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学科主题临床医学
Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus
Tang, Xiaodong; Guo, Wei; Yang, Rongli; Tang, Shun; Ji, Tao
刊名CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
2015-04-01
DOI10.1007/s11999-015-4139-7
473期:4页:1464-1471
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Orthopedics ; Surgery
研究领域[WOS]Orthopedics ; Surgery
关键词[WOS]ENDOPROSTHETIC RECONSTRUCTION ; TUMOR RESECTION ; LIMB SALVAGE ; BONE-TUMORS
英文摘要

Shoulder function often is limited after tumor resection and endoprosthetic replacement of the proximal humerus. This is partly attributable to the inability to reliably reattach rotator cuff tendons to the prosthesis and achieve adequate shoulder capsule repair with a metallic prosthesis. An option to attain these goals is to use synthetic mesh for the reconstruction, although the value of this method has not been well documented in the literature.

We asked whether patients who had shoulder reconstruction using synthetic mesh had (1) better shoulder function; (2) improved ROM compared with shoulder reconstructions without mesh; and (3) more stable joints compared with those in patients with similar resections who had reconstructions without synthetic mesh.

During a 5-year period, we performed 41 intraarticular resections with endoprosthetic reconstructions for malignancies in the proximal humerus meeting specified criteria to generate similarity in the study groups. Twelve patients (29%) were lost to followup before 24 months, leaving 29 patients available for review at a mean of 45 months (range, 24-70 months). This retrospective study compared 14 patients with soft tissue reconstruction that included synthetic mesh with 15 patients with soft tissue reconstruction without the use of synthetic mesh. The choice was made during consultation between the patient and surgeon, after reviewing the perceived advantages and disadvantages of each approach. A tumor band (ligament advanced reinforcement system) was used as synthetic mesh and wrapped around the prosthesis of the proximal humerus for soft tissue reconstruction in the reconstruction-with-mesh group. Study endpoints included the Musculoskeletal Tumor Society (MSTS) function scores, American Shoulder and Elbow Surgeons (ASES) score, shoulder ROM, and proximal migration of the humeral prosthesis.

The mean MSTS score for patients without synthetic mesh reconstruction was 20 +/- A 3 points (66%), whereas for patients with synthetic mesh reconstruction, the mean score was 24 +/- A 2 points (79%; p = 0.001). Patients with synthetic mesh reconstruction had a higher mean total ASES score (85 +/- A 1.1 points versus 72 +/- 1.7 points; p = 0.025), and better function for activities of daily living. They also had better ROM on mean active forward flexion (p = 0.020), abduction (p < 0.001), and external rotation (p < 0.001) than patients without synthetic mesh reconstruction. Proximal migration of the prosthesis was observed in five of 15 of patients in the group without synthetic mesh reconstruction and in none of those treated with synthetic mesh (p = 0.042).

Patients with intraarticular resection and endoprosthetic replacement of the proximal humerus with reconstruction that included synthetic mesh had better shoulder function and ROM, and more stable joints than patients who had reconstruction without synthetic mesh. This result supports prior observations by others and it remains to be shown whether use of the ligament advanced reconstruction system is superior to other types of mesh or other types of reconstructions. Further investigation is needed but our results indicate that using mesh should be considered for patients with tumor resection and endoprosthetic replacement of the proximal humerus.

Level III, therapeutic study.

语种英语
WOS记录号WOS:000350885600043
引用统计
被引频次:5[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/57428
专题北京大学第二临床医学院_骨肿瘤科
北京大学药学院_天然药物与仿生药物国家重点实验室
作者单位Peking Univ, Peoples Hosp, Musculoskeletal Tumor Ctr, Beijing 100044, Peoples R China
推荐引用方式
GB/T 7714
Tang, Xiaodong,Guo, Wei,Yang, Rongli,et al. Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus[J]. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH,2015,473(4):1464-1471.
APA Tang, Xiaodong,Guo, Wei,Yang, Rongli,Tang, Shun,&Ji, Tao.(2015).Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus.CLINICAL ORTHOPAEDICS AND RELATED RESEARCH,473(4),1464-1471.
MLA Tang, Xiaodong,et al."Synthetic Mesh Improves Shoulder Function After Intraarticular Resection and Prosthetic Replacement of Proximal Humerus".CLINICAL ORTHOPAEDICS AND RELATED RESEARCH 473.4(2015):1464-1471.
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