【摘要】 目的探讨限制型肩胛骨假体置换治疗肩胛骨恶性肿瘤的效果。方法回顾性分析近十余年假体置换治疗19例肩胛骨恶性肿瘤的外科治疗适应证、操作要点和改进方法。结果 19例患者平均随访109个月,10例行边缘切除,9例行广泛切除和限制型肩胛骨假体置换手术；边缘切除和广泛切除后复发率分别为30%和11．11%；早期4例仿生型假体术后3例出现仿生肩峰外露和肩胛岗压迫性溃疡,二次翻修假体,MSTS 功能评分53．3%；5例改良型肩胛骨假体置换手术后无假体相关并发症,MSTS 功能评分70%。结论限制性全肩胛骨假体置换手术能在切除恶性肿瘤后,最大限度重建了盂肱关节和肩胛骨胸廓间的肌肉群体功能,建立一个稳定的、无痛的肩关节；改良型假体置换术后假体近期并发症少, 功能好于仿生型假体。更多还原

【Abstract】 Objective Limb salvage for scapular malignant tumors challenges orthopedics oncologist, not only because of preserving the stability of shoulder but also because of preserving the functional forearm and hand.Methods With the retrospective investigating the scapular malignant tumors of the Affiliated First Hospital,Sun Yat-sen University for the recent ten years,this essay analyzed the surgery treatment.There were 19 patients with malignant tumors of the scapula,including 17 cases of the primary malignant tumors and 2 cases of the secondary malignant tumors.Histologic types included seven cases of chondrosarcoma,three cases of Ewing’s sarcoma,two cases of osteosarcoma,two cases of malignant fibrous histiocytoma.Ten cases received margin resection which was the part resection of scapula.Nine cases received wide resection with total scapulectomy.The constrained(rotator cuff-sub- stituting)scapular prosthesis was used to reconstruct following the modified Tikhoff-Linberg procedure (S123B)or total scapular resection(S12B).Results Four of nine replaced with the imitated scapular prosthesis,imitated acromion exposure and pressure ulcer by spine of scapular between five to nine months postoperatively.The revising scapular prosthesis solved the problem by cutting the imitated acromion process and spine of scapula.The functional score rates of the imitated scapula prosthesis was 56.7%(17/30).The modified scapula prosthesis was designed in smaller size without imitated acromion process and spine of scapula,but imitated coracoid process and acromion process were made into one process and were moved to medial,which could be hanged over the stump of the clavicle. Five patients replaced with modified scapula prosthesis,there no prosthetic related complication.The function score of post-operation recovered for 70%(21/30)with the improved scapula prosthesis.With followingup for 61to 182 months,the rate of recurrence after margin resection was thirty percent(3/10); the rate of recurrence after wide resection was eleven percent(1/9).Conclusions The major goals after such resections are to restore shoulder girdle stability and upper extremity function,restore the normal muscle force couples of scapulothoracic and glenohumeral mechanisms,preserve a functional hand and elbow.Replaced with the modified scapular prosthesis the patients have less complication and better function.The functional advantage can be achieved beyond a flail extremity or spacer.更多还原