Gulia Ashish, Puri Ajay, Gupta Srinath, Kurisunkal Vineet
Department of Bone and Soft Tissue Tumors, Tata Memorial Hospital, Mumbai, India.
Shoulder Elbow. 2021 Apr;13(2):188-194. doi: 10.1177/1758573219895988. Epub 2020 Jan 10.
Reconstructing locally aggressive benign bone tumours of the proximal humerus after intralesional curettage is a challenge. We present a novel reconstruction technique '' where a femoral head and a strut allograft are combined to reconstruct the cavity. Complications, graft incorporation time, functional (Musculoskeletal Tumor Society score [MSTS]) and oncological outcomes were evaluated.
Between January 2006 and June 2017, 11 cases (10 giant cell tumours, 1 chondroblastoma) underwent curettage followed by reconstruction with Umbrella construct. There were six females and five males with a mean age of 23 years (range 14-36 years). The maximum longitudinal extent of disease was 9 cm (range 5-9 cm).
The median follow-up was 54 months (range 34-122 months). The mean allograft incorporation time was 7 months (5-8 months). One patient had a graft fracture which was managed conservatively. Two cases developed local recurrence and the construct was revised to a prosthesis in both. The mean MSTS score for the nine cases with retained graft was 27 (23-29).
Umbrella construct is an effective reconstruction modality which helps to maintain joint congruity and limb length. It has acceptable oncological outcomes with good function.
对肱骨近端局部侵袭性良性骨肿瘤进行病灶内刮除术后的重建是一项挑战。我们提出一种新型重建技术，即将股骨头与支撑性同种异体骨联合用于重建骨腔。对并发症、移植物融合时间、功能（肌肉骨骼肿瘤学会评分[MSTS]）及肿瘤学结局进行评估。
2006年1月至2017年6月，11例患者（10例骨巨细胞瘤，1例软骨母细胞瘤）接受刮除术，随后采用“伞状结构”进行重建。其中女性6例，男性5例，平均年龄23岁（范围14 - 36岁）。疾病的最大纵向范围为9 cm（范围5 - 9 cm）。
中位随访时间为54个月（范围34 - 122个月）。同种异体骨平均融合时间为7个月（5 - 8个月）。1例患者发生移植物骨折，采取保守治疗。2例出现局部复发，均将结构改为假体。9例保留移植物患者的平均MSTS评分为27分（23 - 29分）。
“伞状结构”是一种有效的重建方式，有助于维持关节一致性和肢体长度。其肿瘤学结局可接受，功能良好。
