Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Münster, Germany; Department of Orthopedics and Special Orthopedic Surgery, Paracelsus-Klinik Osnabrück, Osnabrück, Germany.
Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Münster, Germany.
J Shoulder Elbow Surg. 2019 May;28(5):908-914. doi: 10.1016/j.jse.2018.11.050. Epub 2019 Feb 1.
The distal humerus is a rare location of bone tumors. Because of the complexity of the elbow joint, poor soft-tissue coverage, and proximity of nerves and vessels, resection and endoprosthetic reconstruction are demanding.
This retrospective study evaluated the clinical results after distal humeral resection and megaprosthetic reconstruction in 12 patients with an average age of 46 years. All patient files were reviewed for clinical information, and postoperative function and patients' contentment were assessed using the Musculoskeletal Tumor Society score.
The predominant diagnoses were bone and soft-tissue sarcoma (n = 6), giant cell tumor (n = 2), and renal cell carcinoma metastasis (n = 2). Local recurrence was the reason for secondary amputation in all cases (n = 3). The prosthetic survival rate after surgery was 82% at 2 years and 64% at 5 years. Reconstruction failure was mainly caused by aseptic loosening of the humeral stem, occurring in 27% (n = 3), followed by aseptic loosening of the ulnar stem in 9% (n = 1) and periprosthetic infection in 9% (n = 1). The mean Musculoskeletal Tumor Society score was 24 points (range, 20-30 points). An extension lag of more than 10° was noted in 6 patients (55%).
Our results suggest that limb salvage with a distal humeral replacement can achieve good functional results in most patients, although the complication rate with special emphasis on the loosening rate of the humeral stem is high. However, limb salvage was not achieved in 27% of patients because of local recurrence.
肱骨远端是骨肿瘤的罕见部位。由于肘关节的复杂性、软组织覆盖不良以及神经和血管的接近，切除和内置假体重建具有挑战性。
本回顾性研究评估了 12 例平均年龄为 46 岁的患者肱骨远端切除和大型假体重建的临床结果。所有患者的病历均进行了回顾，以获取临床信息，并使用肌肉骨骼肿瘤学会评分评估术后功能和患者满意度。
主要诊断为骨和软组织肉瘤（n=6）、巨细胞瘤（n=2）和肾细胞癌转移（n=2）。所有病例（n=3）均因局部复发而进行二次截肢。术后假体 2 年生存率为 82%，5 年生存率为 64%。重建失败主要是由于肱骨柄无菌性松动，发生率为 27%（n=3），其次是尺骨柄无菌性松动，发生率为 9%（n=1）和假体周围感染，发生率为 9%（n=1）。肌肉骨骼肿瘤学会评分平均为 24 分（范围：20-30 分）。6 名患者（55%）存在超过 10°的伸肌滞后。
我们的结果表明，肱骨远端置换保肢可以使大多数患者获得良好的功能结果，尽管假体松动率高，尤其是肱骨柄的松动率高，但仍有 27%的患者因局部复发而无法保肢。
