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对于肱骨近端骨肿瘤切除术后的模块化反式肩关节置换,临床结果不佳且脱位率高。

Poor clinical outcomes and high rates of dislocation after modular reverse shoulder arthroplasty for proximal humeral oncologic resection.

机构信息

UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, CHU Lille, Service d'orthopédie 1, 59000, Lille, France.

Service d'orthopédie 1, Hôpital Roger Salengro, Place de Verdun, Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France.

出版信息

Int Orthop. 2024 May;48(5):1331-1339. doi: 10.1007/s00264-024-06122-7. Epub 2024 Feb 26.

Abstract

PURPOSE

The shoulder is the most common site for upper extremity tumors. The aim of the study was to analyze the outcomes and the complications of modular reverse shoulder arthroplasty (RSA) after proximal humerus resection.

METHODS

We retrospectively included 15 consecutive patients who underwent a modular MUTARS™ RSA reconstruction after proximal humerus tumour resection between 2017 and 2020. The mean age was 52 years. Their clinical outcomes were assessed using the Constant-Murley score and the MSTS shoulder. Radiological outcomes were assessed based on the presence of loosening, osteolysis, and scapular notching. Complications such as dislocation, oncological recurrence, and infection were assessed. Mean follow-up time was 32.9 months (24 to 45).

RESULTS

The mean adjusted Constant score was 50.7% (min 22, max 81), and the mean MSTS score was 15.6 (min 4, max 26). We had no loosening, osteolysis, or scapular notching on the radiographs at last follow-up. We had a high complication rate of 53%: one infection, one oncological recurrence, and six dislocations (40%), of which five were re-operated.

CONCLUSION

In our experience, the MUTARS™ Implantcast™ modular RSA has poor functional results and a high rate of dislocation in the case of large proximal humerus resections below the distal insertion of the deltoid.

摘要

目的

肩部是上肢肿瘤最常见的部位。本研究旨在分析肱骨近端切除后使用模块化反肩假体(RSA)的治疗效果和并发症。

方法

我们回顾性纳入了 2017 年至 2020 年间 15 例连续接受 MUTARS™ RSA 模块化重建的肱骨近端肿瘤切除患者。平均年龄为 52 岁。采用 Constant-Murley 评分和 MSTS 肩部评分评估其临床结果。基于假体松动、骨溶解和肩胛切迹等影像学表现评估影像学结果。评估并发症,如脱位、肿瘤复发和感染。平均随访时间为 32.9 个月(24 至 45 个月)。

结果

调整后的 Constant 评分平均为 50.7%(最小 22,最大 81),MSTS 评分平均为 15.6(最小 4,最大 26)。末次随访时,影像学上未见假体松动、骨溶解或肩胛切迹。并发症发生率较高,为 53%:1 例感染,1 例肿瘤复发,6 例(40%)脱位,其中 5 例需要再次手术。

结论

在我们的经验中,对于肱骨近端切除范围较大,低于三角肌止点的病例,MUTARS™ Implantcast™ 模块化 RSA 的功能结果较差,脱位率较高。

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