人工肱骨头置换术联合新辅助化疗对肱骨近端骨肿瘤的疗效分析

The Efficacy of Humeral Head Replacement Combined with Neoadjuvant Chemotherapy in the Treatment of Proximal Humeral Bone Tumor

目的探讨人工肱骨头置换术联合新辅助化疗对青少年肱骨近端骨肿瘤的疗效。方法选择青少年肱骨近端骨肿瘤52例,根据入院时间,分为观察组及对照组,2001年6月至2008年12月收入院的为对照组,28例,行人工肱骨头置换术;2009年1月至2016年11月收入院的为观察组,24例,行人工肱骨头置换术联合新辅助化疗,对比两组患者术后15个月的平均MSTS评分、肩关节功能及术后15个月的假体松动、断裂、感染、肩关节半脱位、关节面塌陷及肿瘤复发等情况。结果与治疗前相比,治疗后两组患者的疼痛程度、肢体精细活动、肢体活动范围、提举能力、肢体功能情况评分均显著提高,总分也显著提高,组内比较差异有统计学意义,P<0.05;治疗后观察组患者肢体功能、肢体疼痛感及总分显著高于对照组(P<0.05)。观察组优良率明显高于对照组,P<0.05。随访期间,两组均未出现假体无松动移位,患肢肘关节、手部感觉、血运及运动良好、无切口并发症及深部感染。观察组肿瘤复发转移率明显低于对照组。结论人工肱骨头置换术治疗肱骨近端骨肿瘤有效,结合新辅助化疗可降低肿瘤复发率,提高患者生活质量。

Objective To investigate the efficacy analysis of humeral head replacement combined with neoadjuvant chemotherapy in the treatment of proximal humeral bone tumor. Methods 52 cases with proximal humeral bone tumor were di- vided into the observation group and the control group according to admission time. The control group（28 cases） received humeral head replacement, the observation group（ 24 cases ） received humeral head replacement combined with neoadjuvant chemothera- py. The average MSTS score, shoulder function, prosthetic loosening, fracture, infection, shoulder joint semi-dislocation, joint sur- face collapse and tumor recurrence 15 months after surgery of the 2 groups were compared. Results The pain degree,physical activity, physical activity,lifting ability and physical function score of the 2 groups were significant increased after surgery, the to- tal score were significant increased, which had significant difference, P 〈 0.05. The physical function, physical pain and total score of the observation group were higher than the control group, P 〈 0.05. The distinguished achiever ratio of the observation group was higher than the control group, P 〈 0.05. The 2 groups had no prosthesis loose, shifted, with elbow, hand, blood and movement, no incisions and deep infection. The tumor recurrence rate of the observation group was lower than the control group. Conclusion Humeral head replacement is effective on proximal humeral proximal bone tumor, combined with neoadjuvant chemotherapy could decrease the recurrence rate and improve the life quality.