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肿瘤性肩关节切除术后的功能实验室评估。

Functional laboratory assessment after oncologic shoulder joint resections.

作者信息

Damron T A, Rock M G, O'Connor M I, Johnson M, An K N, Pritchard D J, Sim F H

机构信息

Department of Orthopedic Surgery, Mayo Clinic, Mayo Foundation, Rochester, MN, USA.

出版信息

Clin Orthop Relat Res. 1998 Mar(348):124-34.

PMID:9553544
Abstract

A laboratory evaluation was undertaken to assess the shoulder range of motion and distal strength after oncologic resection and reconstruction involving the shoulder joint and to compare these functional parameters based on potentially important variables. Inclusion in the study was limited to 32 patients with bone tumors of the proximal humerus or scapula treated surgically by resection of the shoulder joint including the proximal humerus from 1976 through 1992. Active shoulder range of motion and isometric elbow extension and forearm supination strength are significantly less after surgery in patients with greater amounts of bony resection and with resection of the deltoid. Patients who had a modified Tikhoff-Linberg resection were able to achieve 10 degrees to 15 degrees greater shoulder motion in each direction than were patients who had the classic procedure including complete scapulectomy. However, elbow flexion and extension strength and forearm pronation strength were greater for the patients with the classic resection. Osteoarticular allografts as a reconstructive alternative provide as a group the best shoulder motion and overall distal upper extremity strength, but these reconstructions were performed only when the rotator cuff muscles and deltoid were able to be reconstructed. Diminishing elbow strength was seen with longer followup in the patients with osteoarticular reconstructions, corresponding temporally to subchondral collapse observed on radiographs. Range of shoulder motion except rotation was just as good for allograft vascularized fibular arthrodeses as for the osteoarticular allografts, but strength was significantly less with the arthrodeses.

摘要

进行了一项实验室评估,以评估涉及肩关节的肿瘤切除与重建术后的肩部活动范围和远端肌力,并基于潜在的重要变量比较这些功能参数。该研究纳入了1976年至1992年间因肱骨近端或肩胛骨骨肿瘤接受手术治疗的32例患者,手术方式为切除包括肱骨近端在内的肩关节。骨切除量较大以及三角肌被切除的患者术后主动肩部活动范围、等长伸肘和前臂旋后肌力明显降低。接受改良蒂科夫-林伯格切除术的患者在各个方向上的肩部活动度比接受包括全肩胛骨切除术在内的经典手术的患者大10度至15度。然而,经典切除术患者的屈伸肘肌力和前臂旋前肌力更大。作为一种重建选择,骨关节异体移植总体上能提供最佳的肩部活动度和上肢远端整体肌力,但仅在能够重建肩袖肌肉和三角肌时才进行这些重建。在接受骨关节重建的患者中,随访时间越长,肘部力量下降越明显,这在时间上与X线片上观察到的软骨下塌陷相对应。除旋转外,同种异体血管化腓骨融合术的肩部活动范围与骨关节异体移植术相同,但融合术的力量明显较小。

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