Padiolleau G, Marchand J B, Odri G A, Hamel A, Gouin F
Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France; Laboratoire de la physiopathologie de la résorption osseuse et des tumeurs osseuses primitives. Inserm UI957, faculté de Médecine, 44000 Nantes, France.
Orthop Traumatol Surg Res. 2014 Apr;100(2):177-81. doi: 10.1016/j.otsr.2013.09.012. Epub 2014 Feb 4.
Scapulo-humeral arthrodesis (SHA) is a proven reconstruction method in patients with proximal humerus malignancies requiring resection of the shoulder abduction apparatus (rotator cuff and deltoid muscles) or its nerve supply. Standard practice consists in using a pedicled fibular flap. We use instead a pedicled autologous bone graft harvested from the ipsilateral scapular pillar.
The objective of this study was to assess functional outcomes and radiological healing after SHA using a pedicled scapular pillar graft.
We retrospectively reviewed the charts of the 12 patients managed at a single center by a single surgeon between 1994 and 2011. SHA was performed using a vascularised ipsilateral scapular pillar graft after proximal humerus resection to treat a bone malignancy. The graft was harvested from the ipsilateral scapular pillar, pedicled on the circumflex scapular artery, fitted into the remaining proximal humerus, and secured to the glenoid using screws. A humerus-scapular spine plate was added to stabilize the arthrodesis. Radiographic results were assessed on standard radiographs obtained at last follow-up. Functional outcomes were evaluated using the MusculoSkeletalTumour Society (MSTS) score and Toronto Extremity Salvage Score (TESS).
After a mean follow-up of 4.9 years, 87.5% of SHA junctions were healed, mean MSTS score was 71%, and mean TESS score was 70%.
The outcomes in our patients were similar to those reported after SHA using a pedicled fibular flap. However, our technique does not require microsurgery. It is simple, reproducible, and effective. Its indications of choice are intra- or extra-articular resection of the proximal humerus including the attachments of the rotator cuff and deltoid muscle tendons or the nerves supplying these muscles.
Level IV (retrospective study).
肩胛肱骨融合术（SHA）是一种已被证实的重建方法，适用于需要切除肩部外展装置（肩袖和三角肌）或其神经供应的肱骨近端恶性肿瘤患者。标准做法是使用带蒂腓骨瓣。我们改用从同侧肩胛支柱获取的带蒂自体骨移植。
本研究的目的是评估使用带蒂肩胛支柱移植进行肩胛肱骨融合术后的功能结果和影像学愈合情况。
我们回顾性分析了1994年至2011年间由一名外科医生在单一中心治疗的12例患者的病历。在肱骨近端切除术后，使用带血管蒂的同侧肩胛支柱移植进行肩胛肱骨融合术以治疗骨恶性肿瘤。移植骨从同侧肩胛支柱获取，以旋肩胛动脉为蒂，植入剩余的肱骨近端，并用螺钉固定于肩胛盂。添加肱骨-肩胛冈钢板以稳定融合。在最后一次随访时获得的标准X线片上评估影像学结果。使用肌肉骨骼肿瘤学会（MSTS）评分和多伦多肢体挽救评分（TESS）评估功能结果。
平均随访4.9年后，87.5%的肩胛肱骨融合术连接处愈合，平均MSTS评分为71%，平均TESS评分为70%。
我们患者的结果与使用带蒂腓骨瓣进行肩胛肱骨融合术后报道的结果相似。然而，我们的技术不需要显微手术。它简单、可重复且有效。其选择指征是肱骨近端的关节内或关节外切除，包括肩袖和三角肌肌腱的附着点或供应这些肌肉的神经。
IV级（回顾性研究）。
