Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.

Autor: Capanna R; Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Totti F; Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy., Van der Geest IC; Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands., Müller DA; Department of Orthopedic Surgery, University Hospital Balgrist, Zurich, Switzerland. Electronic address: daniel.mueller@balgrist.ch.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2015 Aug; Vol. 24 (8), pp. e203-11. Date of Electronic Publication: 2015 Apr 01.
DOI: 10.1016/j.jse.2015.02.006
Abstrakt: Hypothesis: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate.
Methods: The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft.
Results: The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred.
Conclusion: Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint.
(Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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