Modified prosthesis in treatment of scapular malignant tumors

Objective Limb salvage for scapular malignant tumors challenges orthopedics oncologist, not only because of preserving the stability of shoulder but also because of preserving the functional forearm and hand.Methods With the retrospective investigating the scapular malignant tumors of the Affiliated First Hospital,Sun Yat-sen University for the recent ten years,this essay analyzed the surgery treatment.There were 19 patients with malignant tumors of the scapula,including 17 cases of the primary malignant tumors and 2 cases of the secondary malignant tumors.Histologic types included seven cases of chondrosarcoma,three cases of Ewing's sarcoma,two cases of osteosarcoma,two cases of malignant fibrous histiocytoma.Ten cases received margin resection which was the part resection of scapula.Nine cases received wide resection with total scapulectomy.The constrained(rotator cuff-sub- stituting)scapular prosthesis was used to reconstruct following the modified Tikhoff-Linberg procedure (S123B)or total scapular resection(S12B).Results Four of nine replaced with the imitated scapular prosthesis,imitated acromion exposure and pressure ulcer by spine of scapular between five to nine months postoperatively.The revising scapular prosthesis solved the problem by cutting the imitated acromion process and spine of scapula.The functional score rates of the imitated scapula prosthesis was 56.7%(17/30).The modified scapula prosthesis was designed in smaller size without imitated acromion process and spine of scapula,but imitated coracoid process and acromion process were made into one process and were moved to medial,which could be hanged over the stump of the clavicle. Five patients replaced with modified scapula prosthesis,there no prosthetic related complication.The function score of post-operation recovered for 70%(21/30)with the improved scapula prosthesis.With followingup for 61to 182 months,the rate of recurrence after margin resection was thirty percent(3/10); the rate of recurrence after wide resection was eleven percent(1/9).Conclusions The major goals after such resections are to restore shoulder girdle stability and upper extremity function,restore the normal muscle force couples of scapulothoracic and glenohumeral mechanisms,preserve a functional hand and elbow.Replaced with the modified scapular prosthesis the patients have less complication and better function.The functional advantage can be achieved beyond a flail extremity or spacer.