全肩关节置换术在肩胛恶性肿瘤治疗中的应用(附5例报道)

HIGH BIOMIMETIC SCAPULAR PROSTHESIS IN TREATING SCAPULAR MALIGNANT TUMORS(REPORT OF 5 CASES)

目的探讨高仿生型人工全肩胛骨肩关节置换及保肢重建技术治疗肩胛骨恶性肿瘤的临床疗效。方法 2005年12月～2006年12月,收治肩胛骨恶性肿瘤患者5例。术前应用三维重建技术定制个体化高仿生型假体,采用扩大切除术后行人工全肩胛骨假体置换,同时行各个肌群原位功能重建。结果随访所有患者均生存5年以上。5例患者近期肘关节活动正常,肩关节前屈、后伸正常,外展和内收接近正常,可以做环绕动作。MSTS评分85%～92.5%,平均90%。肩关节JOA评分80～85,平均83分。结论高仿生人工全肩胛骨肩关节置换术是治疗肩部恶性肿瘤的极其有效的方法,外观和功能都明显优于以前的保肢手术方法。此类假体具有适应症广、活动范围大及稳定性强等优点。该系列设计既保留肢体又重建功能,术后恢复快,最大程度减轻肩关节病残率,患者满意率高。

Objective To investigate the clinical effect of high biomimetic scapular prosthesis and shoulder girdle salvage reconstruction. Methods 5 patients with malignant tumor of scapula were treated in our hospital from December 2005 to December 2006. High scapular biomimetic prosthesis was personally customized with three-dimension techniques before operation. In operation, the procedure included extensive resection of scapula and replacement with personalized biomimetic prosthesis. While all shoulder muscle groups were reconstructed in-situ. Results All patients have got follow-up surveys for more than 5 years. The flexion and extension function of elbow and shoulder joints recovered to normal. The long-term abduction and adduction of shoulder joint recovered with good rotation movement. According to the functional rating system of the Musculoskeletal Tumor Society（MSTS） of the upper extremity, the mean function score was 90（85-92.5%） in all patients. According to the scoring system of the Japan Orthopaedics Association（JOA）, the average score was 83（80-85）. Conclusion The replacement with high biomimetic scapular prosthesis is an effective treatment for patients with scapular malignant tumor. The obtained exterior and function are significantly better than those of previous salvage therapy for more movement range and stability without causing much disability.