King Joseph J, Nystrom Lukas M, Reimer Nickolas B, Gibbs C Parker, Scarborough Mark T, Wright Thomas W
Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USA.
J Shoulder Elbow Surg. 2016 Jan;25(1):45-54. doi: 10.1016/j.jse.2015.06.021. Epub 2015 Aug 6.
Proximal humerus reconstructions after resection of tumors are challenging. Early success of the reverse shoulder arthroplasty for reconstructions has recently been reported. The reverse allograft-prosthetic composite offers the advantage of improved glenohumeral stability compared with hemiarthroplasty for proximal humeral reconstructions as it uses the deltoid for stability.
This article describes the technique for treating proximal humeral tumors, including preoperative planning, biopsy principles, resection pearls, soft tissue tensioning, and specifics about reconstruction using the reverse allograft-prosthetic composite. Two cases are presented along with the functional outcomes with use of this technique. Biomechanical considerations during reconstruction are reviewed, including techniques to improve the deltoid compression force.
Reported instability rates are less with reverse shoulder arthroplasty reconstruction as opposed to hemiarthroplasty or total shoulder arthroplasty reconstructions of tumor resections. Reported functional outcomes are promising for the reverse allograft-prosthetic composite reconstructions, although complications are reported.
Reverse allograft-prosthetic composites are a promising option for proximal humeral reconstructions, although nonunion of the allograft-host bone junction continues to be a challenge for this technique.
肿瘤切除术后的肱骨近端重建具有挑战性。最近有报道称，采用反肩关节置换术进行重建早期取得了成功。与用于肱骨近端重建的半关节置换术相比，反式同种异体移植-假体复合物具有改善盂肱关节稳定性的优势，因为它利用三角肌来维持稳定性。
本文描述了治疗肱骨近端肿瘤的技术，包括术前规划、活检原则、切除要点、软组织张力调整以及使用反式同种异体移植-假体复合物进行重建的细节。介绍了两例病例及其采用该技术后的功能结果。回顾了重建过程中的生物力学考量，包括提高三角肌压缩力的技术。
与肿瘤切除后的半关节置换术或全肩关节置换术重建相比，反肩关节置换术重建的报道不稳定率更低。尽管有并发症的报道，但反式同种异体移植-假体复合物重建的功能结果令人期待。
反式同种异体移植-假体复合物是肱骨近端重建的一个有前景的选择，尽管同种异体骨与宿主骨结合处的不愈合仍然是该技术面临的一个挑战。
