肩胛骨恶性肿瘤保肢手术的功能评价分析  

Functional evaluation and analysis of limb salvage surgery for scapular malignant tumors

作　　者：张本源 高原 夏铁男 张芷豪 邱恩铎 张晓晶 商冠宁 ZHANG Benyuan;GAO Yuan;XIA Tienan;ZHANG Zhihao;QIU Enduo;ZHANG Xiaojing;SHANG Guanning(Department of Orthopedics, Liaoning Cancer Hospital and Institute , Cancer Hospital of China Medical University,Shenyang 110042, China)

机构地区：[1]辽宁省肿瘤医院(中国医科大学肿瘤医院,大连医科大学临床肿瘤学院)骨与软组织外科

出　　处：《中国肿瘤外科杂志》2019年第5期337-340,385,共5页Chinese Journal of Surgical Oncology

基　　金：辽宁省自然科学基金指导计划项目(20180550547);沈阳市高层次创新人才项目(RC180064)

摘　　要：目的研究肩胛骨恶性肿瘤补片重建对术后功能的影响.方法回顾性分析2015年7月至2018年8月在辽宁省肿瘤医院治疗的17例肩胛骨恶性肿瘤患者的临床资料,其中男6例,女11例,年龄17~74(53.6±15.2)岁.肩胛骨原发性恶性肿瘤9例,转移性肿瘤8例.Enneking分期ⅡB期6例,Ⅲ期11例.17例患者均行肩胛骨切除术,手术方式依据Malawer分型和Hayashi分型选择.部分患者通过补片进行肩胛部软组织修复、肩袖重建及肱骨断端袖套悬吊固定;其余采用肌肉复位缝合.采用肌肉骨骼肿瘤协会(MSTS)评分系统评估患者的术后功能.结果术后随访3~39个月,平均15.9(10.0,23.0)个月,均无感染、切口愈合延迟等并发症发生.末次随访时,患者MSTS评分平均为75.5%(43.3%~100.0%).5例行全肩胛骨切除患者的MSTS评分平均为69.4%,其中行补片重建者(4例)为71.7%,未行补片重建者为60.0%.3例保留肩峰患者的MSTS评分平均为70.0%,其中行补片重建者(2例)为73.4%,未行补片重建者为63.3%.8例保留肩峰及肩胛盂患者的MSTS评分平均为83.8%,其中行补片重建者(1例)为93.3%,未行补片重建者为82.4%.1例肩胛下部切除患者未进行补片重建,其MSTS评分为83.3%.结论肩胛骨切除术后行补片重建者较未行补片重建者,可以获得更好的术后功能.Objective To investigate the effect of scapula malignant tumor mesh reconstruction on postoperative function.Methods A retrospective analysis of 17 patients with scapular bone malignant tumors resection in Liaoning Cancer Hospital and Institute from July 2015 to August 2018, including 6 males and 11 females, aged ranging from 17 to 74(53.6±15.2). There were 9 cases of primary scapula malignant tumor, and 8 cases of metastatic tumor. In the Enneking stage, 6 cases of were in the stage of ⅡB and 11 cases in the stage of Ⅲ. All the 17 patients underwent scapulectomy, and the operative methods were selected according to Malawer and Hayashi. Some patients scapular soft tissue repair, rotator cuff reconstruction and suspension fixation of broken humerus through patch. The rest patients were sutured by muscle reduction. The patients postoperative function were assessed by Musculoskeletal Tumor Society(MSTS) scoring system. Results Followed up for 3 to 39 months, the average duration of follow-up was 15.9(10.0,23.0) months, no complications such as infection and delayed wound healing occurred. At the last follow-up, the MSTS score averaged 75.5%(ranging from 43.3% to 100.0%). The average MSTS score of 5 patients undergoing total scapula resection was 69.4%, among them with patch reconstruction(4 cases) the average MSTS score was 71.7%, and without mesh reconstruction MSTS score was 60.0%. The 3 patients with acromion preservation, who average MSTS score was 70.0%, among them with patch reconstruction(2 cases) the average MSTS score was 73.4%, and without patch reconstruction MSTS score was 63.3%. The 8 patients retained the acromion and glenoid cavity, who average MSTS score was 83.8%, among them with patch reconstruction(1 case) MSTS score was 93.3%, and without patch reconstruction the average MSTS score was 82.4%. The 1 patient underwent subscapular resection without patch reconstruction and the MSTS score was 83.3%. Conclusions Patients who received patch reconstruction after scapulectomy had better postoperativ

关 键 词：肩胛骨 肿瘤 手术 补片 肌肉骨骼肿瘤协会评分 

分 类 号：R738[医药卫生—肿瘤]