CAJ | 학술논문

目的探讨肱骨近端骨肿瘤保肢术中使用人工补片重建盂肱关节囊的手术方法及其对稳定肩关节、预防术后肱骨头脱位的效果.方法 2006年2月至2009年1月,回顾性分析接受定制型肱骨近端假体结合聚丙烯非降解性人工补片重建肩关节的患者12例,男7例,女5例;年龄21～55岁,平均38岁.肿瘤类型:骨巨细胞瘤9例,骨肉瘤1例,软骨肉瘤2例.9例骨巨细胞瘤患者中3例为Campanacci Ⅱ期,6例为Campanacci Ⅲ期;1例骨肉瘤患者为Enneking ⅡB期;2例软骨肉瘤患者均为Enneking Ⅱ A期.采用国际骨与软组织肿瘤协会(MSTS)功能评估标准评价术后肩关节功能.结果患者均获得随访,随访时间24～52个月,平均35个月.手术出血量150～500 ml,平均254 ml;手术时间150～200 min,平均172 min.术后患者肩关节前屈20°～60°,平均41°;外展20°～70°,平均42°.MSTS评分为53%～77%,平均66%.术后无一例患者出现臂丛损伤、切口感染及假体脱位;随访期间无一例患者出现局部复发、远处转移或死亡.结论使用聚丙烯非降解性人工补片重建盂肱关节囊可显著减少肱骨近端骨肿瘤保肢术后肱骨头假体脱位的发生,便于周围软组织的附着和长入.
목적 탐토굉골근단골종류보지술중사용인공보편중건우굉관절낭적수술방법급기대은정견관절、예방술후굉골두탈위적효과.방법 2006년2월지2009년1월,회고성분석접수정제형굉골근단가체결합취병희비강해성인공보편중건견관절적환자12례,남7례,녀5례;년령21～55세,평균38세.종류류형:골거세포류9례,골육류1례,연골육류2례.9례골거세포류환자중3례위Campanacci Ⅱ기,6례위Campanacci Ⅲ기;1례골육류환자위Enneking ⅡB기;2례연골육류환자균위Enneking Ⅱ A기.채용국제골여연조직종류협회(MSTS)공능평고표준평개술후견관절공능.결과 환자균획득수방,수방시간24～52개월,평균35개월.수술출혈량150～500 ml,평균254 ml;수술시간150～200 min,평균172 min.술후환자견관절전굴20°～60°,평균41°;외전20°～70°,평균42°.MSTS평분위53%～77%,평균66%.술후무일례환자출현비총손상、절구감염급가체탈위;수방기간무일례환자출현국부복발、원처전이혹사망.결론 사용취병희비강해성인공보편중건우굉관절낭가현저감소굉골근단골종류보지술후굉골두가체탈위적발생,편우주위연조직적부착화장입.
Objective To investigate the surgical technique,postoperative function and dislocation incidence of proximal humerus reconstruction with metallic endoprostheses and polypropylene knitted nonabsorbable mesh after proximal humeral tumor resection.Methods Twenty patients with proximal humeral tumor were retrospectively reviewed.They were performed proximal humerus reconstruction with proximal humeral prosthesis and polypropylene knitted non-absorbable mesh from February 2006 to January 2009.There were 5 women and 7 men with a mean age of 38 years(range,21-55 years)at the time of surgery,and giant cell tumor in 9 patients(including Campanacci Ⅱ for 3,Campanacci Ⅲ for 6),osteosarcoma in 1(Enneking ⅡB).and chondrosarcoma in 2 (Enneking ⅡA).The operative time,blood loss,and shoulder movement postoperation were analysed.According to the assessment system by MSTS,the function of limb after surgery was assessed.Results Patients were followed clinically and radiographically for a minimum of 24 months (mean,35 months;range,24-52 months).The mean operative time was 172 min(range,150-200min).The mean blood loss was 254 ml (range,150-500 ml).There were no shoulder dislocations at final follow-up.The mean shoulder flexion was 41°(range,20°-60°)and mean shoulder abduction was 42°(range,20°-70°).The mean postoperative functional assessment score of the limb was 66%(range,53%-77%).None of the Datients had a wound infection,traction neuropraxia or died after the surgical procedure.Conclnsion The data suggests that the use of a polypropylene knitted non-absorbable mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment after tumor resection.