Limb Salvage for Shoulder Girdle Neoplasm / 대한정형외과학회잡지

ABSTRACT

Between 1987 and 1994, the authors analysed 29 patients who underwent limb sparing resection for shoulder girdle neoplasms. Follow up averaged 24 months. Primary bone and soft tissue malignancy were 23 cases, metastatic carcinoma 3, aggressive giant cell tumor 2, aneurysmal bone cyst 1. By Enneking's criteria, stage IIB 23 cases, stage III 3, stage I 2. The surgical margins were wide(20), marginal(7), and intralesional(2). In 4 cases with S2345B resections(by Musculoskeletal Tumor Society classification), shoulder fusion were done with Ender nail and bone cement. Among twenty patients with S345A(3), S34A(6), S345B(11) resections, arthroplasty with Ender nail and bone cement were done in 11 cases, endoprothesis and its combination with bone cement in 4, vascu- larized fibula graft in I, shoulder fusion with fibula graft in 1, combination of autoclaved bone and endoprothesis were done in 3 cases. Four patients with S12B, no reconstruction were done. For one patient with S45A, segmental resection and reconstruction with autogenous pasteurized bone were done. Oncologic results are CDF 14, DOD 5, NED 3, AWD 7 cases. Complications were local recur- rence 3(10.3%), distal fragment loosening 1, subluxation of humeral head 1, graft site fracture 1, and infection in 1 case. MSTS functional scores for the whole 29 cases were 22.5(75% of normal). S2345B with fusion was 20(67%). For S345A(3) and S34A(6) score was 23.2(77%). For S345B(11), score was 21.7(72%). For S12B(4) and S45A(1), score was 25.8(86%). Although functional results are depend on the extent of bone and soft tissue resection, reconstruction of soft tissue seems to be important. The options for reconstruction of bony defect(endoprothesis complex, living fibula graft or IM nail and cement as a prothesis) did not affect functional outcome.