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目的 (1)描述钢板-假体复合体(plate-prosthesis composite,PPC)的设计、重建过程及效果;(2)描述长节段受累肱骨上段肿瘤切除后的假体重建效果;(3)将PPC的重建效果与传统肱骨上段假体(proximal humeral prosthesis,PHP)进行比较.方法 选自2007年8月至2017年2月于我中心手术治疗的17例长节段受累肱骨上段肿瘤患者[男9例,平均年龄(23.9±17.1)岁]进行回顾性研究.所有患者均行经肩关节的肱骨上段肿瘤瘤段截除术,平均截骨长度为(19.8±3.4)cm,占肱骨全长比例平均为(71.5±6.3)％.笔者按重建方式将患者分为PPC组(8例)和PHP组(9例).PPC组重建方式为:假体近段与常规组配式肿瘤型肱骨上段假体相同,假体柄根据剩余肱骨的长度及髓腔直径预订制为较为粗短的外形;在假体体部中远段预置3个横行钉孔,其孔距与所选用肱骨远端外侧解剖型钢板的钉孔孔距一致,其方向被设计为可在保证肱骨头角度良好的同时使钢板与肱骨下端外侧骨面贴合;重建过程中先以骨水泥法固定假体柄于剩余肱骨髓腔中,后以螺钉将适宜长度的肱骨远端外侧解剖型钢板固定于假体表面及肱骨表面.术后患肢功能应用MSTS 93上肢功能评分评估,将影像学有机械性假体相关并发症表现定义为影像学机械性假体相关并发症发生,将假体生存期定义为自手术至发生影像学机械性假体相关并发症发生的时间.结果 术后平均随访时间为(34.8±28.3)个月.5例(29.4％)发生影像学机械性假体相关并发症,均未行二次手术,平均术后假体生存期为(79.0±15.4)个月.PPC组8例平均手术时间(3.2±1.4)h,平均术中出血量(275.0±146.4)ml.患者术后MSTS 93上肢功能评分平均为22.5±2.4(75.0±8.2)％,无患者发生影像学机械性假体相关并发症.与PHP组患者比较,功能评分、手术时间、术中出血量差异无统计学意义,但在影像学机械性假体相关并发症发生率及相应的假体生存期的比较中,PPC组显著优于PHP组(0:55.6％,P=0.020,77.0:51.5±18.7,P=0.029).结论 长节段受累肱骨上段肿瘤切除后应用假体重建可恢复一定的上肢功能,但其机械性假体相关并发症发生风险较高.应用PPC假体重建可在达到与PHP重建方式相似的术后功能且不增加手术复杂度与风险的同时保持较低的假体相关并发症发生率,因而可作为长节段受累肱骨上段肿瘤切除后的理想重建方式.“,”Objective ( 1 ) To describe the design, reconstructive procedures and outcomes of plate-prosthesis composite ( PPC ); ( 2 ) To describe outcomes of endoprosthetic reconstruction after large segmental resection of proximal humeral tumors; ( 3 ) To compare functional outcomes, implant survival, surgical time, intra-operative haemorrhage and complication rate of PPC with those of proximal humeral prosthesis ( PHP ). Methods We retrospectively reviewed clinical data of 17 patients [ 9 males, average age ( 23.9 ± 17.1 ) years ] who received large segmental resection of proximal humeral tumors in our center from Aug. 2007 to Feb. 2017. All patients received intraarticular proximal humeral resection without the preservation of abductor mechanism. The mean resection length was ( 19.8 ± 3.4 ) cm, accounting for ( 71.5 ± 6.3 ) ％ of the whole humeral length. All patients were divided into PPC group ( n = 8 ) and PHP group ( n = 9 ) according to the reconstructive options. The proximal component of PPC was designed as the same as PHP, and the stem was custom-made to be a dumpy shape based on the length of residual humerus and diameter of medullary cavity. Three transverse screw holes were pre-drilled on the distal part of the prosthesis. The hole distances were designed as the same as that of pre-selected lateral anatomic plate for distal humerus, and the directions of holes were designed to assure the plate fit the bone surface while the prosthetic humeral head was reduced into the glenoid correctly. During reconstruction, the prosthetic stem was firstly cemented into the residual humerus, then the plate was fixed to the prosthesis and residual humerus by screws. Functional outcomes were assessed using MSTS 93 system for the upper extremity. The mechanical prosthetic complication was defined as the observation of imaging evidence of mechanical complication, and the implant survival was defined as the period between surgery and occurrence of mechanical prosthetic complication. Results The mean follow-up period was ( 34.8 ± 28.3 ) months. Five patients ( 29.4％ ) had mechanical prosthetic complications who were dispensed with re-operation, with a mean implant survival of ( 79.0 ± 15.4 ) months. In PPC group, the mean surgical time and intra-operative haemorrhage of 8 patients were ( 3.2 ± 1.4 ) hours and ( 275.0 ± 146.4 ) ml, respectively. The mean MSTS 93 score was 22.5 ± 2.4 ( 75.0 ± 8.2 ) ％ and no patients suffered from mechanical prosthetic complications. Compared with PHP group, PPC group showed no differences on surgical time, intra-operative haemmorhage and MSTS 93 scores, while PPC group showed significant lower mechanical prosthetic complication rates ( 0 versus 55.6％, P = 0.020 ) and better implant survival ( 77.0 months versus 51.5 ± 18.7 months, P = 0.029 ). Conclusions Endoprosthesis reconstruction after large segmental resection of proximal humeral tumors can provide reasonable functions of the upper extremity with a comparatively high risk of mechanical prosthetic complications. PPC can maintain low mechanical prosthetic complication rate without increasing the complexity and risk of surgery, which can be represented as an ideal reconstructive option after large segmental resection of proximal humeral tumors.