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Factors that influence functional outcome after total or subtotal scapulectomy: Japanese Musculoskeletal Oncology Group (JMOG) study.

Hayashi K, Iwata S, Ogose A, Kawai A, Ueda T, Otsuka T, Tsuchiya H - PLoS ONE (2014)

Bottom Line: Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation.The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01).Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan.

ABSTRACT

Background: Scapulectomy requires not only joint resection but also wide resection of the shoulder girdle muscles. Even the significance of reconstruction has not yet been determined because of the difficulties in comparing the different conditions. The purpose of this study was to investigate factors that influence functional outcomes after scapulectomy in a multicenter study.

Methods: This retrospective study comprised 48 patients who underwent total or subtotal scapulectomy and were followed for at least one year after surgery. Patients were registered at the Japanese Musculoskeletal Oncology Group affiliated hospitals. Soft tissue reconstruction for joint stabilization was performed when there was enough remaining tissue for reconstruction of the rotator cuff and tendons. In 23 cases, humeral suspension was performed. The average follow-up period was 61.9 months. Multivariate analysis was performed using the patient's background to determine which factors influence the Enneking functional score or active range of motion.

Results: The average functional score was 21.1 out of 30. Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation. The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01). Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05).

Conclusion: Although shoulder function was almost eliminated following total or subtotal scapulectomy, minimal resection of bone, and soft tissue reconstruction should lead to better function.

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Related in: MedlinePlus

New classification of scapulectomy.Five categories are created in terms of resection area. Preserving glenoid or acromion lead to better function compared to total scapulectomy. Preoperative planning with this classification will contribute to expected postoperative function.
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pone-0100119-g001: New classification of scapulectomy.Five categories are created in terms of resection area. Preserving glenoid or acromion lead to better function compared to total scapulectomy. Preoperative planning with this classification will contribute to expected postoperative function.

Mentions: Multivariate analysis was performed on seventeen factors of the patient’s background to determine which influence Enneking’s functional score or active range of motion for all cases and total scapulectomy cases, respectively. The amount of remaining bone influenced the Enneking functional score, which means that preserving the glenoid or the acromion leads to better function compared to total scapulectomy (Figure 1). However, soft tissue reconstruction did not improve the total Enneking functional outcome score (table 2, table S2 in tables S1). Factors that influenced the functional data included the amount of remaining bone, soft tissue reconstruction, length of resected humerus and nerve resection (p<0.05), listed in table 3, table S3 in tables S1. As for total scapulectomy cases, soft tissue reconstruction did not lead to better total functional score but did improve dexterity of the affected hand (Figure 2). This supports doing soft tissue reconstruction after scapulectomy, which previously had been uncertain to improve functional outcome. Functional outcome would be better overtime. Watanabe et al. reported functional score improved within 2 years after extremity tumor surgery and maintained after that [12]. Our cases are average 5 years follow-up and the functional score should be stabilized in most of the cases.


Factors that influence functional outcome after total or subtotal scapulectomy: Japanese Musculoskeletal Oncology Group (JMOG) study.

Hayashi K, Iwata S, Ogose A, Kawai A, Ueda T, Otsuka T, Tsuchiya H - PLoS ONE (2014)

New classification of scapulectomy.Five categories are created in terms of resection area. Preserving glenoid or acromion lead to better function compared to total scapulectomy. Preoperative planning with this classification will contribute to expected postoperative function.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061101&req=5

pone-0100119-g001: New classification of scapulectomy.Five categories are created in terms of resection area. Preserving glenoid or acromion lead to better function compared to total scapulectomy. Preoperative planning with this classification will contribute to expected postoperative function.
Mentions: Multivariate analysis was performed on seventeen factors of the patient’s background to determine which influence Enneking’s functional score or active range of motion for all cases and total scapulectomy cases, respectively. The amount of remaining bone influenced the Enneking functional score, which means that preserving the glenoid or the acromion leads to better function compared to total scapulectomy (Figure 1). However, soft tissue reconstruction did not improve the total Enneking functional outcome score (table 2, table S2 in tables S1). Factors that influenced the functional data included the amount of remaining bone, soft tissue reconstruction, length of resected humerus and nerve resection (p<0.05), listed in table 3, table S3 in tables S1. As for total scapulectomy cases, soft tissue reconstruction did not lead to better total functional score but did improve dexterity of the affected hand (Figure 2). This supports doing soft tissue reconstruction after scapulectomy, which previously had been uncertain to improve functional outcome. Functional outcome would be better overtime. Watanabe et al. reported functional score improved within 2 years after extremity tumor surgery and maintained after that [12]. Our cases are average 5 years follow-up and the functional score should be stabilized in most of the cases.

Bottom Line: Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation.The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01).Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan; Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan.

ABSTRACT

Background: Scapulectomy requires not only joint resection but also wide resection of the shoulder girdle muscles. Even the significance of reconstruction has not yet been determined because of the difficulties in comparing the different conditions. The purpose of this study was to investigate factors that influence functional outcomes after scapulectomy in a multicenter study.

Methods: This retrospective study comprised 48 patients who underwent total or subtotal scapulectomy and were followed for at least one year after surgery. Patients were registered at the Japanese Musculoskeletal Oncology Group affiliated hospitals. Soft tissue reconstruction for joint stabilization was performed when there was enough remaining tissue for reconstruction of the rotator cuff and tendons. In 23 cases, humeral suspension was performed. The average follow-up period was 61.9 months. Multivariate analysis was performed using the patient's background to determine which factors influence the Enneking functional score or active range of motion.

Results: The average functional score was 21.1 out of 30. Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation. The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01). Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05).

Conclusion: Although shoulder function was almost eliminated following total or subtotal scapulectomy, minimal resection of bone, and soft tissue reconstruction should lead to better function.

Show MeSH
Related in: MedlinePlus