Puri A, Gulia A
Tata Memorial Hospital, E Borges Road, Parel, Mumbai 400012, India.
J Bone Joint Surg Br. 2012 Sep;94(9):1277-81. doi: 10.1302/0301-620X.94B9.29697.
Rarely, the extent of a malignant bone tumour may necessitate resection of the complete humerus to achieve adequate oncological clearance. We present our experience with reconstruction in such cases using a total humeral endoprosthesis (THER) in 20 patients (12 male and eight female) with a mean age of 22 years (6 to 59). We assessed the complications, the oncological and functional outcomes and implant survival. Surgery was performed between June 2001 and October 2009. The diagnosis included osteosarcoma in nine, Ewing's sarcoma in eight and chondrosarcoma in three. One patient was lost to follow-up. The mean follow-up was 41 months (10 to 120) for all patients and 56 months (25 to 120) in survivors. There were five local recurrences (26.3%) and 11 patients were alive at time of last follow-up, with overall survival for all patients being 52% (95% confidence interval (CI) 23.8 to 74) at five years. The mean Musculoskeletal Tumor Society score for the survivors was 22 (73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3) at five years. The use of a THER in the treatment of malignant tumours of bone is oncologically safe; it gives consistent and predictable results with low rates of complication.
极少数情况下，恶性骨肿瘤的范围可能需要切除整个肱骨以实现足够的肿瘤学切缘。我们介绍了我们在20例患者（12例男性和8例女性）中使用全肱骨假体（THER）进行重建的经验，这些患者的平均年龄为22岁（6至59岁）。我们评估了并发症、肿瘤学和功能结果以及植入物存活率。手术于2001年6月至2009年10月期间进行。诊断包括骨肉瘤9例、尤因肉瘤8例和软骨肉瘤3例。1例患者失访。所有患者的平均随访时间为41个月（10至120个月），幸存者的平均随访时间为56个月（25至120个月）。有5例局部复发（26.3%），11例患者在最后一次随访时仍存活，所有患者的五年总生存率为52%（95%置信区间（CI）23.8至74）。幸存者的肌肉骨骼肿瘤学会平均评分为22分（73%；16至23分）。五年时植入物存活率为95%（95%CI 69.5至99.3）。在骨恶性肿瘤的治疗中使用全肱骨假体在肿瘤学上是安全的；它能产生一致且可预测的结果，并发症发生率低。
