1、12021/2/21 22021/2/21Ways of reconstructions Bone cement Iliac bone Osteoarticular allograft arthrodesis Clavicula pro humeral reconstruction Arthrodesis Free vascularised fibula graft Prosthetic arthroplasty32021/2/21ClassificationHemiarthroplasty(humeral head replacements)Total shoulder arthroplas
2、ty(TSA glenohumeral replacements)42021/2/21HemiarthroplastyTSAUnconstrainedHemi-constrainedConstrainedBall-cotylaInverted type52021/2/2162021/2/21Categories of bone neoplasm Giant cell tumors(GCT)chondroblastoma Chondrosarcoma Osteosarcoma Ewings sarcoma Fibrosarcoma Metastatic tumor .72021/2/21Enne
3、king stages benign tumor 1 indolent 2 active 3 aggressive malignant tumor stage grade location metastatic IA low in not IB low out not IIA high in not IIB high out not III any any yes82021/2/21Malawer classification of shoulder girdle resections92021/2/21Type resection Intra-articular proximal humer
4、al resection TypeA:abductors retained TypeB:abductors resected102021/2/21Magnetic resonance imaging(MRI)Margin of resectionA margin of 3 to 4cm distal to the MRI extent of the tumor is sufficient and allows a type A resection112021/2/21Margin of resectionConfined to boneIntramedullary122021/2/21Marg
5、in of resection Extraosseous extension that involves the deltoid,a typeB resection will be required132021/2/21Prosthesis ImplantationHemiarthroplastyTSAB142021/2/21ComparisonHemiarthroplastyTSASimlper procedureAvoid looseningand instabilityPain reliefActivityActive range of motion152021/2/21162021/2
6、/21Despite the increased technical difficulty,longer operating time,and potential complications associated with the glenoid component,TSA appears to be our choiceChoice172021/2/21Rotator cuff182021/2/21Rotator cuff支点支点192021/2/21202021/2/21Soft tissue reconstructiontype A resectionDeltoid（Supraspina
7、tus）Rotator cuff212021/2/2115%222021/2/21Dacron tape232021/2/21Enhance tendon anchor(ETA)242021/2/21Soft tissue reconstructiontype B resectionObtain stability Mobilization(Dacron tape)elbowhand252021/2/21RehabilitationPassive motion exerciseActive exercisesActive resistive strengthening exercises262021/2/21ComplicationsRotator cuff tearingPostoperative glenohumeral instabilityPeriprosthetic humeral fracture272021/2/21Thanks282021/2/21谢谢！292021/2/21
