移植的“肱骨头”吸收-缺损原因和治疗

Reason of absorb-defect and revision in replacing humerus head

目的 分析带或不带腓血管、含腓骨头的腓骨上段替代肱骨头后 ,骨吸收 -缺损的原因 ,寻找缺损肱骨头的修复方法。方法 对 4例因肱骨近端肿瘤行瘤段骨切除、含腓骨头腓骨上段移植患者术后不同时段的临床和X线片表现进行分析。其中 1例应用带肱二头肌短头和喙肱肌蒂喙突转位治疗。随访时间 5 6～ 91个月 (平均 5年 7个月 )。结果 无论带或不带腓血管 ,在软组织床基本相同的条件下 ,移植骨均出现骨吸收 ,但骨缺损仅见 2例。“肱骨头”与肩峰或肩胛盂的反复撞击 ,最终导致骨缺损 ,带肌蒂喙突移位植骨法近期效果良好。结论 虽然“肱骨头”的吸收不可避免 ,但可以用减少撞击来减轻缺损程度 ,带肌蒂喙突移位植骨法可修复较大的缺损。

Objective To study the reason of absorb defect of the replacing humerus head by upper segment of fibula with and without the pedicle of peroneal vessels and to seek the method of the revision after the humerus head defect. Methods The clinical symptoms and X ray plane film manifestation in different time section of 4 patients were analysed after the tumor segmental resection and fibula with fibula head replace for the tumor of proximal humerus. Of these, one case was treated by coracoid process with the pedicle of biceps brachii muscle short head and coracobrachialis muscle transposition. Total time of follow up was 56～91 months (mean 5 years and 7 months). Results Under the similar bed of soft tissue, the absorb appearance of bone were found in all replacing humerus head with or without peroneal vessels, the defect appearance of bone were found only in 2 cases. Repeatedly impingement on the touching point (acromion or glenoid cavity of scapula)has something to do with the absorb defect of 'humerus head'.The near term curative effect was obtained by the method of coracoid process with muscel pedicle graft. Conclusion Although 'humerus head' absorb cannot be avoided, the defect can be decreased by reducing impingement. Greater defect can be repaired by the coracoid process with muscles pedicle transposition.