Abstract
BackgroundHowever, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength.MethodsThe medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8–82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score.ResultsThe mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15–66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9–48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups (p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups (p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1).ConclusionsAlcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).
Highlights
The application of limb salvage with joint preservation is controversial
The remaining 6 patients who had a primary malignant bone tumor were alive and tumor-free. 5 of the 21 patients with metastatic or hematological malignancies were alive with the tumor, with an average survival period of 25.8 months
Selection of the joint-preserving limb salvage operative procedure should be based on tumor origin, site and bone strength
Summary
The application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. As recent advancement of radiation therapy and chemotherapy, limb salvage procedures have been the main method of surgical treatment for humeral malignancies. Most humeral malignant bone tumors are located on the epiphysis and/or the metaphysis. Wide resection of the tumors often requires sacrifice of the native shoulder joint based on the principle of treatment for malignant bone tumors. The ideal surgical procedure for reconstruction after proximal humeral resection remains controversial. Some humeral malignancies occur in the metaphysis or diaphysis, making it possible to preserve the adjacent joints
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