Nguyen Huu Manh, Trung Tran Dung, Vu Duc Viet, Tran Quyet, Dang Quang Minh, Tran Thanh Duc, Tran Nguyen Sang Quang, Van Tran Cong
Department of Orthopaedic Surgery, College of Health Science, VinUniversity, Hanoi, Viet Nam.
Orthopaedic and Sports Medicine Center, Vinmec Healthcare System, Hanoi, Viet Nam.
Ann Med Surg (Lond). 2022 Jan 20;74:103263. doi: 10.1016/j.amsu.2022.103263. eCollection 2022 Feb.
and importance: Wide resection in the surgical treatment of aneurysms bone cysts is often performed in cases where the tumor is large, recurrent, growing, and intensely invasive. Reshaping the defect after tumor removal is a necessary issue to restore shape and maintain function for the patient.
A 26-year-old male patient, diagnosed with an aneurysm bone cyst in the proximal humerus, underwent surgery for curettage and bone grafting twice. After surgery, there was still pain in the shoulder area, the tumor progressed aggressively with limited shoulder movement. Based on the imaging re-evaluation, it was shown that the tumor increased rapidly in size, invaded the soft tissue, and completely changed the normal structure of the shoulder joint, and the proximal humerus. We used a reverse shoulder joint with an additional module to restore the bone defect of the tumor and the function of the shoulder joint. Follows-up showed that patient no longer pain in shoulder area, shoulder joint function recovery is progressing well, Musculoskeletal Tumor Society (MSTS) score is 25 & 28, shoulder joint function score according to ASES scale: 80 & 93.33 respectively at 3 months and 6 months after surgery.
Aggresive aneurysm bone cyst of proximal humerus is not common and still a challenge to the treatment. Due to the bone and joint destruction, the indication of tumor resection and reconstruct the joint and bone loss is required. Among several solution, reverse shoulder megaprosthesis is a newest one can favor the purpose of our treatment. Up to now, this solution is mainly used to preserving for malignant bone tumor.
Tumor wide resection with modular reverse shoulder replacement with the modular segment is a reasonable intervention option in cases of large aneurysm bone cysts, with rapid recurrence, aggressive progression, and soft tissue invasion.
及其重要性：在动脉瘤样骨囊肿的外科治疗中，当肿瘤体积大、复发、生长且具有强烈侵袭性时，常进行广泛切除。肿瘤切除后重塑缺损是恢复患者外形和维持功能的必要问题。
一名26岁男性患者，被诊断为肱骨近端动脉瘤样骨囊肿，接受了两次刮除植骨手术。术后肩部仍有疼痛，肿瘤进展迅速，肩部活动受限。基于影像学重新评估显示，肿瘤大小迅速增加，侵犯软组织，完全改变了肩关节和肱骨近端的正常结构。我们使用了带有附加模块的反肩关节来修复肿瘤的骨缺损和肩关节功能。随访显示患者肩部不再疼痛，肩关节功能恢复良好，肌肉骨骼肿瘤学会（MSTS）评分为25分和28分，根据ASES量表的肩关节功能评分在术后3个月和6个月分别为80分和93.33分。
肱骨近端侵袭性动脉瘤样骨囊肿并不常见，对治疗仍然是一个挑战。由于骨与关节破坏，需要进行肿瘤切除并重建关节和修复骨缺损。在几种解决方案中，反肩关节假体是一种最新的能够满足我们治疗目的的方法。到目前为止，这种解决方案主要用于保留恶性骨肿瘤。
对于大的动脉瘤样骨囊肿，快速复发、侵袭性进展和软组织侵犯的病例，采用模块化反肩关节置换进行肿瘤广泛切除是一种合理的干预选择。
