Kimura Akinori, Sasanuma Hideyuki, Ajiki Takashi, Sekiya Hitoshi, Takeshita Katsushi
Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0438, Japan.
Case Rep Orthop. 2017;2017:8486739. doi: 10.1155/2017/8486739. Epub 2017 Mar 1.
We report a case of recurrent locking of the scapula in the thorax after combined lobectomy and thoracic wall resection for advanced lung cancer. The patient was a 52-year-old man with advanced spindle cell carcinoma in his right lung. He had undergone right lung lobectomy and thoracic wall excision (Th1-5). Intrathoracic repair had not been performed to address the defect in the thoracic wall. Two months after the operation he experienced sudden acute pain in the right shoulder. Three-dimensional computed tomography revealed locking of the scapula intrathoracically. The diagnosis was recurrent locking of the scapula in the thorax. He underwent conservative treatment. Because his symptoms were not alleviated and he continued to experience recurrent locking, we performed partial resection of the inferior part of the scapula. Although scapular locking diminished after this procedure, there were still some pain and "catching" between the scapula and the thoracic wall (T6) when he undertook certain movements. No further surgery could be performed, however, because the cancer from the primary lesion had recurred near the previously operated thoracic wall. A procedure for recurrent intrathoracic locking of the scapula was not successful in this case.
我们报告一例晚期肺癌患者在接受肺叶切除联合胸壁切除术后，肩胛骨反复锁入胸腔的病例。患者为一名52岁男性，患有右肺晚期梭形细胞癌。他接受了右肺叶切除术和胸壁切除术（胸1至胸5）。未进行胸内修复以解决胸壁缺损问题。术后两个月，他右肩部突然出现急性疼痛。三维计算机断层扫描显示肩胛骨锁入胸腔内。诊断为肩胛骨反复锁入胸腔。他接受了保守治疗。由于症状未缓解且仍反复出现锁入情况，我们对肩胛骨下部进行了部分切除。尽管该手术后肩胛骨锁入情况有所减轻，但当他进行某些动作时，肩胛骨与胸壁（胸6）之间仍存在一些疼痛和“卡顿”。然而，由于原发灶的癌症在先前手术的胸壁附近复发，无法再进行进一步手术。在该病例中，针对肩胛骨反复锁入胸腔的手术未成功。
