Li Jianxiong, Bi Jingyou, Zhao Xuelin, Yao Peng, Liu Yatao, Bi Wenzhi
Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China.
Department of Orthopedics, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, P.R.China;Xinxiang Detachment of Henan General Corps of Chinese People's Armed Police, Xinxiang Henan, 453000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):179-183. doi: 10.7507/1002-1892.201907016.
To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors.
A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing's sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking , 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer , 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph.
Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively.
Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
评估全肩胛骨切除术后全肩胛骨置换术治疗肩胛骨肿瘤的有效性。
回顾性分析2010年1月至2017年12月间17例行全肩胛骨切除及全肩胛骨置换术治疗的肩胛骨肿瘤患者的临床资料。其中男性9例，女性8例，平均年龄34.4岁（范围13 - 64岁）。7例诊断为软骨肉瘤，3例为骨肉瘤，2例为尤因肉瘤，1例为高级别肉瘤，1例为多形性去分化肉瘤，1例为纤维肉瘤，1例为浆细胞瘤，1例为骨巨细胞瘤。根据Enneking描述的手术分期系统，1例为3期，8例为ⅠB期，8例为ⅡB期。根据Malawer的肩胛带切除术分类，11例为ⅢB型，5例为ⅣB型，1例为ⅥB型。病程为0.5至8.0个月（平均3.2个月），肿瘤大小为11.0 cm×7.5 cm×6.0 cm至18.5 cm×18.0 cm×12.5 cm。采用1993年肌肉骨骼肿瘤学会（MSTS）上肢功能评分系统及肩关节活动度评估术后肩关节功能。通过影像学检查监测肿瘤复发及转移情况。
1例患者浅表切口愈合不良，其余切口均一期愈合。所有患者均获随访20 - 72个月（平均45.4个月）。17例患者中2例死于肿瘤转移引起的多器官功能障碍综合征；3例发生肺转移，带瘤生存。所有患者均未发生局部复发。总生存率为88.2%（15/17），无病生存率为70.6%（12/17）。分别有1例、1例和1例患者发生外伤后肋骨骨折、无菌性松动及三角肌萎缩。未观察到其他相关并发症。末次随访时，MSTS评分为26.1±1.4，肩关节的前屈、后伸及外展活动度分别为（70.0±7.5）°、（31.2±11.3）°和（54.4±12.5）°。
全肩胛骨切除术后行全肩胛骨置换重建可使肩胛骨肿瘤患者获得满意的肩部外形及可接受的功能结局。
