First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Department of Orthopedics, General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China.
J Shoulder Elbow Surg. 2018 Nov;27(11):2013-2020. doi: 10.1016/j.jse.2018.03.027. Epub 2018 May 18.
There is a high aseptic loosening rate for intercalary prosthetic reconstruction for malignant tumors. We evaluated outcomes and complications of intercalary prosthetic reconstruction for pathologic diaphyseal humeral fractures and report the application of an extracortical plate that can prevent early loosening.
We retrospectively analyzed 9 patients who underwent intercalary prosthetic reconstruction for pathologic diaphyseal humeral fractures secondary to metastatic diseases between March 2011 and September 2017. Procedures were intercalary prosthetic reconstruction in 4 patients (group A) and an implanted intercalary prosthesis with a plate in 5 patients (group B). Operative time, blood loss, complications, and functional score were noted.
Mean operative time for group A and B was 80 ± 14 and 94 ± 5 minutes, respectively; blood loss was 115 ± 26 and 120 ± 31 mL respectively; and follow-up was 11.5 ± 10.1 and 6.2 ± 4.4 months, respectively. At final follow-up, all patients in group A had died, and 3 patients in group B had died; mean survival was 11.5 ± 10.1 and 9.3 ± 1.2 months, respectively. The mean postoperative Musculoskeletal Tumor Society score was 24.5 ± 2.4 and 26.2 ± 0.8, respectively. The mean postoperative American Shoulder and Elbow Surgeons score was 85.5 ± 4.20 and 87 ± 2.6, respectively. There were no significant differences between the 2 groups (P > .05). There was 1 aseptic loosening and 1 radial nerve injury in group A; there were no complications in group B.
The intercalary prosthesis yielded satisfactory outcomes in patients with pathologic diaphyseal humeral fractures, and an extracortical plate can prevent early aseptic loosening.
恶性肿瘤的间插式假体重建有很高的无菌性松动率。我们评估了病理性骨干肱骨骨折间插式假体重建的结果和并发症，并报告了一种可防止早期松动的皮质外钢板的应用。
我们回顾性分析了 2011 年 3 月至 2017 年 9 月间因转移性疾病而行病理性骨干肱骨骨折间插式假体重建的 9 例患者。4 例患者行间插式假体重建（A 组），5 例患者行带钢板的植入式间插假体（B 组）。记录手术时间、失血量、并发症和功能评分。
A 组和 B 组的平均手术时间分别为 80±14 分钟和 94±5 分钟，失血量分别为 115±26 毫升和 120±31 毫升，随访时间分别为 11.5±10.1 个月和 6.2±4.4 个月。末次随访时，A 组所有患者均死亡，B 组 3 例患者死亡；平均生存时间分别为 11.5±10.1 个月和 9.3±1.2 个月。术后肌肉骨骼肿瘤学会评分平均为 24.5±2.4 分和 26.2±0.8 分。术后美国肩肘外科评分平均为 85.5±4.20 分和 87±2.6 分。两组间差异无统计学意义（P＞0.05）。A 组发生无菌性松动 1 例，桡神经损伤 1 例；B 组无并发症。
病理性骨干肱骨骨折患者采用假体重建效果满意，皮质外钢板可预防早期无菌性松动。
