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頁籤選單縮合
題 名 | Management of Aggressive Benign and Malignant Bone Tumors of the Shoulder Region=多層面肩胛帶具侵犯的良性及惡性骨腫瘤的處理 |
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作 者 | 許文蔚; 施信農; 徐郭堯; | 書刊名 | 長庚醫學 |
卷 期 | 22:1 1999.03[民88.03] |
頁 次 | 頁52-60 |
分類號 | 416.66 |
關鍵詞 | 骨腫瘤; 肩胛環帶; 重建術; 外展肌; Bone tumor; Shoulder girdle; Reconstruction; Abductor; |
語 文 | 英文(English) |
中文摘要 | 背景:肩胛帶是良性侵犯及惡性腫瘤好發的部分之一,切除病灶及保存肢體是可 行之治療。然而,重建手術對骨科醫生是一項挑戰,而結果功能各不相同。 方法:我們經歷14這樣的病例,有8位男性,6位女性,年齡從15至70歲,平均36歲,最短追 跡 2 年或至病人過世。有 13 例是腔室外,有 1 位是腔室內病灶,有 4 例巨大細胞瘤,4 例骨肉瘤,3 例軟骨肉瘤及 4 例的其他腫瘤。 全剖巨大細胞瘤是第三期,而惡性瘤則有第 二期 --A 至第三期不等。為了要分類腫瘤位置,肩胛帶被分為三個解剖區。 治療方式包括 5 例徹底切除,4 例肩胛骨切除術, 3 例截肢術,1 例清除及 1 例清除加植骨術,9 例病 人有補助的化學治療或放射治療。 結果:追�j時,6例病人有滿意的功能,而8例病人僅有平常及不良的功能,4例病人死於病 灶轉移,而 10 位病人仍然存活。 結論:治療的選擇,是依腫瘤的期別,切除的範圍,病人之各別需要,醫生的經驗及醫院的 器材供給而決定。至於肩胛旋轉肌群的保存與重建,恐怕是肩關節功能最重要之因素。局部 輔助療法,的確可降低局部再發,但仍不影響其功能。 |
英文摘要 | Background: The shoulder girdle is one of the most common sites of aggressive malignant and benign bone tumors. Curative resections and sparing of the limb are possible. However, reconstruction mehtods remain a challenge and the functional results vary. Methods: Fourteen patients with aggressive benign or malignant bone tumors about the shoulder girdle who were treated with surgical resection with possible need for reconstructions were retrospectively analyzed. There were 8 men and 6 women. Their ages ranged from 15 to 70 years; the mean age at operation was 36 years. Ten patients had malignant bone tumors and four had extensive giant-cell tumors. A variety of reconstructive procedures were performed after resection of the tumors. The choice of procedure depended on the type of resection and the needs of the patients. Supplementary chemotherapy or radiotherapy was undertaken after surgical procedures in 9 patients. Results: The length of follow up ranged from 16 months to 10 years. The functional results were described and graded quantitatively according to the functional rating system of the Musculoskeletal Tumor Society. Overall, 6 patients achieved excellent and good shoulder functions at follow-up examination, while 8 acquired fair or poor functional results. Four patients died from lung metastasis, while 10 survived and are disease free. Resection of the glenoid cavity and the proximal part of the humerus with loss of the abductor mechanism resulted in poor function of the shoulder. Conclusion: The choice of treatment options depended upon the staging of tumors, the extent of resection, the needs of individual patients, the preservation and reconstruction of rotator cuff, the experience of surgeons, and the facilities at the hospital. The functional results were related to the area of involvement and the type of resection. The preservation of the abductor mechanism provided good functional results. |
本系統中英文摘要資訊取自各篇刊載內容。