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Extra-articular resection of shoulder joint for bone sarcomas: Oncologic and limb-salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation.

肩关节外切除术治疗骨肉瘤: 32 例患者的肿瘤和保肢结果与肩关节离断和前肢截肢术的比较。

  • 影响因子:2.88
  • DOI:10.1002/jso.25838
  • 作者列表:"Tsuda Y","Fujiwara T","Evans S","Kaneuchi Y","Abudu A
  • 发表时间:2020-03-01
Abstract

BACKGROUND AND OBJECTIVES:We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra-articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. METHODS:Thirty-two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. RESULTS:The 5-year OS for patients who underwent extra-articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5-year OS = 30%; P = .091). The 5-year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%-70%) and was similar in the endoprosthesis and excision arthroplasty group. CONCLUSIONS:Extra-articular resection of the shoulder joint for bone sarcomas is an effective limb-salvage method. However, local recurrence remains a principal concern.

摘要

背景和目的: 我们旨在确定重建的总生存率 (OS) 、手术并发症、和接受肩关节外切除术治疗原发性骨肉瘤患者的功能结局。对接受截肢手术的患者的OS和局部复发率也进行了评估比较。 方法: 对 1988 年至 2017 年间收治的 32 例患者进行研究。肿瘤位于肱骨 22 例 (69%),肩胛骨 10 例 (31%)。切除类型Malawer ⅳ 型 6 例 (19%),ⅴ 型 21 例 (66%),ⅵ 型 5 例 (15%)。23 例 (72%) 采用内假体重建,9 例 (28%) 采用肱骨悬吊至锁骨的切除关节成形术。手术切缘宽 16 例,边缘 8 例,病灶内 3 例,5 例患者不可用。在研究期间,40 例患者接受了前肢截肢术,11 例患者接受了肩关节离断术。 结果: 接受肩关节外切除的患者的 5 年OS为 42%,与接受截肢的患者相比无统计学差异 (5 年OS = 30%; P =.091)。重建的 5 年生存率为 94%,与内假体和切除关节成形术相似。局部复发和并发症分别为 6 例 (19%) 和 10 例 (31%)。需要翻修手术的重建失败的患者有 2 例 (6%)。保肢治疗 30 例 (94%)。肌肉骨骼肿瘤协会功能评分的中位数为 61% (四分位间距,57%-70%),在内假体和切除关节置换组中相似。 结论: 肩关节外切除治疗骨肉瘤是一种有效的保肢方法。然而,局部复发仍然是一个主要问题。

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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