Abstract：
BACKGROUND: Giant cell tumors (GCT) of the proximal humerus are rarely reported case that requires complex surgeries due to involvement of the shoulder joint. Therefore, we report the first retrospective comparative study where the postoperative functional outcomes, recurrence rate and complications in patients who underwent arthrodesis of shoulder after resection of grade III GCT with and without neoadjuvant denosumab are compared.
METHODS: A retrospective review of eight cases of grade III GCT of proximal humerus receiving resection and fibular strut graft and arthrodesis between January 2014 and December 2019 is performed. They were stratified into two groups: one group of four patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of four patients did not receive denosumab before surgery. Primary outcomes included the functional outcomes assessed by revised Musculoskeletal tumor society (MSTS) score and shoulder pain and disability index (SPDI) at 6-weeks and 12-months postoperatively while secondary outcomes included complications and recurrences.
RESULTS: There was no significant difference in terms of SPDI at 6 weeks and 12 months, MSTS at 12 months, complications, recurrence among denosumab and non-denosumab groups. At 6-weeks follow-up, a significantly better pain score in SPDI and MSTS was acquired in the denosumab group.
CONCLUSIONS: Resection and reconstruction with or without neoadjuvant denosumab for Grade III GCT of proximal humerus had similar functional outcomes and with no major differences in recurrence and complications. Hence, postoperative pain relief while long-term benefits were not discovered with the use of neoadjuvant denosumab.
METHODS: A retrospective review of eight cases of grade III GCT of proximal humerus receiving resection and fibular strut graft and arthrodesis between January 2014 and December 2019 is performed. They were stratified into two groups: one group of four patients received once-weekly denosumab 120 mg for 4-weeks before resection and reconstruction, while the other group of four patients did not receive denosumab before surgery. Primary outcomes included the functional outcomes assessed by revised Musculoskeletal tumor society (MSTS) score and shoulder pain and disability index (SPDI) at 6-weeks and 12-months postoperatively while secondary outcomes included complications and recurrences.
RESULTS: There was no significant difference in terms of SPDI at 6 weeks and 12 months, MSTS at 12 months, complications, recurrence among denosumab and non-denosumab groups. At 6-weeks follow-up, a significantly better pain score in SPDI and MSTS was acquired in the denosumab group.
CONCLUSIONS: Resection and reconstruction with or without neoadjuvant denosumab for Grade III GCT of proximal humerus had similar functional outcomes and with no major differences in recurrence and complications. Hence, postoperative pain relief while long-term benefits were not discovered with the use of neoadjuvant denosumab.
摘要：
背景：肱骨近端巨细胞瘤（GCT）很少报道，由于肩关节受累而需要复杂手术的病例。因此,我们报告了第一项回顾性比较研究，其中术后功能结局，比较了有和没有新辅助denosumab的III级GCT切除术后接受肩关节固定术的患者的复发率和并发症。
方法：回顾性分析2014年1月至2019年12月间接受肱骨近端III级GCT切除和腓骨支柱移植并进行关节固定术的8例患者。他们被分为两组：一组四名患者在切除和重建前每周接受一次denosumab120mg，持续4周，而另一组4例患者在手术前没有接受denosumab。主要结果包括术后6周和12个月通过修订的肌肉骨骼肿瘤协会（MSTS）评分和肩痛和残疾指数（SPDI）评估的功能结果，而次要结果包括并发症和复发。
结果：在6周和12个月时，SPDI没有显着差异，12个月的MSTS，并发症,denosumab和非denosumab组的复发。在6周的随访中，在denosumab组,SPDI和MSTS的疼痛评分明显更好.
结论：使用或不使用新辅助denosumab治疗肱骨近端GCT的切除和重建具有相似的功能结果，并且在复发和并发症方面没有重大差异。因此，术后疼痛缓解，而新辅助使用denosumab没有发现长期益处。
方法：回顾性分析2014年1月至2019年12月间接受肱骨近端III级GCT切除和腓骨支柱移植并进行关节固定术的8例患者。他们被分为两组：一组四名患者在切除和重建前每周接受一次denosumab120mg，持续4周，而另一组4例患者在手术前没有接受denosumab。主要结果包括术后6周和12个月通过修订的肌肉骨骼肿瘤协会（MSTS）评分和肩痛和残疾指数（SPDI）评估的功能结果，而次要结果包括并发症和复发。
结果：在6周和12个月时，SPDI没有显着差异，12个月的MSTS，并发症,denosumab和非denosumab组的复发。在6周的随访中，在denosumab组,SPDI和MSTS的疼痛评分明显更好.
结论：使用或不使用新辅助denosumab治疗肱骨近端GCT的切除和重建具有相似的功能结果，并且在复发和并发症方面没有重大差异。因此，术后疼痛缓解，而新辅助使用denosumab没有发现长期益处。
