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論文 |
論文
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Hayashi, Katsuhiro ; Niu, Xiaohui ; Tang, Xiaodong ; Singh, Vivek Ajit ; Asavamongkolkul, Apichat ; Kawai, Akira ; Yamamoto, Norio ; Shirai, Toshiharu ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Miwa, Shinji ; Tsuchiya, Hiroyuki ; 林, 克洋 ; 山本, 憲男 ; 白井, 寿治 ; 武内, 章彦 ; 木村, 浩彰 ; 三輪, 真嗣 ; 土屋, 弘行
概要:
Total scapulectomy and reconstruction has been performed for scapular tumor, however, most of the reconstruction methods
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have resulted in poor functional outcomes and there is still room for improvement. Most of the reports of reconstruction after scapulectomy are from a single institution. In the present study, we investigated functional outcomes after total scapulectomy in a multicenter study in The Eastern Asian Musculoskeletal Oncology Group (EAMOG). Thirty-three patients who underwent total scapulectomy were registered at EAMOG affiliated hospitals. The patients were separated into no reconstruction group (n=8), humeral suspension group (n=15) and prosthesis group (n=10). Functional outcome was assessed by the Enneking score. One-way ANOVA was used to compare parameters between the patient groups. Complications included five local recurrences, one superficial infection, one dislocation and one clavicle protrusion. The average follow-up period was 43.5. months. The average active flexion range was 45.8° (0-120°), and 37.1° in abduction (0-120°). The mean total functional score was 22.9 out of 30 (15-29), which is a satisfactory score following resection of the shoulder girdle. There were significant differences in reconstruction methods for active range of motion. Bony reconstruction provided better range of motion in this study. There was a variety of reconstruction methods after scapulectomy in the eastern Asian countries. Although better functional score was obtained using scapular prosthesis or recycled bone and prosthesis composite grafting, postoperative function is still lower than preoperative function. Modified designed prosthesis with or without combination of recycle bone or allograft would restore the lost shoulder function in the future. © 2016 The Authors.<br />Embargo Period 12 months
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論文
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Shirai, Toshiharu ; Tsuchiya, Hiroyuki ; Terauchi, Ryu ; Tsuchida, Shinji ; Mizoshiri, Naoki ; Igarashi, Kentaro ; Miwa, Shinji ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Hayashi, Katsuhiro ; Yamamoto, Norio ; Kubo, Toshikazu
概要:
Objective: We perform reconstruction using frozen tumor bone treated by liquid nitrogen after excision of malignant bone
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tumors. To prevent post-operative infection, we use iodine-coated implants that we developed. The purpose of this study is to compare the outcome of reconstruction using frozen autograft with non-coated implants (group N) and iodine-coated implants (group I).Methods: Sixty-two patients were included in group N. The mean age was 31.9 ± 2.3 years. A total of 20 patients died and two were lost to follow-up, averaging 20.0 ± 2.9 months post-operatively, leaving 40 patients available for an assessment at a mean of 79.1 ± 5.8 months post-operatively. There were 38 patients in group I. The mean age was 29.8 ± 3.9 years. The mean follow-up period was 32.1 ± 3.0 months. All patients were alive at the latest follow-up. Survival of frozen bone was determined by Kaplan-Meier analysis.Results: In group N, survival of frozen bone was 80.7 ± 6.0% and 57.4 ± 10.2% at 5 and 10 years, respectively. Complications were encountered in 31 of 62 patients (50.0%), including deep infection in 10 (16.1%), fracture in 11 (17.7%), local soft-tissue recurrence in 6 (9.7%) and bone absorption in 4 (6.5%). In group I, survival of frozen bone was 86.7 ± 6.3% at 5 years. Complications were encountered in 8 of 38 patients (21.1%), including deep infection in one (2.6%), fracture in four (10.5%), local soft-tissue recurrence in two (5.3%) and bone absorption in one (2.6%). There was a significantly lower infection rate in group I (P = 0.032).Conclusion: Reconstruction using frozen autograft combined with iodine-coated implants for patients with malignant bone tumor is very useful method in which good limb function can be gained with minimized risk of infection. © The Author 2016. Published by Oxford University Press. All rights reserved.<br />Article number hyw065 / Embargo Period 6 months
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