Cladière-Nassif V, Bourdet C, Audard V, Babinet A, Anract P, Biau D
Hôpital Cochin, 27 rue du Fabourg Saint Jacques, 75014 Paris, France.
Bone Joint J. 2017 Sep;99-B(9):1244-1249. doi: 10.1302/0301-620X.99B9.2016-1317.R1.
Resection of the proximal humerus for the primary malignant bone tumour sometimes requires resection of the deltoid. However, there is no information in the literature which helps a surgeon decide whether to preserve the deltoid or not. The aim of this study was to determine whether retaining the deltoid at the time of resection would increase the rate of local recurrence. We also sought to identify the variables that persuade expert surgeons to choose a deltoid sparing rather than deltoid resecting procedure.
We reviewed 45 patients who had undergone resection of a primary malignant tumour of the proximal humerus. There were 29 in the deltoid sparing group and 16 in the deltoid resecting group. Imaging studies were reviewed to assess tumour extension and soft-tissue involvement. The presence of a fat rim separating the tumour from the deltoid on MRI was particularly noted. The cumulative probability of local recurrence was calculated in a competing risk scenario.
There was no significant difference (adjusted p = 0.89) in the cumulative probability of local recurrence between the deltoid sparing (7%, 95% confidence interval (CI) 1 to 20) and the deltoid resecting group (26%, 95% CI 8 to 50). Patients were more likely to be selected for a deltoid sparing procedure if they presented with a small tumour (p = 0.0064) with less bone involvement (p = 0.032) and a continuous fat rim on MRI (p = 0.002) and if the axillary nerve could be identified (p = 0.037).
A deltoid sparing procedure can provide good local control after resection of the proximal humerus for a primary malignant bone tumour. A smaller tumour, the presence of a continuous fat rim and the identification of the axillary nerve on pre-operative MRI will persuade surgeons to opt for a deltoid resecting procedure. Cite this article: 2017;99-B:1244-9.
对于原发性恶性骨肿瘤，肱骨近端切除有时需要切除三角肌。然而，文献中没有信息可帮助外科医生决定是否保留三角肌。本研究的目的是确定切除时保留三角肌是否会增加局部复发率。我们还试图找出能说服专家外科医生选择保留三角肌而非切除三角肌手术的变量。
我们回顾了45例接受肱骨近端原发性恶性肿瘤切除的患者。保留三角肌组29例，切除三角肌组16例。回顾影像学研究以评估肿瘤范围和软组织受累情况。特别注意MRI上肿瘤与三角肌之间是否存在脂肪间隙。在竞争风险情况下计算局部复发的累积概率。
保留三角肌组（7%，95%置信区间（CI）1至20）和切除三角肌组（26%，95%CI 8至50）的局部复发累积概率无显著差异（校正p = 0.89）。如果患者肿瘤较小（p = 0.0064）、骨受累较少（p = 0.032）、MRI上有连续脂肪间隙（p = 0.002）且能识别腋神经（p = 0.037），则更有可能被选择进行保留三角肌手术。
对于原发性恶性骨肿瘤，肱骨近端切除后保留三角肌手术可提供良好的局部控制。较小的肿瘤、连续脂肪间隙的存在以及术前MRI上腋神经的识别会促使外科医生选择保留三角肌手术。引用本文：2017；99 - B：1244 - 9。
