BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with reg...BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.展开更多
cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University ar...cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.展开更多
The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral he...The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.展开更多
目的总结打压、支撑植骨术治疗股骨头坏死的中期疗效,比较采用自体腓骨和同种异体皮质管状骨(下称异体腓骨)行支撑植骨的疗效。方法2004年8月-12月,采用打压、支撑植骨术治疗股骨头坏死40例,分为自体腓骨组和异体腓骨组。自体腓骨组20例...目的总结打压、支撑植骨术治疗股骨头坏死的中期疗效,比较采用自体腓骨和同种异体皮质管状骨(下称异体腓骨)行支撑植骨的疗效。方法2004年8月-12月,采用打压、支撑植骨术治疗股骨头坏死40例,分为自体腓骨组和异体腓骨组。自体腓骨组20例(27髋),其中男17例(23髋),女3例(4髋);年龄22～53岁,平均41岁;国际骨循环研究学会(Association Research Circulation Osseous,ARCO)分期Ⅱ期22髋,Ⅲ期5髋。异体腓骨组20例(31髋),其中男17例(25髋),女3例(6髋);年龄18～55岁,平均40岁;ARCO分期Ⅱ期23髋,Ⅲ期8髋。两组一般资料比较差异均无统计学意义(P>0.05)。采用Harris评分评估临床疗效,X线片评估影像学疗效。需再行保髋手术或转行全髋关节置换作为观察终点。结果40例患者均获随访,随访时间36～40个月,平均37.5个月。自体腓骨组与异体腓骨组股骨头保存率分别为92.6%、90.3%。末次随访Harris评分自体腓骨组由术前(70.82±8.26)分提高至(86.36±6.27)分,异体腓骨组由术前(69.94±9.59)分提高至(87.45±7.03)分,两组治疗前后比较差异均有统计学意义(P<0.05),术后两组间比较差异无统计学意义(P>0.05)。影像学评估显示,自体腓骨组和异体腓骨组术后塌陷纠正或未加重分别为17髋(63.0%)和21髋(67.8%),获得良好修复分别为20髋(74.1%)和22髋(71.0%),两组比较差异无统计学意义(P>0.05)。自体腓骨组术后并发症发生于术后负重行走后,而异体腓骨组出现于术后伤口愈合期。结论对于股骨头坏死患者,在经股骨颈植腓骨基础上采用改良的微创打压、皮质支撑植骨技术可取得较好中期疗效。异体腓骨与自体腓骨作为支撑材料,疗效相似。展开更多
基金Supported by National Natural Science Foundation of China,No.81301671
文摘BACKGROUND In children with osteosarcoma around the knee joint without epiphysis involvement,joint-sparing surgery seems to be an ideal way to retain knee joint function.However,there are two points of debate with regard to the technique:How to accurately achieve a safe surgical margin,and how to achieve intercalary reconstruction of the massive bone defect following resection of the tumor.CASE SUMMARY We present the case of an 8-year-old girl with osteosarcoma of the distal femur without involvement of the epiphysis.Epiphyseal distraction was applied to separate the epiphysis and metaphysis,and this provided a safe surgical margin.The massive bone defect was reconstructed with a custom-made antibioticloaded polymethyl methacrylate(PMMA)construct combined with a free nonvascularized fibular graft.Six months after surgery,bone union between the autograft and host bone was confirmed in both the proximal and distal femur by computer tomography(CT)examination.Moreover,considerable callus formation was found around the PMMA construct.After 28 mo of follow-up,there was no sign of recurrence or metastasis.The patient could walk without any aid and carry out her daily life activities satisfactorily.CONCLUSION In cases of osteosarcoma without epiphysis involvement,epiphyseal distraction can be easily applied to obtain a safe margin.Hybrid reconstruction with an antibiotic-loaded PMMA construct combined with a free non-vascularized fibular graft has the advantages of being easy to manufacture,less time-consuming to place,and less likely to get infected,while also ensuring bone union.Our case provides an alternative technique for biological reconstruction after joint-sparing surgery in patients with osteosarcoma around the knee without epiphyseal involvement.
文摘cases (97 hips) with avascular necrosis of femoral head caused by variors factors treated by the free transferring fibular graft with vascular pedicle in the Second Teaching Hospital of Xi'an Medical University are reported. All patients have ben followed up for 2 to 11 years. Excellent and good rate of operative results was 86. 6%. A long observation indicated that this procedure was superior to the other operations for the osteonecrosis of femoral head. Successful interim and final operative results can warrant its continued use in management of this kind of patients.
文摘The internal fixation failure for treatment of femoral neck fracture is mainly due to improper fixation, loss of fixation stability and premature ambulation. Bone nonunion and avascular osteonecrosis of the femoral head caused by the internal fixation failure for femoral neck fracture are always the complex topics in orthopedics. With regard to patients who sustain these complications, total hip arthroplasty is a proper choice for elderly patients, but is not acceptable by young patients. We report nine patients with the failure of internal fixation for femoral neck fracture who were treated with free vascularized fibular grafting and internal fixation with cannulated screw from November 2001 to October 2003. All of them achieved good results.
文摘目的总结打压、支撑植骨术治疗股骨头坏死的中期疗效,比较采用自体腓骨和同种异体皮质管状骨(下称异体腓骨)行支撑植骨的疗效。方法2004年8月-12月,采用打压、支撑植骨术治疗股骨头坏死40例,分为自体腓骨组和异体腓骨组。自体腓骨组20例(27髋),其中男17例(23髋),女3例(4髋);年龄22～53岁,平均41岁;国际骨循环研究学会(Association Research Circulation Osseous,ARCO)分期Ⅱ期22髋,Ⅲ期5髋。异体腓骨组20例(31髋),其中男17例(25髋),女3例(6髋);年龄18～55岁,平均40岁;ARCO分期Ⅱ期23髋,Ⅲ期8髋。两组一般资料比较差异均无统计学意义(P>0.05)。采用Harris评分评估临床疗效,X线片评估影像学疗效。需再行保髋手术或转行全髋关节置换作为观察终点。结果40例患者均获随访,随访时间36～40个月,平均37.5个月。自体腓骨组与异体腓骨组股骨头保存率分别为92.6%、90.3%。末次随访Harris评分自体腓骨组由术前(70.82±8.26)分提高至(86.36±6.27)分,异体腓骨组由术前(69.94±9.59)分提高至(87.45±7.03)分,两组治疗前后比较差异均有统计学意义(P<0.05),术后两组间比较差异无统计学意义(P>0.05)。影像学评估显示,自体腓骨组和异体腓骨组术后塌陷纠正或未加重分别为17髋(63.0%)和21髋(67.8%),获得良好修复分别为20髋(74.1%)和22髋(71.0%),两组比较差异无统计学意义(P>0.05)。自体腓骨组术后并发症发生于术后负重行走后,而异体腓骨组出现于术后伤口愈合期。结论对于股骨头坏死患者,在经股骨颈植腓骨基础上采用改良的微创打压、皮质支撑植骨技术可取得较好中期疗效。异体腓骨与自体腓骨作为支撑材料,疗效相似。
