肱骨近段肿瘤人工假体置换的临床分析

Clinical analysis of prosthesis replacement for proximal humerus tumors

目的：探讨人工假体置换术和软组织重建对肱骨近端良恶性肿瘤患者预后和肩关节功能的影响以及手术策略。方法：2007年4月至2014年4月间对17例肱骨近端侵袭性良性肿瘤和原发恶性肿瘤患者行瘤段切除人工假体置换并软组织重建。从病理类型、肿瘤分期、手术方式对患者预后情况、肩关节功能状况的影响进行评估。结果：17例均获随访，随访时间8-96（平均58.9）个月。11例原发恶性肿瘤中有5例患者死于肿瘤复发或转移，6例无瘤生存24-91（平均54.83）个月。6例侵袭性良性肱骨肿瘤患者均无死亡，目前生存39-96（平均72.33）个月。17例患者肢体功能平均达到正常功能的64.88%，全肩关节置换患者肢体功能（平均72.56%）与半肩关节置换患者（平均56.25%）比较差异有统计学意义（P〈0.05）；保留外展肌及肌肩袖的IA型切除患者的术后肩关节功能（平均68.75%）与切除外展肌及肌肩袖IB型切除患者（平均61.44%）比较差异有统计学意义（P〈0.05）。结论：肱骨近端侵袭性良性肿瘤和原发恶性肿瘤人工假体置换患者的生存期主要与肿瘤病理类型有关，术后肩关节功能的恢复与假体的选择、软组织切除范围有关。

Objective： To explore surgical strategies, functions and prognosis of artificial prosthesis replacement and soft tissue reconstruction for patients with invasive benign or primary malignant proximal humerus tumor. Methods： A total of 17 patients with invasive benign or primary malignant proximal humerus tumor underwent prosthetic replacement after segment bone tumor resection and soft tissues reconstruction from April 2007 to April 2014 were enrolled. Based on histological types, tumor stages and surgical procedures, the effects of artificial prosthesis replacement and soft tissue reconstruction on prognosis and shoulder joint function were evaluated. Results： All patients were followed up for 8 to 96 months （average time： 58.9 months）. Among 11 patients with primary malignant tumor, 5 died of tumor recurrence or metastasis, and 6 showed tumor-free survival for 24 to 91 months （average time： 54.83 months）. The 6 patients with aggressive benign tumors survived for 39 to 96 months, with an average of 72.33 months. The shoulder joint function of 17 patients recovered to 64.88% of normal. There were significant differences in the shoulder joint function between the patients who underwent half shoulder replacement and those who underwent total shoulder replacement （56.25% vs 72.56%, P〈0.05）. There were significant differences in the shoulder joint function between the patients who underwent Type I A excision （retention of abductor muscles and rotator cuff） and those who underwent Type I B excision （68.75% vs 61.44%, P〈0.05）. Conclusion： The survival of patients with invasive benign or primary malignant proximal humerus, who underwent artificial prosthesis replacement and soft tissue reconstruction, is closely related to tumor types. The shoulder joint function is associated with the methods of prosthesis replacement and soft tissue resection.