Siegel H J, Lopez-Ben R, Mann J P, Ponce B A
Section of Orthopaedic Oncology, University of Alabama at Birmingham Medical Centre, 1313 13th Street South, Birmingham, Alabama 35205, USA.
J Bone Joint Surg Br. 2010 May;92(5):707-12. doi: 10.1302/0301-620X.92B5.23246.
Bone loss secondary to primary or metastatic lesions of the proximal humerus remains a challenging surgical problem. Options include preservation of the joint with stabilisation using internal fixation or resection of the tumour with prosthetic replacement. Resection of the proximal humerus often includes the greater tuberosity and adjacent diaphysis, which may result in poor function secondary to loss of the rotator cuff and/or deltoid function. Preservation of the joint with internal fixation may reduce the time in hospital and peri-operative morbidity compared with joint replacement, and result in a better functional outcome. We included 32 patients with pathological fractures of the proximal humerus in this study. Functional and radiological assessments were performed. At a mean follow-up of 17.6 months (8 to 61) there was no radiological evidence of failure of fixation. The mean revised musculoskeletal Tumour Society functional score was 94.6% (86% to 99%). There was recurrent tumour requiring further surgery in four patients (12.5%). Of the 22 patients who were employed prior to presentation all returned to work without restrictions. The use of a locking plate combined with augmentation with cement extends the indications for salvage of the proximal humerus with good function in patients with pathological and impending pathological fractures.
继发于肱骨近端原发性或转移性病变的骨质流失仍然是一个具有挑战性的外科问题。治疗方案包括通过内固定稳定关节以保留关节，或切除肿瘤并进行假体置换。肱骨近端切除通常包括大结节和相邻骨干，这可能会因肩袖和/或三角肌功能丧失而导致功能不佳。与关节置换相比，通过内固定保留关节可能会减少住院时间和围手术期发病率，并产生更好的功能结果。本研究纳入了32例肱骨近端病理性骨折患者。进行了功能和影像学评估。平均随访17.6个月（8至61个月），没有影像学证据表明固定失败。改良的肌肉骨骼肿瘤学会功能评分平均为94.6%（86%至99%）。4例患者（12.5%）出现复发性肿瘤需要进一步手术。在22例就诊前有工作的患者中，所有患者均恢复工作且无限制。使用锁定钢板并结合骨水泥强化，扩大了对肱骨近端进行挽救性治疗的适应症，对于病理性骨折和即将发生病理性骨折的患者，可使其获得良好功能。
