上腕骨近位部悪性骨腫瘍の人工骨頭置換術における軟部組織再建

概要

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Malignant tumors in proximal humeri are often experienced. However, these cases are much fewer than benign ones such as usual fracture or arthritis. This article describes our surgical technique for malignant humeral tumor and the results after surgery. The cases were two males and one female (total 3 shoulders). The ages are between 11 and 50 years old (mean25.3). These cases consist of two osteosarcomas and one bone malignant fibrous histiocytoma(MFH) ,and observation periods were at the range of 18 to 40 months(mean 27). Surgical method: After chemotherapy, tumors covered with some muscles were excised. Rotator cuff and joint capsule were cut at the glenohumeral joint level and most deltoid muscles were removed. Then, after long prosthesises were inserted, artificial meshes were utilized to make the new joints stabilized. Quick-DASH and JOA score were 9.1 and 59.3 respectively. One shoulder showed subluxation inferiorly and all shoulders were not able to work enough by themselves spontaneously. Malignant bone tumor is a very specific disease. Therefore, patients might make the function less important compared with the recurrence of the tumor. However, shoulder dislocation should be prevented and this mesh graft seems to be quite useful for that. Next step is to acquire active movement of the new shoulder joint and muscular flap might be necessary for the achievement of that.