Composite reverse shoulder arthroplasty can provide good function and quality of life in cases of malignant tumour of the proximal humerus
Composite reverse shoulder arthroplasty can provide good function and quality of life in cases of malignant tumour of the proximal humerus
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DOI：
10.1007/s00264-017-3538-7
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发表时间：
2017-12-01
影响因子：
2.7
通讯作者：
Chammas, Michel
中科院分区：
文献类型：
--
作者：
Lazerges, Cyril;Dagneaux, Louis;Chammas, Michel
目的 肱骨近端肿瘤的治疗仍然是手术挑战。迄今为止，尚无研究评估针对该适应症的复合反向肩关节置换术后的生活质量评分。因此，我们评估了肱骨恶性肿瘤同种异体移植重建后的功能和生活质量。方法在平均随访 5.9 年后，对由同一中心的一位外科医生治疗的六例肱骨肿瘤病例进行了回顾。这些肿瘤包括两处软骨肉瘤、一处浆细胞瘤和三处转移瘤。切除骨骺、干骺端和骨干5例（S3S4S5A），骨骺和干骺端1例（S3S4A）。所有病例均采用同种异体复合反向肩关节置换术进行重建。结果通过运动范围、QuickDash 评分和 Short Form 12 (SF-12) 健康调查进行评估。 X线照片评估骨整合和并发症。结果在最后一次随访时，肩部前屈、外展和外旋的平均运动范围分别为95度、57度和11度。 QuickDASH 平均评分从 28 分提高到 41 分，VAS 疼痛评分从 5.1 分提高到 2.3 分。术后MSTS评分为73%，Constant评分为46.1/100。 SF-12 PCS 和 MCS 分数也有所提高，分别从 44.4 和 39.7 提高到 45.5 和 56.1。平均满意度得分为8.1/10。 结论 复合反向肩关节置换术是肱骨恶性肿瘤切除术后重建的可行替代方案。尽管肿瘤全切除是最重要的目标，但功能和生活质量评分令人满意。
Purpose Management of proximal humeral tumours remains a surgical challenge. No study to date has assessed the quality of life scores following the composite reverse shoulder arthroplasty for this indication. We, therefore, evaluated function and quality of life following reconstruction with allograft for malignant tumour of the humerus.Methods A series of six cases of humeral tumour treated by a single surgeon in a single centre was reviewed after a mean follow-up of 5.9 years. The tumours included two chondrosarcomas, one plasmocytoma and three metastases. Resection involved bone epiphysis, metaphysis and diaphysis in five cases (S3S4S5A) and epiphysis and metaphysis in one case (S3S4A). For reconstruction, an allograft composite reverse shoulder arthroplasty was used in all the cases. Outcomes were assessed with range of motion, the QuickDash score and the Short Form 12 (SF-12) Health Survey. Radiographs assessed osseointegration and complications.Results At the final follow-up, the mean shoulder range of motion were respectively 95 degrees, 57 degrees and 11 degrees for forward flexion, abduction and external rotation. Mean QuickDASH score improved from 28 to 41 and VAS-pain scores improved from 5.1 to 2.3. The post-operative MSTS score was 73% and the Constant score was 46.1/100. The SF-12 PCS and MCS scores were also improved, respectively from 44.4 and 39.7 to 45.5 and 56.1. The mean satisfaction score was 8.1/10.Conclusions Composite reverse shoulder arthroplasty is a viable alternative for reconstruction after resection of malignant humeral tumour. Although total tumour resection was the most important objective, the functional and quality of life scores were satisfactory.