Shoulder bone tumor resection and homograft reconstruction

Bone grafting is to transplant the whole bone tissue or large bone tissue to the defect of the patient's bone, and at the same time, it must be fixed internally to facilitate bone healing and restore limb function. This procedure is suitable for: 1 repairing large bone defects left after invasive benign bone tumor or low-grade solitary bone tumor resection. 2 malignant bone tumors (IA, IIA) rescue the limbs under the aid of chemotherapy. 3 large segmental bone defects left after trauma. 4 bone and joint disease that are not suitable for artificial joint replacement due to age or other reasons. Bone segment transplantation has a large bone mass, and all kinds of allogeneic bones are used, including bone transplantation, long bone end transplantation, bone end partial transplantation and semi-articular replacement. There have been many successful reports at home and abroad. For bone graft or large bone graft surgery, CT scan and MRI examinations must be performed according to the medical examination and X-ray photographs. If the tumor is to be biopsied, to determine the nature of the lesion and the surgical staging, carefully design the surgical plan. Special attention should be paid to the treatment of the cross section of the graft bone and the recipient bone segment, and the transverse, stepped or oblique resection should be selected as needed. Internal fixation equipment should be reasonably selected. Long-axis intramedullary fixation is mostly used for tubular bone. Whether it is upper limb or lower limb bone graft, internal fixation of intramedullary nail should be selected as much as possible. Pressurized steel plate can also be used, but attention should be paid to autologous bone fragment at the bone-binding end. If you need to transplant the joint, you should pay attention to the left and right sides of the bone graft. The ligaments, tendons and muscles should be reattached to the corresponding parts of the bone graft. A small hole is usually drilled in the graft bone and fixed with stainless steel wire. When the proximal humerus is operated, a small bone can be lifted on the tibial tuberosity of the graft bone, and the receptor patellar ligament is inserted under the bone block and fixed to the graft bone through the bone block and ligament with screws. Effective antibiotics should be used to prevent infection before and after bone graft surgery. Observe whether there is hematoma formation or necrosis of the skin edge, and whether the wound has rejection reaction such as exudate. Late complications often occur 2 to 3 months after surgery. Common bone resorption, large amount of fluid exudation from the wound and loose internal fixation should be treated according to the situation. In addition to the strong internal fixation, the transplanted bone segment should also be properly externally fixed, and functional exercise should be carried out step by step. The upper humerus bone tumor was resected and the shoulder joint reconstruction was performed with the same kind of bone segment with articular cartilage. The deltoid, rotator cuff and scapula joints are preserved during surgery. Treatment of diseases: bone tumors Indication Resection of the shoulder bone tumor with the same bone graft reconstruction is applicable to: 1. Invasive benign bone tumor at the upper end of the tibia. 2. Surgical staging of IA, IB and IIA and chemotherapy-sensitive IIB of the upper tibia malignant bone tumor. Contraindications 1. Surgical staging of IIB malignant bone tumors invades the axillary vascular bundle. 2. Invade the tumor of the deltoid muscle and destroy the rotator cuff and the labrum. 3. There are acute and chronic infections in the whole body or in the local area. Preoperative preparation 1. Surgical staging of IIB malignant bone tumors invades the axillary vascular bundle. 2. Invade the tumor of the deltoid muscle and destroy the rotator cuff and the labrum. 3. There are acute and chronic infections in the whole body or in the local area. Surgical procedure Incision The incision is from the 1cm of the anterior and posterior border of the shoulder to the junction of the middle and outer 1/3 of the clavicle, and then along the deltoid intermuscular groove to the deltoid stop, and can extend distally. The deep fascia was dissected and peeled off to the sides to reveal the deltoid, pectoralis major and cephalic veins. 2. Reveal the tumor The deltoid and pectoralis major intervertebral groove is identified by the direction of the cephalic vein. The biopsy should be included in the resection range. Cut off the pectoralis major muscles, pull the diaphragm and biceps shorts inward, cut off the starting point of the deltoid muscle along the lower edge of the clavicle and the lower edge of the shoulder, lift the deltoid muscle to reveal the upper part of the humerus, and cut off the biceps. Long head. 3. Determine the length of the osteotomy According to the results of pathological examination and X-ray film to determine the length of bone resection, usually exceed the lesion range of X-ray on the X-ray film 3 ~ 5cm. The deltoid stop can be cut as needed. Cut off the latissimus dorsi and the great round muscle to protect the phrenic nerve. 4. Resection of the tumor Determine the plane of osteotomy, cut the periosteum in a ring shape, and cut the humeral shaft with a wire saw. Hold the ligament clamp to clamp the proximal segment of the humerus and abduct, cut off the starting point of the triceps, peel off the periosteum and the tumor to the shoulder joint, and cut the switch capsule. Mark the tendons of the rotator cuffs, try to retain their length, and remove the tumor and the upper end of the humerus. Stop bleeding completely. Take the distal segment of the intramedullary tissue for pathological examination to find out whether there are tumor cells. 5. Bone graft The length of the humeral shaft and the diameter of the humeral head were measured. The same type of bone segment of the articular cartilage of the appropriate size was selected, and after repairing and rinsing, the defect was placed at the defect site to maintain a moderate degree of tightness. 6. Fixation and suturing Repair the joint capsule and rotator cuff with horizontal suture stitching without absorbing suture. The 6-hole auto-compression plate or intramedullary nail was used to fix the bone graft, and the graft bone segment was kept at the 45°-60° outer stent. The large round muscle, latissimus dorsi and pectoralis major muscle were sutured at the corresponding site of the bone graft. Muscle starting point. Rinse the wound with isotonic saline and antibiotic solution, close the wound, and drain the flow tube deep into the muscle layer. The outer end of the drainage tube is properly fixed. complication 1. Infection. 2. Internal fixation loose and fracture.