[The tikhoff-linberg procedure.].
The Tikhoff-Linberg procedure represents one of the possibilities for treatment of extensive bone and soft tissue tumors in the shoulder region, and is a limb saving alternative to interscapulothoracic amputation. This procedure includes a resection of the proximal part of the humerus, a total scapulectomy, and a total or partial excision of the clavicula. The authors operated by this method in a time period of 26 years on eight patients. The diagnoses of operated bone tumors were three osteosarcomas, three chondrosarcomas, one fibrosarcoma and one clinically solitary metastasis. The tumor was located four times in the scapula, three times in the upper part of humerus, in one patient simultaneously occured malignisation of enchondromatosis in the humerus and scapula. In two patients with longer resection of the proximal humerus a replacement was performed, once by means of a Küntscher nail, once by humeral endoprosthesis. Three patients are long term survivals, five died of generalisation of the tumorous disease. Only in one patient local recurrence occured of osteosarcoma, in all other patients the requierments of oncological radicality were fullfilled. Unsatisfactory resuluts of long term survival may be explained by the large extent of tumors and by the long time elapsed before the right diagnosis was established. Among complications registered in three cases the wound healed per secundam, one patient suffered an axillary and subclavia vein thrombosis, the endoprosthesis had to be removed because of late infection. In two patients it was necessary to sacrifice the musculocutaneus nerve, in one of them in addition the radialis nerve. The procedure results in substantial functional impairment of the shoulder and arm, but the function of the elbow, forearm and hand remains preserved. The surviving patients are well adapted to their condition and are able to perform even medially heavy work with the operated extremity. Key words: Tikhoff-Linberg procedure, malignant bone tumors, shoulder, limb saving surgery.
Kofránek
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Ortopedická klinika IPVZ, FN Na Bulovce, Praha.
Matejovský
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