Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi'an, China.
Orthop Surg. 2010 Feb;2(1):19-26. doi: 10.1111/j.1757-7861.2009.00058.x.
To evaluate functional outcomes and complications of reconstruction of the proximal humerus after intra-articular tumor resection.
Twenty-five patients who underwent Malawer I type resection and reconstruction of the proximal humerus for treatment of malignant or invasive benign tumors from August 1999 to August 2005 were evaluated. A variety of reconstructive procedures, including modular tumor prosthesis, osteoarticular allograft, and allograft-prosthetic composite (APC), were performed after resection of tumor. Oncological and radiographic parameters were evaluated. The modified Musculoskeletal Tumor Society (MSTS) evaluation system was used to assess limb functional outcome.
The study group consisted of 10 male and 15 female patients, among which there were 20 malignant and 5 benign tumors. Restoration of shoulder function was achieved with a prosthesis in 6 patients, osteoarticular allograft in 12, and allograft-prosthesis composite in 7. At a mean of 48 months follow-up, 2 patients had died of disease. Two patients had local recurrence and 2 had metastatic disease. On the basis of the modified MSTS functional evaluation, the mean scores were 22.50 in the modular prosthesis group, 24.58 in the osteoarticular allograft group, and 27.00 in APC group, respectively. Joint instability and subluxation were serious complications affecting shoulder function in 10 patients.
Reconstruction of the proximal humerus is an option that provides good relief of pain and preserves manual dexterity. Functional outcomes are better for APC and allograft than for modular prosthesis, due to retention of the rotation cuff. Complications in the APC group were less than in the allograft one.
评估关节内肿瘤切除后肱骨近端重建的功能结果和并发症。
1999 年 8 月至 2005 年 8 月，对 25 例因恶性或侵袭性良性肿瘤接受 Malawer I 型切除和肱骨近端重建的患者进行评估。肿瘤切除后，采用各种重建方法，包括模块式肿瘤假体、骨关节同种异体移植物和同种异体-假体复合物（APC）。评估了肿瘤学和影像学参数。采用改良肌肉骨骼肿瘤学会（MSTS）评估系统评估肢体功能结果。
研究组包括 10 例男性和 15 例女性患者，其中 20 例为恶性肿瘤，5 例为良性肿瘤。6 例患者采用假体、12 例患者采用骨关节同种异体移植物、7 例患者采用同种异体-假体复合物重建来恢复肩部功能。在平均 48 个月的随访中，2 例患者因疾病死亡。2 例患者局部复发，2 例患者发生转移。根据改良 MSTS 功能评估，在模块式假体组、骨关节同种异体移植物组和 APC 组的平均评分为 22.50、24.58 和 27.00。10 例患者出现关节不稳定和半脱位等严重并发症，影响肩部功能。
肱骨近端重建是一种可以缓解疼痛和保留手灵活性的选择。APC 和同种异体移植物的功能结果优于模块式假体，因为保留了旋转袖。APC 组的并发症少于同种异体移植物组。
