全锁骨切除治疗锁骨尤文肉瘤一例并文献复习  

Total Claviculectomy as Treatment of Clavicular Ewing＇s Sarcoma： a Case Report and Literature Review

作　　者：陈宇[1] 于秀淳[1] 徐明[1] 郑凯[1] Chen Yu;Yu Xiuchun;Xu Ming;Zheng Kai(Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan 250031, China)

机构地区：[1]济南军区总医院骨病科,250031

出　　处：《中华骨科杂志》2018年第10期620-626,共7页Chinese Journal of Orthopaedics

摘　　要：目的分析全锁骨切除术治疗锁骨尤文肉瘤的临床疗效，探讨锁骨重建对手术效果的影响。方法回顾性分析1例锁骨尤文肉瘤患者的临床资料，男，13岁，因左锁骨尤文肉瘤接受化疗治疗，具体方案为顺铂120mg／m^2，用时1天，阿霉素30mg／m^2，连续应用3天，异环磷酰胺2．0g/m^2，连续应用5天，进行2疗程，间隔2周，后在全身麻醉下行左侧全锁骨切除术，未行锁骨重建术，并继续行上述方案化疗共9个疗程。术后随访患肢外观、肢体功能（美国肩肘外科协会功能评分[（American Shoulder and Elbow Surgeons’form，ASES）；骨与软组织肿瘤协会评分（Musculoskeletal Tumor Society，MSTS）]、x线检查、ECT全身骨扫瞄和肺部CT扫描。对全锁骨切除术治疗锁骨尤文肉瘤的疗效进行分析并复习相关文献，探讨锁骨重建术对手术效果的影响及其必要性。结果术后获得23个月有效随访，患者主观评价术肢功能无障碍，可正常进行体育锻炼。体格检查显示左肩较对侧下沉约2cm，肩关节外观较对侧无明显改变，左肩功能恢复良好，左肩活动度：外展：90°，内收：40°，前屈：90°，后伸：45°，中立位内旋80°，中立位外旋60°，上举无受限，左肩各方向活动肌力均为V级，左肩ASES评分96分，MSTS评分29分。锁骨正位X线片提示胸椎轻度侧凸，未见肿瘤复发、转移征象。结论全锁骨切除旷置术治疗锁骨尤文肉瘤的疗效满意，由于锁骨重建增加手术难度和并发症风险，因此可应用旷置术治疗锁骨恶性肿瘤。Objective To analyze the efficacy of total claviculectomy in the treatment of Ewing＇s sarcoma and to discuss the impact of clavicular reconstruction on the outcome. Methods The clinical records of a 13-year-old male patient with left cla- vicular Ewing＇s sarcoma were reviewed. The subject received 2 cycles （at an interval of 2 weeks） of neoadjuvant chemotherapy comprising cisplatin 120 mg/m^2 （1 d）, adriomycin 30 mg/m^2 （3 d）, and ifosfamide 2.0 g/m^2 （5 d）. Total claviculectomy was carried out without clavicular reconstruction and the patient underwent 9 cycles of subsequent chemotherapy. The appearance and func- tion of the operated limb, radiological examinations of the surgical site, ECT bone scans and pulmonary CT were followed up. The literatures regarding the total and subtotal excision of the clavicle were reviewed to investigate the importance of clavicular recon- struction. Results After 23-months of follow-up, the patient was subjectively free of limb function compromise. Physical examina- tions indicated drooping of the operated shoulder by 2 cm, whereas the appearance was similar between both shoulders. Functionality of the operated limb was recovered. The motion of the left shoulder： abduction 90°, adduction 40°, anterior flexion 90°, extension 45°, internal rotation 80°, external rotation 60°, and no restriction of limb elevation. Manual muscle strength tests showed V/V muscle strength of the operated limb. American Shoulder and Elbow Surgeons＂ form （ASES） and Musculoskeletal Tumor Society （MSTS） score were 96 and 30, respectively. Postoperative X-ray films demonstrated mild thoracic scoliosis. The patient did not ap- pear recurrence and metastasis. Conclusion Total claviculectomy is efficacious for treating clavicular Ewing＇s sarcoma. Clavicular reconstruction may not be imperative for treatment of clavicular malignancy because of the increased technical difficulty and great risk of complications.

关 键 词：肉瘤 EWING 锁骨 外科手术 骨重建 功能恢复 

分 类 号：R738[医药卫生—肿瘤]