Gulia Ashish, Pruthi Manish, Gupta Srinath, Nadkarni Shravan
Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India.
Assistant Professor, Bone and Soft Tissue Services, Dept of Surgical Oncology, Tata Memorial Hospital, and Homi Bhabha National Institute (HBNI), Mumbai, India.
J Clin Orthop Trauma. 2021 Jul 6;20:101496. doi: 10.1016/j.jcot.2021.101496. eCollection 2021 Sep.
Most malignant bone tumors are treated with surgical excision, adhering to oncologic principles, followed by reconstruction to preserve form and function whenever feasible. Primary bone tumors around the elbow are rare accounting for <1% of all skeletal tumors. They pose a reconstructive challenge, due to the complex interplay between the osseous & capsulo-ligamentous structures which is essential for elbow stability and function. Tumors affecting the proximal ulna are rare and reconstruction of the defects following these tumors is extremely challenging. Various reconstruction options like arthrodesis, autogenous bone grafts, allografts, re-implantation of sterilized tumor bone, pseudoarthrosis, and endoprosthesis have been tried with variable success. However, due to lack of standardization and the rarity of the site, surgeons are often in a dilemma to choose the correct option. This can lead to suboptimal functional outcomes and long-term failures. In this article, we reviewed the published literature on proximal ulnar tumors and noted the pros and cons of various reconstructive procedures. We have also attempted to formulate reconstruction recommendations based on the level of resection of proximal ulna.
大多数恶性骨肿瘤采用手术切除治疗，遵循肿瘤学原则，只要可行，术后进行重建以保留外形和功能。肘部周围的原发性骨肿瘤罕见，占所有骨骼肿瘤的比例不到1%。由于对维持肘关节稳定性和功能至关重要的骨结构与关节囊韧带结构之间存在复杂的相互作用，这些肿瘤带来了重建方面的挑战。影响尺骨近端的肿瘤罕见，对这些肿瘤切除后的缺损进行重建极具挑战性。已经尝试了各种重建方法，如关节融合术、自体骨移植、同种异体骨移植、灭菌肿瘤骨再植入、假关节形成和假体植入，但效果不一。然而，由于缺乏标准化以及该部位的罕见性，外科医生在选择正确的重建方法时常常左右为难。这可能导致功能结果不理想和长期失败。在本文中，我们回顾了关于尺骨近端肿瘤的已发表文献，并指出了各种重建手术的优缺点。我们还试图根据尺骨近端的切除水平制定重建建议。
