Min Li, Zhou Yong, Tang Fan, Zhang Wenli, Luo Yi, Duan Hong, Tu Chongqi
Department of Orthopedics, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, 610041, People's Republic of China.
Sarcoma Biology Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Jackson 1115, Boston, MA, 02114, USA.
Int Orthop. 2017 May;41(5):1057-1063. doi: 10.1007/s00264-017-3429-y. Epub 2017 Mar 6.
Recently, endoprosthesis reconstruction has been used for scapular malignant tumours. Our aim is to present and evaluate the clinical indications, peri-operative technique, and mid-term clinical results.
Scapular hemiarthroplasty after total scapulectomy has been performed in 15 patients between 2011 and 2014. Clinical records and radiographs were evaluated retrospectively.
The average follow-up was 41.2 months. No infection, dislocation, pressure ulcer, wound healing problems or mechanical failures were reported. Three patients died due to lung metastasis. The final follow-up average Musculoskeletal Tumor Society (MSTS) scoring system score was 25.3 points. The average ranges of motion of shoulder abduction and forward flexion were 45.3°and 65.7°, respectively. There were significant differences in function, lifting ability, MSTS scores, abduction function and flexion function between the seven patients with artificial ligament reconstruction for articular capsule and the others with direct suture. Three patients who had reconstruction of the rotator cuff were verified to gain better post-operative hand positioning, lifting ability, MSTS score, and abduction function than the others without rotator cuff reconstruction.
As long as the indications and surgical skills are fully mastered, reconstruction with the scapular hemiarthroplasty endoprosthesis can result in mid-term oncologic salvage, good post-operative function and low complication rate after scapulectomy for malignant tumors.
近年来，人工关节置换重建术已应用于肩胛骨恶性肿瘤的治疗。我们的目的是介绍并评估其临床适应证、围手术期技术及中期临床疗效。
2011年至2014年期间，对15例患者行全肩胛骨切除术后进行肩胛骨半关节置换术。对临床记录和X线片进行回顾性评估。
平均随访41.2个月。未报告感染、脱位、压疮、伤口愈合问题或机械故障。3例患者因肺转移死亡。末次随访时，肌肉骨骼肿瘤学会（MSTS）评分系统的平均得分为25.3分。肩关节外展和前屈的平均活动范围分别为45.3°和65.7°。7例行关节囊人工韧带重建的患者与其他直接缝合的患者在功能、举力、MSTS评分、外展功能和屈曲功能方面存在显著差异。3例行肩袖重建的患者术后手部位置、举力、MSTS评分和外展功能均优于未行肩袖重建的患者。
只要充分掌握适应证和手术技巧，肩胛骨半关节置换人工关节重建术可使恶性肿瘤肩胛骨切除术后获得中期肿瘤挽救、良好的术后功能及较低的并发症发生率。
