保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤  

Radical scapulectomy with limb salvage for sarcomas of shoulder girdle

作　　者：郭卫[1] 孙馨[1] 燕太强[1] 汤小东[1] 

机构地区：[1]北京大学人民医院骨与软组织肿瘤治疗中心,100044

出　　处：《中华骨科杂志》2011年第6期587-593,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨累及肩关节的肩部恶性肿瘤保肢术式的临床疗效。方法2001年7月至2008年7月采用保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤16例，男11例，女5例；年龄17＂-67岁，平均38．4岁。8例起源于肩胛骨，软骨肉瘤4例、Ewing肉瘤1例、转移癌3例；5例起源于肩部软组织，滑膜肉瘤2例、纤维肉瘤1例、血管外皮瘤1例、高分化脂肪肉瘤1例；3例起源于肱骨近端，骨肉瘤1例、转移癌2例。经典Tikhoff-Linberg手术12例，改良Tikhoff-Linberg手术4例。结果手术时间2．5-4．0h，平均3h。术中出血1000-3000ml，平均1600ml。全部病例随访6-74个月，中位随访时间40个月。2例术前放疗者伤口延迟愈合，1例尺神经损伤。1例肱骨近端骨肉瘤患者出现局部复发及肺转移，行肩胛带离断术后18个月死亡。1例纤维肉瘤患者出现肺转移，23个月后死亡。1例滑膜肉瘤患者术后3个月出现肺转移，随访9个月带瘤生存。5例转移癌患者中4例于术后11～23个月死亡。至随访期末死亡6例，带瘤生存1例，无瘤生存9例。五年总体生存率34．6％。术后3个月接受经典术式者1993年美国骨肿瘤学会功能评分平均14．7分，接受改良术式者为19．5分。结论对累及肩关节的肩部恶性肿瘤采用Tikhoff-Linberg手术可达到肿瘤广泛切除，保留上肢肢体及部分功能。经典术式术后肩部功能较差。Objective To evaluate the functional outcomes of different limb salvage procedures in patients with bone and soft tissue sarcomas of the shoulder girdle. Methods From July 2001 to July 2008, 16 patients with limb salvage for sarcomas of shoulder girdle were respectively analyzed, including 11 males and 5 females with an average age of 38.4 years （range, 17-67）. Localizations of the tumors were 8 in the scapula （including 4 chondrosarcomas, 1 Ewing sarcoma, and 3 metastases）, 5 soft tissues of the shoulder girdle （including 2 synoviosarcomas, 1 fibrosarcoma, 1 hemangiopericytoma, and 1 well-differentiated liposarco- ma）, and 3 proximal humerus （including 1 osteosarcoma and 2 metastases）. Twelve patients were treated with classical Tikhoff-Linberg procedures, and 4 with improved procedures. Results The mean surgical time duration was 3 hours. The mean blood loss was 1600 ml. The mean follow-up time was 40 months. Major complications included 2 cases of delayed wound healing, and 1 ulnar nerve injury. One patient had local recurrence and died of pulmonary metastases 18 months after second operation of interscaputothoracal amputation. The patient with fibrosarcoma also died of pulmonary metastases 23 months later. One patient with synoviosarcoma was alive with pulmonary metastases in 9 months. Four of 5 patients with carcinoma metastases died during 11 to 23 months later. The 5-year cumulative survival rate was 34.6%. Functions were preserved in the whole hand and elbow. The MSTS functional score of the patients receiving classical Tikhoff-Linberg procedures was 14.7, while improved Tikhoff-Linberg procedures was 19.5. Conclusion The Tikhoff-Linberg procedure not only provides a wide resection of tumors in the shoulder girdle but also preserve the whole hand and elbow functions. The shoulder function was poor in patients receiving classical Tikhoff-Linberg procedures.

关 键 词：肩胛骨 肱骨 骨肿瘤 软组织肿瘤 挽救疗法 

分 类 号：R738[医药卫生—肿瘤]