 20°-70°）. The mean postoperative functional assessment score of the limb was 66% （range, 53%-77%）. None of the patients had a wound infection, traction neuropraxia or died after the surgical procedure. Conclusion The data suggests that the use of a polypropylene knitted non-absorbable mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment after tumor resection.