RESUMO
Objective:To explore the method of repairing huge bone and soft tissue defects in clavicle area after en bloc resection of primary malignant tumor of clavicle and the effect of shoulder joint function.Methods:Data of 3 patients with primary malignant tumors of clavicle who underwent en bloc resection (total or subtotal clavicle resection) and individualized repair of bone and soft tissue defects in clavicular region from January 2018 to December 2021 were retrospectively analyzed. All patients were female aged 45, 57 and 14 years old, respectively. Tumor types were osteosarcoma, solitary plasmacytoma and pleomorphic undifferentiated sarcoma. Postoperative adjuvant chemotherapy, shoulder rehabilitation training were performed. Oncological assessment and shoulder joint activity assessment were regularly performed. Musculoskeletal Tumor Society score (MSTS), Constant-Murley scoring and University of California, Los Angeles (UCLA) scoring system were used for functional assessment of shoulder joint.Results:All 3 cases were followed up with follow-up period of 33, 23 and 8 months respectively. No tumor recurrence or metastasis was detected at the last follow up. After tumor resection, one patient with osteosarcoma and one patient with pleomorphic undifferentiated sarcoma underwent reconstruction with clavicular plate and ligament advanced reinforcement system (LARS) ligament. One patient with solitary plasmacytoma underwent LARS ligament reconstruction only after tumor resection. At the latest follow-up, MSTS scores were 28, 30 and 28, Constant-Murley scores were 80, 90 and 84, and UCLA scores were 29, 33 and 30, respectively. No complications occurred during perioperative and postoperative follow-up period.Conclusion:Reconstruction of clavicle and surrounding important ligaments after en bloc resection of primary clavicle malignant tumor is of great significance to the recovery of postoperative shoulder joint function. Satisfactory stability and good shoulder joint function could be obtained after reconstruction of clavicle and sternoclavicular joint.
RESUMO
Objective To study the preliminary effect of combining ligament advanced reinforcement system (LARS) and semi-joint replacement for malignant tumor around the knee in children.Methods 9 cases of malignant tumor around the knee (5 boys and 4 girls) from February 2015 to May 2017 were analyzed respectively.The average age was 9.2 years old (ranged from 5 to 12 years).The follow-up time was 6 to 28 months,with an average of 13.5 months.The preoperational biopsy diagnosis respectively were Ewing sarcoma (3 cases) and osteosarcoma (6 cases).According to Enneking staging system,all 9 cases were staged as ⅡB.The planned courses of standardized preoperative neoadjuvant chemotherapy were successfully given to all patients on time.All patients were given tumor extensive resection and modular prosthesis replacement.Suitable length prosthesis were prepared according to CT and MRI.LARS were annularly bundled to the prosthesis.Then residual patella ligaments,cruciate ligaments,collateral ligaments,capsules and muscles were tightly sutured to LARS.Adjuvant chemotherapy and functional exercise were given after operation.Bone healing,limb discrepancy,and complications were regularly recorded.Functional outcomes were assessed by the system of the Musculoskeletal Tumor Society (MSTS) and the range of motion (ROM) of both knee joints.Results All patients successfully received standardized chemotherapy.In all courses of chemotherapy,bone marrow all restored.No other major complications occurred during chemotherapy.Primary healing of incisions were obtained.No obvious limb discrepancy.The average limb length discrepancy was 2.9±1.8 cm (0.5～6.4 cm),the femur was 1.9±1.0 cm (0.6～3.9 cm),the tibia was 0.8±0.5 cm (0.2～2.0cm).The distance between the lower limb alignment and the center of the knee was 0.3±0.1 cm (0.2～0.6 cm).MSTS score was 24.6±3.2 of the last follow-up,and 21.4± 1.9 of preoperation,the difference was statistically significant (t=2.71,P=0.03).ROM of the knee were 71.7°± 18.2° at the last follow-up,and 69.1 °± 17.9° before operation,and the difference was statistically significant (t=3.261,P=0.01).No infection,snapping knee,limp,dislocation,periprosthesis fractures,prosthetic broken or loosening.2 case had lung metastasis and still survived.NO local recurrence or other metastasis cases.Conclusion LARS combined with semijoint replacement for the treatment of malignant tumor around the knee in children have a satisfactory postoperative joint function recovery and simple surgical technique and fewer complications,and preserve the contralateral osteophytes to minimize the occurrence of limb inequality,but the long-term efficacy needs further follow-up.