Department of Orthopedic Oncology, Xijing Hospital affiliated to the Fourth Military Medical University, Shaan'xi, Xi'An, China.
J Reconstr Microsurg. 2012 Jul;28(6):419-25. doi: 10.1055/s-0032-1315766. Epub 2012 Jun 18.
It is a challenge to perform a joint-preserving resection for patients with bone sarcomas in the proximal humerus. We determined whether osteotomy under navigation guidance made joint-saving resection possible for juxtaarticular humeral sarcomas while adhering to oncological principles.
Between January 2008 and July 2010, joint-preserving surgeries were performed on six patients with proximal humeral sarcomas under navigation guidance. Five tumors extended to, and one extended beyond, the epiphyseal line. Planned osteotomy under image-guided navigation was employed to achieve a clear surgical margin while preserving the humeral head and rotator cuff. All tumors were removed en bloc and intercalary defects were reconstructed by a combination of allograft and vascularized fibula graft. All specimens were examined for resection margin. Patients were followed up for an average of 19.1 months.
The entire glenohumeral joint was preserved in five patients and part of the humeral head was saved in one patient. Clear surgical margin was obtained in all specimens. The minimum closest distance between the osteotomy line and tumor edge was 7 mm. No patient experienced local recurrence. One patient developed lung metastasis and was alive with disease. The mean Musculoskeletal Tumor Society (MSTS) 93 score was 92.1%. All reconstruction was in situ at final follow-up.
With careful patient selection, image navigation-assisted surgery made it possible to excise the bone exactly as seen in orientation in magnetic resonance imaging (MRI) image, yielding a clear margin and preserving all or part of the humeral head in limb salvage procedures for patients with juxtaarticular bone sarcomas in proximal humerus.
Therapeutic study; Level IV.
在肱骨近端进行保关节切除对骨肉瘤患者是一个挑战。我们确定在遵循肿瘤学原则的情况下，导航引导下的截骨术是否可以使关节内肱骨肉瘤实现保关节切除。
2008 年 1 月至 2010 年 7 月，在导航引导下对 6 例肱骨近端骨肉瘤患者进行了保关节手术。5 例肿瘤延伸至骺线，1 例延伸超过骺线。采用图像引导下的规划性截骨术，以在保留肱骨头和肩袖的同时获得清晰的手术切缘。所有肿瘤均整块切除，采用同种异体骨和带血管腓骨移植相结合进行节段性骨缺损重建。所有标本均进行切缘检查。患者平均随访 19.1 个月。
5 例患者保留了整个盂肱关节，1 例患者保留了部分肱骨头。所有标本均获得了清晰的手术切缘。截骨线与肿瘤边缘的最小最近距离为 7mm。无患者发生局部复发。1 例患者发生肺转移，仍带瘤生存。平均肌肉骨骼肿瘤学会（MSTS）93 评分 92.1%。最终随访时所有重建均位于原位。
通过仔细的患者选择，图像导航辅助手术可以使我们精确地切除磁共振成像（MRI）图像中所见的骨，获得清晰的切缘，并在肱骨近端关节内骨肉瘤的保肢手术中保留肱骨头的全部或部分。
治疗性研究；IV 级。
