Villalobos Camilo E, Hayden Brett L, Silverman Andrew, Choi Ikjoon, Wittig James C
Department of Orthopedic/Oncology, Mount Sinai Medical Center, New York, NY, USA.
Ann Surg Oncol. 2009 Aug;16(8):2321-2. doi: 10.1245/s10434-009-0522-5. Epub 2009 Jun 6.
The scapula is a relatively uncommon site for primary bone sarcomas. Tumors arising from the scapula are often initially contained by the rotator cuff muscles that protect pertinent adjacent muscles as well as the brachial plexus and axillary blood vessels. Limb-sparing resection of a scapula sarcoma is technically complex and requires meticulous dissection and mobilization of the brachial plexus and axillary blood vessels. Several muscles must be capable of being preserved in order to reconstruct the scapula and shoulder girdle with a special customized total scapula replacement. The goal of reconstruction is to restore a stable shoulder girdle to preserve elbow and hand function.
In the procedure demonstrated in this video, limb-sparing scapula resection and reconstruction was performed for a patient with a multicentric epithelioid hemangioendothelioma. The steps of the procedure are detailed along with accommodations made for the multicentric nature of the tumor. To allow for optimal postoperative function and maximum soft tissue coverage, a small constrained scapular prosthesis was utilized. The glenohumeral ligaments were reconstructed with a Gore-Tex aortic graft. Multiple muscle rotation flaps were performed to cover and protect the prosthesis as well as restore shoulder girdle stability.
Limb-sparing surgery for scapula sarcomas and anatomic reconstruction with a constrained total scapula prosthesis is a reliable and safe technique for resecting selected sarcomas and reconstructing the shoulder girdle. A stable shoulder girdle can be restored for optimal hand and elbow function. A total scapula prosthetic reconstruction is the authors' procedure of choice when the deltoid, trapezius, rhomboid, latissimus, and serratus anterior muscles are capable of being preserved. The functional outcome is superior to a forequarter amputation and a flail (nonreconstructed) shoulder in which the extremity is left hanging by soft tissues (nonanatomic method).
肩胛骨是原发性骨肉瘤相对少见的发病部位。起源于肩胛骨的肿瘤通常最初被肩袖肌肉所包绕，这些肌肉保护着相关的邻近肌肉以及臂丛神经和腋血管。肩胛骨肉瘤的保肢手术在技术上较为复杂，需要对臂丛神经和腋血管进行细致的解剖和游离。为了用特殊定制的全肩胛骨置换物重建肩胛骨和肩胛带，必须保留几块肌肉。重建的目标是恢复稳定的肩胛带以保留肘部和手部功能。
在本视频展示的手术中，为一名患有多中心上皮样血管内皮瘤的患者实施了保肢肩胛骨切除及重建手术。详细介绍了手术步骤以及针对肿瘤多中心性质所做的调整。为了实现最佳的术后功能和最大程度的软组织覆盖，使用了一个小型受限肩胛骨假体。用戈尔特斯（Gore-Tex）主动脉移植物重建盂肱韧带。进行了多个肌肉旋转皮瓣手术以覆盖和保护假体并恢复肩胛带稳定性。
肩胛骨肉瘤的保肢手术以及用受限全肩胛骨假体进行解剖重建是切除特定肉瘤并重建肩胛带的一种可靠且安全的技术。可以恢复稳定的肩胛带以实现最佳的手部和肘部功能。当三角肌、斜方肌、菱形肌、背阔肌和前锯肌能够保留时，全肩胛骨假体重建是作者首选的手术方式。其功能结果优于前半侧截肢和连枷肩（未重建），在连枷肩中肢体仅靠软组织悬挂（非解剖方法）。
