Limb salvage for osteosarcoma of the proximal humerus
- VernacularTitle:肱骨近端骨肉瘤的保肢治疗
- Author:
Xiaodong TANG
;
Wei GUO
;
Rongli YANG
- Publication Type:Journal Article
- Keywords:
osteosarcoma;
humerus;
limb salvage;
prosthesis
- From:
Orthopedic Journal of China
2006;0(23):-
- CountryChina
- Language:Chinese
-
Abstract:
[Objective] A retrospective study of patients with osteosarcoma in the proximal humerus was carried out to evaluate the effect of limb salvage surgery.[Methods]Thirty-eight patients received neoadjuvant chemotherapy and limb salvage were included in the study.Extraarticular or intraarticular resections of the proximal humerus were performed in 5 patients and 33 patients,respectively.The reconstructions included 31 custom-made prosthetic replacements,4 allograft prosthetic composites,1 bone cement spacer,and 2 autografts.The image files of patients receiving intraarticular resection were studied to identify tumor invasion of glenoid and deltoid muscule.[Results]Local recurrence encountered in 5 patients(13.2%)including 1 with extraarticular resection and 4 with intraarticular resection.In patients with intraarticular resection,image study revealed gleoid and deltoid muscule invasion occurred in 7 patients,of whom only 4 had local recurrence.The overall 5-year survival rate was 56.4%,and the disease-free survival rate was 40.5%.Complication rate of limb salvage surgery was 18.4%,which included two autograft bone fractures,one embolism of upper limb artery combined with radial nerve injury,and 4 shoulder joint instabilities.The functional outcomes of mean MSTS 93 score was 22.7 points(75.6%).The active external extension of shoulder joint was restricted in patients with extraarticular resection of no more than 30 degrees,and in patients with intraarticular resection of mean 45 degrees.[Conclusion]Acceptable oncological result and better function could be obtained after intraarticular resection of osteosarcoma in proximal humerus if glenoid or deltoid muscle invasion was not found on image study.Prosthetic replacement in these patients had lower complication rate,and better upper limb or hand function.
