锁骨恶性肿瘤的外科治疗

Surgical treatment for the clavicular malignant tumors

[目的]回顾分析锁骨恶性肿瘤的临床特点,并评价其肿瘤性及功能性结果。[方法]2006年1月~2015年6月,16例锁骨恶性肿瘤患者接受了切除术,其中6例行异体骨重建。包括男性10例,女性6例。年龄6-75岁,中位年龄53岁。左侧锁骨7例,右侧9例,肩峰端3例,骨干5例,胸骨端6例,累及胸骨端及骨干2例。肿瘤类型:转移瘤5例,浆细胞瘤4例,尤文肉瘤3例,骨髓瘤1例,纤维肉瘤1例,软骨肉瘤1例,非霍杰金淋巴瘤1例。手术切缘包括:广泛切除8例,边缘切除7例,囊内切除1例。根据MSTS功能评价标准及ConstantMurley肩关节评分进行评估。[结果]随访时间12~60个月,平均30个月。2例转移瘤(包括肺癌和肾癌各1例)复发,其余14例均未见局部复发。16例中,6例死亡,10例无复发存活。6例异体骨重建患者,2例分别随访至12和14个月时,出现植骨未愈合、内固定松动伴活动时疼痛,予以取出内固定并取出异体骨。根据MSTS功能评分及Constant-Murley肩关节评分,术后12个月时,两组患者评分相比术前均明显改善,未重建组术后功能评分与异体骨重建组相比,差异无统计学意义(P=0.159,P=0.462)。[结论]对锁骨恶性肿瘤,锁骨部分或全部切除可达到局部控制。使用异体骨重建易不愈合,相比未重建患者术后功能并无显著改善,因此不建议使用异体骨重建。

[Objective] To explore clinical characteristics of clavicular malignant tumor and evaluated the postoperative on- cologic and functional results. [Methods] From January 2006 to June 2015, 16 patients with clavicular malignancy underwent total or partial claviculectomy, including that 6 patients got clavicular reconstruction with allograft （the reconstruction group）, the remaining 10 patients had claviculectomy alone （the non-reconstruction group）. Of them, 10 males and 6 females aged on average of 53 years ranged from 6 to75 years. Furthermore, 7 patients had the tumor on the left side while 9 on the right side, in- cluding 5 of metastatic tumor, 4 of plasmacytoma, lof myeloma, 3 of Ewing＇s sarcoma, 1 of fibrosarcoma, 1 of non-Hodgkin lym- phoma and 1 of chondrosarcoma. In term of tumor resection, 8 patients had the tumor widely excised, 7 patients had marginally excised, whereas the remainig 1 patient got only the intra-lesion resection. Musculoskeletal Tumor Society score and Constant- Murley score were used for evaluation. [Results] The patients were followed up for an average of 30 months ranged from 12 to 60 months. Only 2 patients with metastatic lesion, including 1 from lung cancer and 1 from kidney cancer, suffered from local recurrence, while the remaining 14 patients had no local recurrence. Of the 16 patients, 6 died of the malignancy, whereas the remaining 10 patients were alive without recurrence. As result of non-union of allograft reconstruction with or without fixation loosening in 2 of the 6 patients, the allograft and fixation were finally removed. The MSTS Scores and Constant-Murley scores in the reconstruction group were not significantly higher than those in the non-reconstruction group （P=0.159 and P=0.462） . [Conclusion] Claviculectomy can provide good local tumor control. Patients with allograft reconstruction had no better func-tion than those without reconstruction. Considering the non-union of bone, allograft reconstruction is not recom- mended.