肱骨近端骨肉瘤的保肢治疗的论文.docVIP

　　肱骨近端骨肉瘤的保肢治疗的论文 肱骨近端骨肉瘤的保肢治疗 【关键词】 骨肉瘤　肱骨　保肢　人工关节 【摘要】 ［目的］对肱骨近端骨肉瘤病例的临床及影像资料进行回顾性分析，总结保肢治疗效果，以及局部复发与切除范围和影像评估的关系。［方法］对38例肱骨近端骨肉瘤患者进行新辅助化疗及保肢治疗，平均随访43.2个月。其中5例接受关节外切除，33例接受关节内切除；重建方法包括定制型肱骨近端假体置换31例、人工假体异体骨复合物4例、骨水泥临时假体1例，2例自体骨移植。分析关节内切除病例的影像资料，以判断肩胛盂及三角肌是否可能受到侵犯。［结果］5例（13.2%）患者发生局部复发。关节外切除的复发率为20%（1/5），关节内切除为12.1%（4/33）。在接受关节内切除的患者中，7例影像评估显示肩胛盂及三角肌受侵犯，其中4例局部复发。患者总体5年生存率为56.4%，无瘤生存率为40.5%。并发症包括2例自体移植骨骨折，1例上肢动脉栓塞合并桡神经损伤，4例关节内切除人工假体重建的患者出现肩关节不稳定，总体并发症发生率18.4%（7/38）。msts上肢功能评分平均22.7分（75.6%）。关节外切除患者肩部主动外展活动均未能超过30°，关节内切除患者为平均45°。［结论］对影像检查没有肩胛盂或三角肌侵犯的肱骨近端骨肉瘤病例进行关节内切除，可获得较好的肿瘤学和功能结果。肱骨近端人工假体重建的并发症发生率低，较好的维持了上肢和手部的功能。. 【关键词】 骨肉瘤　肱骨　保肢　人工关节 　　limb salvage for osteosara of the proximal humerus 　　tang xiao-dong, guo usculoskeletal tumor center, people’s hospital, peking university, beijing 100044, china 　 abstract: ［objective］a retrospective study of patients al humerus b salvage surgery. ［methods］thirty-eight patients received neoadjuvant chemotherapy and limb salvage al humerus ed in 5 patients and 33 patients, respectively. the reconstructions included 31 custom-made prosthetic replacements, 4 allograft prosthetic posites,1 bone cement spacer, and 2 autografts. the image files of patients receiving intraarticular resection or invasion of glenoid and deltoid muscule.［results］local recurrence encountered in 5 patients (13.2%) including 1 age study revealed gleoid and deltoid muscule invasion occurred in 7 patients, of only 4 had local recurrence. the overall 5-year survival rate b salvage surgery bolism of upper limb artery bined ean msts 93 score ore than 30 degrees, and in patients ean 45 degrees.［conclusion］acceptable oncological result and better function could be obtained after intraarticular resection of osteosara in proximal humerus if glenoid or deltoid muscle invasion age study. prosthetic replacement in these patients had lob or hand function. 　 key erus; limb salvage; prosthesis 　　肱骨近端是骨肉瘤的第三好发部位［1］，约11.7%的骨肉瘤发生于上肢长骨［2］。有关该部位骨肉瘤外科治疗的报道不多［3］，以往手术多以肩胛带截肢为主，随着