肱骨近端肿瘤切除反肩关节假体重建的早期功能效果

The short-term function of reverse shoulder arthroplasty after resection of the proximal humerus bone tumour

目的探讨反肩关节重建肱骨近端肿瘤切除后骨缺损的早期临床疗效及治疗经验。方法收集自2013年1月至2014年12月8例反肩关节复合骨移植重建治疗肱骨近端肿瘤切除患者的病历资料，男3例，女5例；年龄25-61岁，平均38岁；2例软骨肉瘤（Enneking ⅠB期1例、ⅡB期1例），6例Campanacci3级骨巨细胞瘤（3例合并病理性骨折）；均行MalawerI型肿瘤切除，并行Zimmer Trabecular Metal^TM反肩关节重建手术。术后门诊随访，包括摄肩关节X线片，测量肩关节活动度，使用Constant-Murley功能评分及国际骨肿瘤协会（musculoskeletal tumor society，MSTS）功能评分进行功能评价。结果8例均获得随访，随访时间3-26个月，平均13个月；手术时间2-3．5h，平均2．7h；术中出血量为300-850ml，平均510ml；切除肱骨近端6-10cm，平均8cm；异体骨复合重建7例，瘤骨灭活再植1例，其中2例患者行背阔肌止点移位重建。随访肩关节X线片显示7例异体骨与宿主骨界面未愈合，1例灭活瘤骨与宿主骨界面于术后1年愈合，所有患者均有不同程度的移植骨骨质吸收现象，但假体稳定，假体骨界面未见透亮线，未发现关节脱位及假体松动。至末次随访时，所有患者无肿瘤复发，无肩关节疼痛；肩关节主动活动，外展活动度为100°-175°，平均155°；主动前屈为115°-170°，平均150°；Constant-Murley功能评分为68％-87％，平均76％；MSTS功能评分为87％-97％，平均92％。结论反肩关节复合骨移植治疗肱骨近端肿瘤切除后骨缺损的早期功能良好，可安全用于相对年轻的骨肿瘤者，远期疗效还有待于进一步观察。

Objective To explore the short-term functional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor resection. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old （25-61）. 2 chon- drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stage Ⅰ B and stage ⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer type Ⅰ resection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow-up was scheduled, and the patient received X-ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant-Murley score and musculoskeletal tumor society（MSTS） score was recorded. Results The mean duration of the operation was 2.7 h （2-3.5 h）. The bleeding in the operation was 510 ml （300-850 ml）. The mean length of humerus resection was 8 em （6-10 cm）. The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow-up was 13 months （3-26 months）. No infection, dislocation, or loosening of prosthesis was found by the last follow-up. The X-ray showed the case who received reimplantation after tumor bone deactivation had achieved bone union 1 year postoperation, 7 cases received allograft had still nonunion at the host-graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recurrence of the tumor was found. At last follow-up, active abduction was 155° （100°- 175°） and active forward elevation was 150° （115°-170°） and Constant-Murley score was 76% （68%-87%）. The MSTS score was 92% （87%-97%）. Conclusion The functional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor resection was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long-term results need further study.