背景:如何在安全边界切除肩胛骨肿瘤并保留肩关节的良好功能是骨肿瘤医师需要面临的挑战.目的:评估改良肩胛骨假体置换治疗肩胛骨恶性肿瘤的临床适应证、手术要点及中期疗效.方法:回顾性分析2011年6月至2015年9月在我院骨科运用改良肩胛骨假体置换治疗的25例肩胛骨恶性肿瘤患者的临床疗效,其中男15例,女10例,年龄17~45岁,平均31.6岁.包括6例骨肉瘤,8例软骨肉瘤,6例骨髓瘤,2例尤文肉瘤,1例多形性未分化肉瘤,2例复发的软骨肉瘤.所有患者均为Enneking Ⅱb期,肿瘤范围均累及国际骨与软组织肿瘤协会(MSTS)肩胛带分区的S1、S2区.骨肉瘤、尤文肉瘤、多形性未分化肉瘤、复发的软骨肉瘤患者术前、术后均行新辅助化疗.12例患者使用人工韧带重建关节囊,13例直接缝合重建关节囊.结果:随访时间18~72个月,平均48.5个月.3例患者死于肺转移.无局部复发.无感染、脱位、压迫性溃疡、切口愈合问题等并发症.末次随访时,MSTS评分为23~28分,平均25.5分;肩关节外展30°~70°,平均46°;前屈范围55°~80°,平均69.4°.结论:改良肩胛骨假体置换保肢保关节适用于治疗肩胛骨S1、S2区中度或低度恶性肿瘤,在注重关节囊、残留肩袖肌肉重建的情况下可获得较为满意的肩关节功能.%Background: How to remove scapular tumors at the safe boundary and retain the good function of the shoulder is a challenge for orthopedists. Objective: To evaluate clinical indications, peri-operative technique, and mid-term clinical re-sults of endoprosthesis reconstruction for scapular malignant tumors. Methods: Scapular hemiarthroplasty after total scapu-lectomy was performed in 25 patients between June 2011 and September 2015 in our hospital. Clinical and radiographic re-cords were evaluated retrospectively. There were 15 males and 10 females with the mean age of 31.6 years old (range, 17-45 years), including 6 osteosarcomas, 8 chondrosarcomas, 6 myelomas, 2 Ewing sarcomas, 1 polymorphous undifferentiated sarcoma and 2 recurrent chondrosarcomas. According to the Enneking surgical staging, all patients were classified intoⅡb stage, and the tumors were involved in region S1 and S2 on the basis of shoulder girdle classification scheme of the Muscu-loskeletal Tumor Society (MSTS). The patients with osteosarcoma, Ewing sarcoma, polymorphous undifferentiated sarcoma and recurrent chondrosarcoma received neoadjuvant chemotherapy before and after surgery. In terms of joint capsule recon-struction, 12 were reconstructed with artificial ligament, and the rest were treated by direct suture. Results: The average du-ration of follow-up was 48.5 months (range, 18-72 months). Three patients died of lung metastasis. No infection, disloca-tion, pressure ulcer, wound healing problems, mechanical failures or local recurrence were reported. The final follow-up av-erage MSTS scoring system score was 25.5 (range, 23-28). The average ranges of motion of shoulder abduction and forward flexion were 46°(30°-70°) and 69.4°(55°-80°), respectively. Conclusions: Reconstruction with the scapular hemiarthroplas-ty endoprosthesis can result in mid-term oncologic salvage, good post-operative function and low complication rate after scapulectomy for low-and intermediate-grade malignancy tumors which only involved the S2 and S1 regions. Satisfactory shoulder joint functions can be obtained by reconstruction of joint capsule and residual rotator cuff muscles.
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