Analysis Of The Effect Of Custom-made Total Shoulder Arthroplasty In The Treatment Of Malignant Tumor Of Scapula

Purpose:To investigate the classification,the extent of resection,prosthesis design and the method of reconstruction of upper limb function after removal of malignant tumor of scapula;To comparative and analysis the clinical curative effect of reconstruction function and stability of shoulder by replacement of artificial total scapular and shoulder joint prosthesis in the treatment of malignant tumor in scapula.Methods:collect thirteen patients with malignant tumor of scapula that were treated in our hospital’s Department of Orthopedics Oncology Group from September 2014 to December 2016.There are 4 cases of male,accounting for 30.8%,9 cases female,accounting for 69.2%,and the ratio of male to female was 1∶2.25,aging from 27 to 65 years old with an average of 47.5 years old;seven cases of chondrosarcoma,one case of osteosarcoma,one case of giant cell tumor of bone,one case of hemangioma,one case of malignant fibrous histiocytoma;one case bone metastasis of nasopharyngeal carcinoma;one case of tuberculosis around the scapula.According to Malawer’s surgical classification system of shoulder girdle to resect,various reconstruction procedures were performed for these patients after operation.Five patients with malignant tumor of scapula(S12)were treated by replacement of artificial total scapula and shoulder joint prosthesis after tumor resection,there were four females and one male patients,aging from 32 to 55 years old with an average of 41.4 years,three cases of chondrosarcoma,one cases of vascular tumor and one cases of fibrous osteosarcoma;Five patients of partial resection of scapula;three cases of humeral head suspension after total scapula resection.Preoperative,intraoperative and postoperative evaluation included: preoperative preparation,prosthesis design,key points of operation,rehabilitation exercise,postoperative functional score and complications;Retrospective analysis of the relevant literature,and comparative analysis of clinical results to draw conclusions.Results:Five patients with malignant tumor of scapula(S12)were treated by replacement of artificial total scapula and shoulder joint prosthesis after tumor resection,with an average operation time of 210 min,ranging from 186 min to 260 min.A follow-up of Seven to Twenty-three months was done,an average of 13 months;There were no complications such as tumor recurrence,infection,prosthesis loosening,dislocation,break and periprosthetic fracture during the follow-up period;Postoperative,the average score of MSTS was 90%(85%~92%).Tumor recurrence were found in two cases of six cases of malignant tumor of scapula after partial resection,recurrence rate of 33%,the second phase,1 case was treated with partial resection of scapula,and the other was treated with total scapula resection and humeral head suspension;The average score of MSTS was 85%(75%~92%).There were no complications such as tumor recurrence and infection during the follow-up of 3 patients with total resection of the scapula and humerus,the average score of MSTS was 63%(56%~68%).According to the JOA scoring system,score from pain,function,exercise,X-ray and joint stability:5 cases of after partial resection of scapula,the score ranged from 76 to 82 with an average of 81 points;3 cases were treated with total resection of scapula and humeral head suspension,the score was from 55 to 65,with an average of 60 points;5 patients with malignant tumor of scapula(S12)were treated with total resection of scapula and replacement of artificial total scapula and shoulder joint prosthesis,the score was from 82 to 87,with an average of 85 points;The patient satisfaction rate of 100%.Conclusion:Objective to compare the clinical efficacy of the surgical treatment of malignant tumor of scapula,and review of the relevant literature of the reconstruction function after operation:After resection of malignant tumor of scapula,according to the degree of resection and the sex,age,occupation,the function of the shoulder joint and the limitation of the activity of the patients,the way of reconstruction was chosen.Reconstruction of shoulder joint function after total scapula resection,only with sufficient muscle coverage,compared with other surgical methods,the functional reconstruction of total shoulder arthroplasty is better.In particular,according to the 3D printing model design prosthesis and the application of the concept of rehabilitation exercise,for patients with postoperative better function.This method improves the prosthesis design,make it more adapt to the human body,after a large range of activities and stability is also greatly enhanced;the operation can effectively reduce tumor recurrence and limb preservation and reconstruction of shoulder joint function,postoperative recovery fast,painless,high patient satisfaction.Artificial shoulder prosthesis for patients with malignant tumor of scapula,it is an effective clinical programme,the surgery is worth spread learning.