| Objectives:To analyze the clinical efficacy and prognosis of different surgical methods in patients with proximal humerus central low-grade chondrosarcomas.Methods:A retrospective analysis on 25 patients with central low-grade chondrosarcoma of proximal humerus who were diagnosed by clinical manifestation,imaging and pathology and none of the participants had received surgical treatment in the Third Affiliated Hospital of Kunming Medical University during June 2008 to December 2017.Patients were divided into A group of extended curettage and local adjuvant treatment(17 cases)and B group of wide excision and reconstructive surgery operation(8 cases)according to the different treatment methods.Observe the operative time,blood loss,complications,hospital stays,local recurrence rate,pulmonary metastasis,long-term survival rate,and MSTS score for the joint function of groups after surgery.Compare the differences and changes of observation indexes among the two groups with the two independent sample t-test.Statistical differences existed when P<0.05,Log-rank test of Kaplan-Meier to estimates the relationship among surgical methods,local recurrence and survival time for single factors analysis.Results:All the 25 patients were followed up after surgery,including 13 males and 12 females.The mean age patients were 47.80±10.41 years(range,30-77 years),and the mean lesion length was 7.46±1.37 cm(range,5.00-10.40 cm),and the average duration of follow-up was 82.24±27.07 months(range,38-130 months).There are 17 patients in group A with a mean age was 48.291±10.92 years,and the mean lesion length was 7.19±1.32cm,and the average duration of follow-up was 86.35±28.68 months.There are 8 patients in group B with a mean age was 46.75±9.87 years,and the mean lesion length was 8.03±1.38cm,and the average duration of follow-up was 73.50±22.42 months.The operative time was significantly lower(t=-12.01,P<0.001)in group A(120.00 ±14.58 minutes)than in group B(204.38 ±19.90 minutes).The hospital stay was significantly shorter(t=-10.21,P=0.001)in group A(6.65±1.17 days)than in group B(11.63±1.06 days).The average amount of intraoperative blood was significantly less(t=-7.40,P=0.001)in group A(195.88±71.07 mL)than in group B(390.00±27.78 mL).The MSTS score of joint function was significantly better(t=6.66,P=0.001)in group A(28.94±0.90)than in group B(26.25±1.04).There were no significant differences in the size of the lesion.Also,there were no significant differences between intralesional curettage and wide excision(P>0.05).No metastasis disease occurred in either group during the follow-up period.There are two patients local recurrence in group A,the local recurrence rate was 8.0%(2/17),patients with local recurrence were treated with segmental tumor resection and joint replacement.The incidence of complications was significantly lower(P=0.023)in group A(5.9%)than in group B(50%).In group A,One patient(5.9%,1/17)developed deep infection one month after surgery,which was cured by debridement and antibiotic bone cement filling.In group B,4 patients(50%,4/8)developed osteoporosis of the humerus.None of the 25 patients had tumor-free survival,and the Kaplan-Meier survival analysis showed that there were no significant differences between the surgical methods for central low-grade chondrosarcoma of the proximal humerus and the local-recurrence free survival time(P>0.05).Conclusions:Extended intralesional curettage is an effective treatment for central low-grade chondrosarcoma of the proximal humerus.Which the surgery way has the benefit of good MSTS score of joint function,shorter operation time,shorter hospital stay,less intraoperative blood,and lower complications and local recurrence rate.For the patients with central low-grade chondrosarcoma of proximal humerus,we firstly suggest extended curettage to decrease soft tissue damage and the risk of surgery,so as to significantly improve the function of limbs. |
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