肱骨连接器重建肱骨干转移癌切除后骨缺损的研究

A study on humeral shaft prosthesis in the reconstruction of bone defects after resection of humeral shaft metastatic carcinoma

目的探讨应用肱骨连接器重建肱骨干转移癌手术切除后骨缺损的临床疗效。方法回顾性分析2011年5月至2014年1月,我科采取定制型肱骨连接器重建肱骨干转移癌切除后骨缺损的6例,其中女2例、男4例;年龄50～63岁,平均（57.5±4.8）岁。左侧肱骨干转移癌2例、右侧4例。统计手术时间及术中出血量。术前、术后行（visual analogue scale,VAS）评分评价患肢疼痛情况;术后采用肌肉骨骼肿瘤学会（musculoskeletal tumor society system,MSTS）保肢评分系统随访评价患肢功能。结果随访6～32（平均16.5）个月,手术时间95～120（平均104.5）min,术中出血300～800（平均491.7）ml。本组6例中,除1例术后周围软组织内复发转移灶、1例连接器近端柄部出现无菌性松动并翻修外,均未发生桡神经及肱动脉损伤、上肢不等长、感染、假体周围骨折等并发症及安全性问题。术后3个月患肢VAS评分平均（1.7±1.5）分较术前平均（5.0±1.4）分显著改善,差异有统计学意义（Ρ=0.001）。术后3个月患肢MSTS评分平均（24.8±2.1）（22～28）分。结论肱骨连接器重建肱骨干转移癌切除后骨缺损,不仅临床疗效满意,而且术中操作方便、手术创伤小、术后并发症少,是肱骨干转移癌的姑息性外科治疗一种较好的重建方法。

Objective To investigate the clinical results in the reconstruction of bone defects after resection of humeral shaft metastatic carcinoma by using humeral shaft prosthesis. Methods In a retrospective study, 6 patients with humeral shaft metastatic carcinoma were treated with a kind of self-made humeral shaft prosthesis from May 2011 to January 2014. There were 4 males and 2 females, whose mean age was （ 57.5±4.8 ） years old （ range： 50-63 years ）. There were 2 cases of metastases on the left side of the humerus and 4 cases of metastases on the right side. The operation time and intraoperative blood loss were recorded. The preoperative and postoperative limb pain was evaluated by the visual analogue scale （ VAS ）. The postoperative limb function was analyzed with the Musculoskeletal Tumor Society （ MSTS ） system. Results The mean follow-up period was 16.5 months （ range： 6-32 months ）. The mean operation time was 104.5 min （ range： 95-120 min ）. The intraoperative blood loss was 491.7 ml （ range： 300- 800 ml ）. Postoperative recurrence in the surrounding soft tissues occurred to a patient. Another patient had aseptic loosening around the proximal end of the prosthesis, and revision surgery was performed. No such complications as radial nerve injury, brachial artery injury, inequality of upper limbs, infection or periprosthetic fractures were found, and there were no safety problems. The mean preoperative VAS score was 5.0±1.4, which was significantly improved to 1.7±1.5 at 3 months after the operation, and the differences were statistically significant （ P=-0.001 ）. The MSTS score was ranged from 22 to 28 with an average score of 24.8±2.1 at 3 months after the operation. Conclusions Satisfactory clinical results can be achieved in the reconstruction of bone defects after the surgical resection of humeral shaft metastatic carcinoma by using humeral shaft prosthesis. The results show that it can significantly reduce pain and improve limb function with a convenient procedure, little trauma and less complication. The study offers a new palliative treatment option for the patients with humeral shaft metastatic carcinoma.