Wittig James C, Bickels Jacob, Wodajo Felasfa, Kellar-Graney Kristen L, Malawer Martin M
Department of Orthopedic Surgery, New York University Medical Center and the Hospital for Joint Diseases, New York, NY, USA.
Clin Orthop Relat Res. 2002 Apr(397):143-55. doi: 10.1097/00003086-200204000-00020.
Patients with high-grade sarcomas arising from the scapula or periscapular soft tissues traditionally have been treated with either a total scapulectomy or a wide, en bloc, extraarticular scapular resection, termed the Tikhoff-Linberg resection. The major challenge after such resections is to restore shoulder girdle stability while preserving a functional hand and elbow. The current authors describe three patients who had an extraarticular, total scapula resection (modified Tikhoff-Linberg) for a high-grade sarcoma. Each patient had reconstruction with a constrained (rotator cuff-substituting) total scapula prosthesis in an effort to optimally restore the normal muscle force couples of both glenohumeral and scapulothoracic mechanisms. At latest followup, the Musculoskeletal Tumor Society functional score was 24 to 27 of 30 (80%-90%). All patients had a stable, painless shoulder and functional hand and elbow. Forward flexion and abduction ranged from 25 degrees to 40 degrees. Glenohumeral rotation (internal rotation, T6; external rotation -10 degrees) below shoulder level, shoulder extension, and adduction were preserved. Protraction, retraction, elevation, and abduction of the scapula were restored and contributed to shoulder motion and upper extremity stabilization. There were no complications. Total scapula reconstruction with a constrained total scapula prosthesis is a safe and reliable method for reconstructing the shoulder girdle after resection of select high-grade sarcomas. The authors emphasize the clinical indications, prosthetic design, surgical technique, and early functional results.
传统上，肩胛骨或肩胛周围软组织来源的高级别肉瘤患者一直采用全肩胛骨切除术或广泛的整块关节外肩胛骨切除术（即蒂科夫-林伯格切除术）进行治疗。此类切除术后的主要挑战是在保留手部和肘部功能的同时恢复肩胛带的稳定性。本文作者描述了3例因高级别肉瘤接受关节外全肩胛骨切除术（改良蒂科夫-林伯格术式）的患者。每位患者均采用受限型（替代肩袖）全肩胛骨假体进行重建，以最佳地恢复盂肱关节和肩胛胸壁关节正常的肌力耦联。在最近一次随访时，肌肉骨骼肿瘤学会功能评分为30分中的24至27分（80%-90%）。所有患者的肩部均稳定、无痛，手部和肘部功能良好。前屈和外展范围为25度至40度。肩胛下水平以下的盂肱关节旋转（内旋，T6；外旋-10度）、肩部后伸和内收功能得以保留。肩胛骨的前伸、后缩、上抬和外展功能得以恢复，并有助于肩部运动和上肢稳定。未出现并发症。采用受限型全肩胛骨假体进行全肩胛骨重建是一种安全可靠的方法，用于在切除特定高级别肉瘤后重建肩胛带。作者强调了临床适应证、假体设计、手术技术和早期功能结果。
