肿瘤型肱骨近端假体重建肩关节的临床效果

Clinical effect of shoulder joint reconstruction with endoprostheses following proximal humerus tumors resection

目的：探讨肱骨近端骨肿瘤切除后人工假体重建肩关节的功能的临床效果。方法对18例肱骨近端骨肿瘤患者采用肿瘤型肱骨近端假体重建肩关节，肿瘤类型：骨肉瘤6例，软骨肉瘤4例，浆细胞瘤1例，恶性骨巨细胞瘤4例，转移癌3例。骨肉瘤、浆细胞瘤患者手术前后均接受化疗。术后6个月采用MSTS功能评分系统评价术后肩关节功能。结果1例失访，17例获随访，时间10～96（52.8±8.4）个月。死亡4例，复发1例，肩关节半脱位2例。肩关节MSTS功能评分为9～27（18．6±3．5）分，其中优8例，良5例，中2例，差2例，优良率13/17。结论应用肿瘤型肱骨近端假体治疗肱骨上段肿瘤能降低术后并发症，需注意肩袖和外展装置的修复，大多数保肢患者肩关节功能恢复满意。

Objective To explore the clinical effect of shoulder joint reconstruction with endoprostheses following proximal humerus tumors resection.Methods 18 patients underwent reconstructive procedures of shoulder joint with endoprostheses after intra-articular resection of tumors in the proximal humerus.Histological types were of 6 osteosar-comas,4 osteochondrosarcomas,1 solitary bone plasmacytoma ,4 maligant giant-cell tumors of bone,3 metastatic car-cinomas of bone.The patients with osteosarcomas or bone plasmacytoma received neo-adjuvant chemotherapy.The Musculoskeletal Tomor Society （MSTS）evaluation system was used to assess functional outcome at 6 months postop-eration.Results 17 cases were followed-up for 10~96（52.8 ±8.4）months.1 patient had local recurrence,4 pa-tients died,2 shoulder subluxation.The average MSTS Function score was 9 ~27（18.6 ±3.5）points with 8 excel-lent,5 good,2 fair,2 poor.The rate of the excellent or good was 13/17.Conclusions The method for treatment of tumors in proximal humerus by using endoprostheses can reduce complication after operation.More attention must be played on the reconstruction of the rotator cuff and the abduction mechanisms.Most of patient could reserve the satis-fied function of shoulder joint.