Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2013 Sep;133(9):1219-24. doi: 10.1007/s00402-013-1795-5. Epub 2013 Jun 23.
Arthrodesis of the shoulder is a straightforward and established alternative to reconstruct the shoulder function after tumor resection of the proximal humerus. In most cases, some kind of intercalary bone graft is used to bridge the bony defect. However, due to low stability of a single fibula autograft and disadvantages of exogenous graft material when performing combined allo- and autograft reconstruction, efforts to develop new surgical techniques, with the intention to lower the complication rates, are ongoing.
We present a detailed description of the surgical technique and the outcome of three patients with osteosarcomas of the proximal humerus, which were treated with tumor resection and autologous double-barrel vascularized fibula bone graft for arthrodesis of the shoulder. The construct was stabilized using a 4.5-mm pelvic reconstruction plate positioned on the scapular spine and the lateral aspect of the humerus.
A wide surgical margin was achieved in all patients. Two of them could be reintegrated and are able to work with excellent shoulder function. In one patient, who developed metastasis, a deep infection under chemotherapy 16 months after index surgery complicated the postoperative course.
The fibula's unique dual endosteal and periosteal blood supply makes it effective as a double-barrel bone graft for major long bone defects, which requires extra bone volume to prevent fractures until bone hypertrophy occurs. Additional bone and scar formation between the two struts are believed to provide a stable and long lasting construct, as seen in our patients.
肩关节融合术是一种直接且成熟的选择，可在肱骨近端肿瘤切除后重建肩关节功能。在大多数情况下，需要使用某种间置物来桥接骨缺损。然而，由于单腓骨自体移植物稳定性差，以及在进行同种异体和自体联合重建时外源性移植物材料的缺点，人们一直在努力开发新的手术技术，以降低并发症发生率。
我们详细描述了 3 例肱骨近端骨肉瘤患者的手术技术和结果，这些患者接受了肿瘤切除和自体双套管血管化腓骨骨移植以进行肩关节融合。该结构通过放置在肩胛骨脊柱和肱骨外侧的 4.5 毫米骨盆重建板来稳定。
所有患者均获得了广泛的手术切缘。其中 2 例患者得以重新融入社会并能够工作，且具有出色的肩部功能。在 1 例发生转移的患者中，索引手术后 16 个月在化疗期间发生深部感染，使术后病程复杂化。
腓骨独特的双骨髓内和骨膜血供使其成为主要长骨缺损的有效双套管骨移植物，需要额外的骨体积来防止骨折，直到骨肥大发生。我们的患者中可见，两支柱之间的额外骨和瘢痕形成提供了稳定且持久的结构。
