Steinke N M, Ostgård S E, Jensen O M, Nordentoft A M, Sneppen O
Ortopaedkirurgisk afdeling E, Universitetshospitalet i Arhus.
Ugeskr Laeger. 1991 Sep 9;153(37):2555-7.
A total of 121 patients with sarcomas localized to the shoulder girdle were referred to the Sarcoma Centre in Arhus. Of these, 17 (14%) underwent interscapulothoracic amputation. At the time of treatment, the average age was 51 years (17-82 years). Eleven of these patients had sarcomas of bone and six had soft tissue sarcomas. Late diagnosis or previous surgical interventions contributed to the indication for the mutilating procedure. At the time of referral, six of the 11 cases of bone sarcomas were complicated by a pathological fracture and all six soft tissue sarcomas had been submitted to incisional biopsy or non-radical treatment. The soft tissue sarcomas were usually large with an average maximum diameter of 10 cm (4-15 cm). Postoperative recovery was uncomplicated in all cases. Local recurrence occurred in three patients (18%). Eight patients (47%) developed metastases and died from the tumour on an average of 32 months (7-94 months) after operation. Two patients died from other causes without tumour. Seven patients (41%) were tumourfree and alive for an average of 69 months (21-128 months) after operation. Only three of these seven patients wore their shoulder-arm prosthesis regularly while the remainder preferred to be either without a prosthesis or to use a lightweight shoulder prosthesis. None of the seven patients still experienced phantom pain necessitating analgetics. All of the patients were self-reliant in everyday life and the five patients who had been occupationally active until the time of operation had returned to work. The prognosis after interscapulothoracic amputation depends upon the primary malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)
共有121例肩部带骨肉瘤患者被转诊至奥胡斯肉瘤中心。其中,17例(14%)接受了肩胛骨胸廓离断术。治疗时,平均年龄为51岁(17 - 82岁)。这些患者中,11例为骨肉瘤,6例为软组织肉瘤。诊断延迟或先前的手术干预促成了这种致残手术的指征。转诊时,11例骨肉瘤患者中有6例并发病理性骨折,所有6例软组织肉瘤均接受了切开活检或非根治性治疗。软组织肉瘤通常较大,平均最大直径为10厘米(4 - 15厘米)。所有病例术后恢复均无并发症。3例患者(18%)出现局部复发。8例患者(47%)发生转移,平均术后32个月(7 - 94个月)死于肿瘤。2例患者死于其他原因,未患肿瘤。7例患者(41%)无瘤存活,平均术后69个月(21 - 128个月)。这7例患者中只有3例定期佩戴肩臂假体,其余患者要么更喜欢不使用假体,要么使用轻质肩部假体。这7例患者中无一例仍有需要镇痛的幻肢痛。所有患者在日常生活中都能自理,5例术前有工作的患者已恢复工作。肩胛骨胸廓离断术后的预后取决于原发性恶性疾病。(摘要截断于250字)