Surgical technique and clinical results for scapular allograft reconstruction following resection of scapular tumors
Surgical technique and clinical results for scapular allograft reconstruction following resection of scapular tumors
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DOI：
10.1186/1756-9966-28-45
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发表时间：
2009-04-01
影响因子：
11.3
通讯作者：
Tu, Chongqi
中科院分区：
文献类型：
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作者：
Zhang, Kaiwei;Duan, Hong;Tu, Chongqi
背景：肩胛骨肿瘤切除术后，肩胛骨异体移植重建等有效手术技术的进展，增强了肩胛骨肿瘤切除术后患者的肩关节稳定性和肢体功能。方法：回顾性分析7例肩胛骨肿瘤切除术后行同种异体移植重建的病例资料。所有患者都进行了广泛的边缘切除（部分肩胛骨切除术），切除了所有受影响的软组织，以获得干净的手术边缘。分别在3例和4例患者中进行了切除和保留关节盂的重建。用钢板和螺钉将剩余宿主肩胛骨固定在大小匹配的同种异体肩胛骨移植物上。肩袖经常受到影响，大部分被切除。三角肌和关节囊很少受累，但优先重建。剩余的肌肉被重新连接到同种异体移植物上。结果：中位随访26个月（范围14-50个月）。根据国际残肢保留协会的标准，平均功能评分为24分（80%）。主动肩外展和前屈活动范围分别为40度-110度和30度-90度。保留关节盂和切除关节盂的重建在总分上没有差异（平均24.5分/81%对24分/79%），但保留关节盂的手术在外展/屈曲运动方面优于后者（平均72度/61度对55度/43度）。在研究随访期间，1例患者复发后死亡，1例患者局部复发后存活，5例患者存活，无原发肿瘤复发迹象。术后并发症，如肩关节脱臼、关节不连和关节退变在本研究期间未见。结论：在本病例中，肩胛骨异体移植重建具有令人满意的功能、美观和肿瘤预后。关节囊和三角肌的保存和重建被认为是使用同种异体肩胛骨移植物的先决条件，尽管在技术上具有挑战性，但推荐进行肩袖重建。
Background: Progress in developing effective surgical techniques, such as scapular allograft reconstruction, enhance shoulder stability and extremity function, in patients following scapular tumor resection.Methods: Case details from seven patients who underwent scapular allograft reconstruction following scapular tumor resection were reviewed. A wide marginal resection (partial scapulectomy) was performed in all patients and all affected soft tissues were resected to achieve a clean surgical margin. The glenoid-resected and glenoid-saved reconstructions were performed in three and four patients, respectively. The residual host scapula were fixed to the size-matched scapular allografts with plates and screws. The rotator cuff was affected frequently and was mostly resected. The deltoid and articular capsule were infrequently involved, but reconstructed preferentially. The remaining muscles were reattached to the allografts.Results: The median follow-up was 26 months (range, 14-50 months). The average function scores were 24 points (80%) according to the International Society of Limb Salvage criteria. The range of active shoulder abduction and forward flexion motion were 40 degrees-110 degrees and 30 degrees-90 degrees, respectively. There was no difference between the glenoid-saved and glenoid-resected reconstructions in the total scores (mean, 24.5 points/81% versus 24 points/79%), but the glenoid-saved procedure was superior to the later in terms of abduction/flexion motion (mean, 72 degrees/61 degrees versus 55 degrees/43 degrees). During the study follow-up period, one patient died following a relapse, one patient lived despite of local recurrence, and five patients survived with no evidence of recurrence of the original cancer. Post-surgical complications such as shoulder dislocations, non-unions, and articular degeneration were not noted during this study period.Conclusion: Scapular allograft reconstruction had a satisfactory functional, cosmetic, and oncological outcome in this case series. Preservation and reconstruction of the articular capsule and deltoid are proposed to be a prerequisite for using scapular allografts and rotator cuff reconstruction is recommended, although technically challenging to perform.