肱骨近端Ⅱ-Ⅲ级骨巨细胞瘤保肢手术与康复训练7例

Limb preservation surgery combined with perioperative rehabilitation for the treatment of 7 patients with stageⅡ to Ⅲ giant cell tumor of bone in the proximal humerus

目的:探讨瘤段扩大切除加人工假体置换术及围手术期的康复治疗对肱骨近端骨巨细胞瘤的保肢、关节功能恢复的效果。方法:自2007年3月到2010年3月,共收治肱骨近端Ⅱ-Ⅲ级骨巨细胞瘤7例,男3例,女4例,平均年龄34.6岁(18～49岁),平均病程19个月(6～35个月)。7例术前均经病理检查及X线证实为肱骨近端骨巨细胞瘤。临床表现为进行加重的肩部疼痛,体检臂近端肿胀、压痛明显,肩关节活动障碍。所有病例采用瘤段扩大切除后以定制的人工假体置换,围手术期辅以康复训练。采用CMS评分及OSIS评分评价患肩功能与患肩稳定性。结果:7例均获随访,时间14～35个月,平均17个月。术后随访无重大并发症发生,无复发病例。术后1年7例患肩CMS评分平均为70.7分(63～82分),OSIS评分平均25.1分(18～29分)。肩关节功能优2例,良5例;肩关节稳定性优1例,良6例。结论:瘤段扩大切除加人工假体置换术辅以围手术期功能训练治疗肱骨近端Ⅱ-Ⅲ级骨巨细胞瘤疗效确切,达到切除肿瘤与保肢目的。

Objective：To study the effects of the extensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation for the treatment of stage Ⅱ to Ⅲ giant cell tumor of bone in the proximal humerus.Methods：From March 2007 to March 2010,7 patients with stage Ⅱ to Ⅲ giant cell tumor of bone in the proximal humerus were treated.Among the patients,3 patients were male and 4 patients were female with a mean age of 34.6 years （ranged,18 to 49 years）.The mean course of disease was 19 months （ranged,6 to 35 months）.All the patients were confirmed to suffer stage Ⅱ to Ⅲ giant cell tumor of bone in the proximal humerus by pathology and X-ray examinations.Clinical manifestations of the patients included persistence aggravated pain of the shoulder,swelling in the proximate arm with obviously tenderness,activity limited of the joint.All the patients were treated with extensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation.CMS and OSIS score system were used to evaluate shoulder function and shoulder stability.Results：All the patients were followed up,and the duration ranged from 14 to 35 months,with an average of 17 months.There were no serious complications or recurrence in all cases.One year after the surgery CMS and OSIS score system were 70.7 scores （ranged,63 to 82 scores） and 25.1 scores （ranged,18 to 29 scores） respectively.According to evaluation for shoulder function,2 patients got an excellent result and 5 good.According to evaluation of shoulder stability,1 patient got an excellent result and 6 good.Conclusion：Extensive resection of the tumor-loading segment and artificial humerus head replacement combined with perioperative rehabilitation for the treatment of stage Ⅱ to Ⅲ giant cell tumor of bone in the proximal humerus would not only preserve the upper extremity but also preserve the function of upper extremity.