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目的探讨人工肱骨头置换术联合新辅助化疗治疗肱骨近端骨肿瘤的疗效。方法选取50例肱骨近端骨肿瘤患者,随机分为两组,对照组(24例)采用肿瘤段切除、异体骨移植联合新辅助化疗治疗,观察组(26例)采用肿瘤段切除、人工肱骨头置换术联合新辅助化疗治疗。观察并记录术后两组肩关节功能、生活质量、随访情况,比较两组术后12个月的疗效。结果术后12个月,两组肩关节功能比较,观察组优良率明显高于对照组(P<0.05);两组术前SF-36量表评分各项得分无统计学差异(P>0.05);术后12个月,观察组在生理功能和生理职能上,评分明显高于对照组(P<0.05),其余各项评分相比,无统计学差异(P>0.05)。所有患者均获得随访,随访时间12~24个月,平均14.6个月。观察组中,1例骨肉瘤患者术后14个月死于肺转移,无肿瘤复发。术后患者的肩关节功能、血运与运动良好,无伤口感染、假体松动、断裂等并发症发生。对照组中,1例软骨肉瘤患者于术后10个月死于肺转移,2例骨肉瘤患者术后9个月肿瘤复发;2例患者关节面塌陷,1例骨不愈合。结论人工肱骨头置换术联合化疗对肱骨近端骨肿瘤具有较好治疗效果,能明显改善患者生活质量,术后并发症较少,值得临床推广使用。
Objective To investigate the effect of artificial humeral head replacement combined with neoadjuvant chemotherapy in the treatment of proximal humeral bone tumors. Methods Fifty patients with proximal humeral bone tumors were randomly divided into two groups. The control group (24 cases) was treated by tumor resection and allogeneic bone transplantation combined with neoadjuvant chemotherapy. The resection group (26 cases) Head replacement combined with neoadjuvant chemotherapy. The shoulder joint function, quality of life and follow-up of the two groups were observed and recorded. The curative effect of 12 months after operation was compared between the two groups. Results Compared with the control group, the excellent and good rates of shoulder joint function in the two groups at 12 months after operation were significantly higher than those in the control group (P <0.05). There was no significant difference between the two groups in the score of SF-36 before operation (P> 0.05 ). At 12 months after operation, the score of the observation group was significantly higher than that of the control group (P <0.05). There was no significant difference between the other groups (P> 0.05). All patients were followed up for 12-24 months with an average of 14.6 months. In the observation group, one patient with osteosarcoma died of lung metastasis 14 months after operation, with no tumor recurrence. Patients with postoperative shoulder function, good blood and exercise, no wound infection, prosthesis loosening, fracture and other complications. In the control group, 1 patient with chondrosarcoma died of lung metastasis 10 months after operation, 2 patients with osteosarcoma recurred at 9 months after operation, 2 patients had articular surface collapse, and 1 patient did not heal. Conclusions Artificial humeral head replacement combined with chemotherapy has a good therapeutic effect on proximal humeral bone tumors, which can significantly improve the quality of life of patients with less postoperative complications and is worthy of clinical promotion.