肿瘤假体置换在肱骨近端恶性骨肿瘤治疗中的应用  

Tumor prosthesis replacement in proximal humeral application in the treatment of malignant bone tumor

作　　者：王永贵[1] 刘江涛[1] 

机构地区：[1]湖北医药学院附属襄阳医院骨科,441021

出　　处：《中国骨与关节杂志》2014年第7期511-515,共5页Chinese Journal of Bone and Joint

摘　　要：目的：探讨肿瘤假体置换在肱骨近端恶性骨肿瘤中应用的临床疗效。方法回顾分析2000年7月至2010年1月，我院治疗的32例肱骨近端恶性骨肿瘤患者，其中骨肉瘤10例，尤文氏肉瘤6例，骨巨细胞瘤7例，转移癌5例，软骨肉瘤4例。肩关节功能重建的方法是采用定制的人工肩关节肿瘤假体，术后根据Enneking骨骼肌肉肿瘤术后肢体功能评定标准进行疗效评价。结果术后随访3.1～5.3年（平均4.2年），32例中2例死亡，2例复发，1例发生假体周围慢性感染，2例发生肩关节半脱位；所有患者肘、腕关节和手的功能基本正常，肩关节外展60°～90°（平均75°），前屈35°～55°（平均45°），后伸40°～60°（平均50°），内收15°～20°（平均17.5°）。根据Enneking的骨骼肌肉肿瘤术后功能评分系统对32例进行评估，最低11分2例，最高28分2例；其中24～30分14例，18～23分9例，12～17分7例，12分以下2例，优良率为71.9%。结论人工肩关节假体置换在治疗肱骨近端恶性肿瘤，不仅能保留患肢完整的外观形态，而且能在很大程度上保留上肢的功能，是一种值得肯定的治疗方法。Objective To investigate the clinical results of tumor prosthesis replacement in the treatment of malignant bone tumors of the proximal humerus.Methods Clinical data of 32 patients with malignant bone tumors of the proximal humerus who were treated from July 2000 to January 2010 were retrospectively analyzed. There were 10 cases of osteosarcoma, 6 cases of Ewing’s sarcoma, 7 cases of giant cell tumors, 5 cases of metastatic carcinoma and 4 cases of chondrosarcoma. In functional reconstruction of the shoulder joint, the custom artificial tumor prosthesis of the shoulder joint was used. According to Enneking’s functional criteria after the muscular-skeletal tumor surgery, the clinical results were evaluated.Results All the patients were followed up for 4.2 years on average （ range： 3.1-5.3 years ） after the operation. Among them, death occurred in 2 cases, postoperative recurrence in 2 cases, chronic periprosthetic infection in 1 case and shoulder subluxation in 2 cases. The elbow, wrist and hand functions in all the patients were normal. The shoulder abduction was 75° on average （ range： 60°-90° ）, the lfexion 45° on average （ range： 35°-55° ）, the extension 50° on average （ range： 40°-60° ） and the adduction 17.5° on average （ range： 15°-20° ）. According to Enneking’s functional criteria after the muscular-skeletal tumor surgery, the minimum score was 11 points in 2 cases and the maximum score was 28 points in 2 cases. There were 14 cases whose score ranged from 24 points to 30 points, 9 cases from 18 points to 23 points, 7 cases from 12 points to 17 points and 2 cases less than 12 points. The excellent and good rate was 71.9%.Conclusions Artiifcial shoulder joint replacement is an effective method in the treatment of malignant bone tumors of the proximal humerus, because not only the entire appearance of the affected extremity will be kept, but also the function of the upper extremity can be preserved to a great extent.

关 键 词：假体植入 假体和植入物 肱骨 近端肢体 

分 类 号：R738.1[医药卫生—肿瘤]