肩胛带韧带样纤维瘤华西分区指导外科治疗的远期疗效观察  

Long-term effectiveness of“West China Classification”guided surgical treatment of desmoid-type fibromatosis in shoulder girdle

作　　者：周思私 唐凡[1] 闵理[1] 罗翼[1] 周勇[1] 段宏[1] 屠重棋[1] ZHOU Sisi;TANG Fan;MIN Li;LUO Yi;ZHOU Yong;DUAN Hong;TU Chongqi(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2020年第6期744-750,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评估肩胛带韧带样纤维瘤(desmoid-type fibromatosis,DTF)华西分区指导外科治疗的远期临床疗效。方法回顾分析2003年6月-2016年12月收治的32例肩胛带DTF患者临床资料,男14例,女18例;年龄14~56岁,平均36.8岁。肿瘤最大径7~19 cm,平均11.1 cm。根据肩胛带DTF华西分区,肿瘤位于Ⅰ区4例、Ⅱ区3例、Ⅲ区6例、Ⅳ区3例、Ⅰ+Ⅱ区5例、Ⅱ+Ⅲ区5例、Ⅰ+Ⅱ+Ⅲ区6例。根据肩胛带DTF华西分区及血管神经受累情况,12例采用前路手术(A组),14例采取后路手术(B组),6例采用前-后联合入路手术(C组)。记录并比较3组患者1993美国骨肿瘤学会评分系统(MSTS93)评分(包括疼痛、肢体功能、满意度、手的位置、手灵活度、举物能力6方面)、日本骨科协会(JOA)评分、肩关节活动度(包括前屈、后伸、外展、内收)及并发症发生情况。结果 32例患者均获随访,随访时间30~190个月,平均94.6个月。随访期间共5例(15.6%)患者发生并发症,其中A组2例(16.6%)、B组2例(14.3%)、C组1例(16.6%),各组并发症发生率比较差异均无统计学意义(P=1.000)。至末次随访时,共4例(12.5%)患者肿瘤复发,其中A组1例(8.3%)、B组2例(14.3%)、C组1例(16.6%),各组复发率比较差异均无统计学意义(P=1.000)。末次随访时,A、B组MSTS93评分的疼痛、肢体功能、满意度、手灵活性、手的位置评分及总分均显著优于C组(P<0.05),A、B组间差异无统计学意义(P>0.05);C组举物能力评分显著低于A组(P<0.05),其余组间比较差异无统计学意义(P>0.05)。A、B组JOA评分及肩关节前屈、后伸、外展、内收活动度均显著优于C组(P<0.05);A组后伸活动度优于B组,B组前屈活动度优于A组,差异有统计学意义(P<0.05),其余指标A、B组间差异均无统计学意义(P>0.05)。结论根据肩胛带DTF华西分区选择适当的手术入路,充分暴露并完整切除肿瘤,取得了较满意的远期临床疗效。Objective To evaluate the long-term effectiveness of patients received surgical treatment under the guidance of“West China Classification”of desmoid-type fibromatosis(DTF)in the shoulder girdle.Methods The clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed,including 14 males and 18 females,aged 14-56 years with an average age of 36.8 years.The maximum diameter of the tumor was 7-19 cm,with an average of 11.1 cm.According to the“West China Classification”of DTF in the shoulder girdle,there were 4 cases of regionⅠ,3 cases of regionⅡ,6 cases of regionⅢ,3 cases of regionⅣ,5 cases of regionsⅠ+Ⅱ,5 cases of regionsⅡ+Ⅲ,and 6 cases of regionsⅠ+Ⅱ+Ⅲ.In addition,the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach.Finally,12 cases were operated via anteroposterior approach(group A),14 via posterior approach(group B),and 6 via combined anteriorposterior approach(group C).The 1993 Musculoskeletal Tumor Society(MSTS93)score(including pain,limb function,satisfaction,hand position,hand flexibility,and lifting ability),Japanese Orthopedic Association(JOA)score,range of motion(ROM)of shoulder joint(including flexion,extension,abduction,and adduction),and complications of patients in the 3 groups were recorded and compared.Results All the 32 patients were followed up 30-190 months,with an average of 94.6 months.At last follow-up,complications occurred in 5 cases(15.6%),including 2 cases(16.6%)in group A,2(14.3%)in group B,and 1(16.6%)in group C.There was no significant difference in the incidence of complications among the 3 groups(P=1.000).Tumor recurrence occurred in 5(15.6%)cases,including 1(8.3%)case in group A,2(14.3%)in group B,and 1(16.6%)in group C.No significant difference was found in the recurrence rate among the 3 groups(P=1.000).At last follow-up,MSTS93 score of pain,limb function,satisfaction,hand flexibility,and hand position in groups A and B were

关 键 词：肩胛带 韧带样纤维瘤 手术入路 远期疗效 

分 类 号：R738.6[医药卫生—肿瘤]