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[目的]探讨应用非限制型肱骨头假体治疗肱骨上段恶性骨肿瘤的疗效及经验,为临床合理选择治疗方法提供依据。[方法]回顾性研究了2003年6月～2006年1月,本科收治的采用非限制型人工肱骨头假体置换治疗的肱骨上段恶性骨肿瘤患者13例。其中骨肉瘤9例,Enneking分期ⅡA期;骨巨细胞瘤3例,Enneking分期ⅡA期;骨浆细胞瘤1例,Enneking分期IB期。男9例,女4例;年龄16～56岁(平均年龄28.5岁),所有患者均行新辅助化疗+人工假体置换。术后对患者假体位置、疼痛、功能、患者心理承受等进行观察随访。[结果]所有患者均获随访,随访时间平均48个月。1例骨肉瘤患者于术后15个月后出现肺转移多器官衰竭死亡。所有病例术后患肩疼痛明显减轻,未出现假体松动,术后综合评分较术前均有提高。[结论]非限制型肱骨头假体置换治疗肱骨近端骨肿瘤,严格掌握适应证,配合术前及术后化疗,可以达到良好的手术效果。
[Objective] To discuss the curative effect and experience of applying unrestricted humeral head prosthesis in the treatment of malignant bone tumor of the upper humerus, and provide the basis for clinical reasonable choice of treatment methods. [Methods] From June 2003 to January 2006, 13 patients with malignant bony tumor of the upper humerus treated with unrestricted artificial humeral head prosthesis were retrospectively studied. Including osteosarcoma in 9 cases, Enneking stage Ⅱ A; 3 cases of giant cell tumor of bone, Enneking stage Ⅱ A; 1 cases of bone plasmacytoma, Enneking stage IB. 9 males and 4 females; aged 16 to 56 years (mean age 28.5 years), all patients underwent neoadjuvant chemotherapy + artificial prosthesis replacement. Postoperative patient prosthesis position, pain, function, patient psychological tolerance were observed and followed up. [Results] All patients were followed up for an average of 48 months. One patient with osteosarcoma died of multiple organ failure of lung metastasis 15 months after operation. All cases of postoperative shoulder pain was significantly reduced, no prosthesis loosening, postoperative comprehensive score increased compared with preoperative. [Conclusion] Unconstrained humeral head prosthesis replacement for the treatment of proximal humerus bone tumors, strict indications, combined with preoperative and postoperative chemotherapy, can achieve good surgical results.