肩周恶性骨肿瘤保肢治疗的分析与探讨  

Limb-salvage Treatment for Malignant Bone Tumor around Shoulder

作　　者：彭红春[1] 彭丹[1] 黎志宏[1] 徐敏[1] 

机构地区：[1]中南大学湘雅二医院骨科,长沙410011

出　　处：《中国现代手术学杂志》2010年第1期41-44,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的分析探讨肩部周围恶性骨肿瘤保肢治疗方法和疗效。方法22例肩周部恶性骨肿瘤患者,其中肱骨上端15例,肩胛骨7例;软骨肉瘤9例,骨肉瘤10例,滑膜肉瘤3例。均行保肢治疗,化疗后行瘤段切除特制人工关节置换术15例,全肩胛骨切除、肱骨头悬吊术6例,肩胛骨部分切除术1例。术后定期辅助化疗。结果2例失访,20例平均随访40个月（3个月-6年）。1例复发;2例发生肺转移,其中1例死亡。根据Ennek ing肢体功能评价标准：优8例,良7例,可3例,差2例。结论对于肩部恶性骨肿瘤,在规范的辅助化疗下行合适的手术,可以达到彻底切除肿瘤并保存一定的肩部功能。Objective To investigate the therapy and effect of limb-salvage treatment for malignant bone tumor around shoulder.Methods The clinical data of 22 cases suffered malignant bone tumors were reviewed,including 9 of chondrosarcoma,10 of osteosarcoma and 3 of synovial sarcoma.The tumors located in proximal humerus in 15 cases and scapula in 7 cases.All cases were performed limb-salvage surgery,including 15 cases of tumor-bearing bone resection and arthroplasty,6 cases of total scapula resection and the caput humeralis slinging and 1 case of partial scapula resection.Preoperative neoadjuvant chemotherapy was carried out to determine the extent of resection,and postoperative adjuvant chemotherapy to consolidate the efficacy regularly.Results 20 patients were followed up for 3 months to 6 years（average 40 months）,and 2 cases were lost.Recurrence was found in 1 case and pulmonary metastasis in 2 cases.There was a death in the patients with pulmonary metastasis.According to Enneking limb function evaluation criteria,the outcomes revealed excellent in 8,good in 7,fair in 3 and false in 2.Conclusion In the limb-salvage treatment,the appropriate surgical procedures combined with standard adjuvant chemotherapy can remove the tumor completely and conserve a certain shoulder function for malignant bone tumor around shoulder.

关 键 词：肩 骨肿瘤 保肢 

分 类 号：R738.1[医药卫生—肿瘤]