Abstract
BackgroundScapulectomy requires not only joint resection but also wide resection of the shoulder girdle muscles. Even the significance of reconstruction has not yet been determined because of the difficulties in comparing the different conditions. The purpose of this study was to investigate factors that influence functional outcomes after scapulectomy in a multicenter study.MethodsThis retrospective study comprised 48 patients who underwent total or subtotal scapulectomy and were followed for at least one year after surgery. Patients were registered at the Japanese Musculoskeletal Oncology Group affiliated hospitals. Soft tissue reconstruction for joint stabilization was performed when there was enough remaining tissue for reconstruction of the rotator cuff and tendons. In 23 cases, humeral suspension was performed. The average follow-up period was 61.9 months. Multivariate analysis was performed using the patient’s background to determine which factors influence the Enneking functional score or active range of motion.ResultsThe average functional score was 21.1 out of 30. Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation. The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01). Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05).ConclusionAlthough shoulder function was almost eliminated following total or subtotal scapulectomy, minimal resection of bone, and soft tissue reconstruction should lead to better function.
Highlights
The shoulder girdle is one of the common sites for malignant tumors of bone and soft tissues [1]
The amount of remaining bone influenced the Enneking functional score, which means that preserving the glenoid or the acromion leads to better function compared to total scapulectomy (Figure 1)
As for total scapulectomy cases, soft tissue reconstruction did not lead to better total functional score but did improve dexterity of the affected hand (Figure 2)
Summary
The shoulder girdle is one of the common sites for malignant tumors of bone and soft tissues [1]. When the tumor locates in the scapula, total or partial scapulectomy should be performed. There are many procedures, such as humeral suspension, prosthetic replacement, recycled bone grafts, or soft tissue reconstruction. Even though the procedure of scapulectomy has been used for more than 100 years, the optimal reconstruction technique has not yet been determined [2,3]. Humeral suspension is commonly performed, but it is not certain whether it contributes to functional outcomes compared with no reconstruction. We have published seven cases of total scapulectomy in which there was no significant difference in function between the soft tissue reconstruction group and the nonreconstructed group [4]. The purpose of this study was to investigate factors that influence functional outcomes after scapulectomy in a multicenter study
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