肿瘤型假体机械性重建保肢手术治疗股骨远端骨肉瘤:单中心、回顾性早中期疗效分析

目的探讨肿瘤型假体在股骨远端骨肉瘤保肢手术中的临床疗效。方法对42例确诊为股骨远端骨肉瘤患者进行新辅助化疗及瘤段切除肿瘤型假体膝关节重建。结果 42例获15-55月(平均32月)随访。短期并发症发生率为11.9%,按Enneking功能评分系统,优19例,良21例,中等2例。2年无瘤生存32例;5年无瘤生存26例,4例带瘤生存,5年总生存率为71.4%。结论对股骨远端骨肉瘤配合新辅助化疗行肿瘤广泛性切除,应用肿瘤型假体重建膝关节,取得较好的治疗效果。

新辅助化疗结合保肢手术治疗肢体骨肉瘤33例分析

目的探讨新辅助化疗结合肢体保肢手术治疗骨肉瘤的临床疗效。方法对33例四肢骨肉瘤患者进行保肢治疗,其中21例完成术前、后新辅助化疗;10例因各种原因未能完成术后化疗。按Enneking分期,ⅠB期5例,ⅡA期7例,ⅡB期19例。施行人工关节置换术15例,瘤段截除灭活再植术11例,异体骨移植5例。所有病例均做切除标本病理切片的坏死率评估。结果随访时间9～78个月,平均36个月。肢体功能重建评估优9例,良15例,可5例,差2例,优良率72.7%。结论保肢手术结合新辅助化疗是治疗肢体骨肉瘤的比较理想的方法,有效的术前化疗是保肢成功的关键,坚持术后化疗是预防肺转移的有效措施。

介入加放疗保肢治疗肢体骨肉瘤(3例)

目的探索肢体骨肉瘤保肢的人性化治疗方法。方法选择以HD-MTX-CF、DDP、ADM为主要组成药物的化疗方案,超选择肢体骨肉瘤供血血管灌注,2～3周期后,再给与局部放疗。结果所治3例中,24h疼痛减轻,3～7d疼痛消失。肿块3W后逐渐缩小。随访2～4年,3例均存活。2例无瘤生存,肢体功能大部分保留,1例虽肢体功能完整保留,却多发转移,仍在化疗中。结论介入加放疗是肢体骨肉瘤的较好治疗方法。可作为肢体骨肉瘤的首选人性化治疗方法。

3D-MR 重建技术在骨肉瘤治疗中的应用价值

研究目的主要以探讨分析 3D-MR 重建技术在骨肉瘤治疗中的应用价值为主。方法:研究时间为 2019 年 3 月~2021 年 1 月,研究对象的选取主要从我院收治的骨肉瘤患者120例中进行,在遵照伦理学的基础上根据1:1的方式,分为试验组予以3D-MR 重建技术治疗和对照组予以常规手术治疗,两组患者各为60例,在评价指标中,手术时间、术中出血量、术后并发症等应予以高度重视。结果:相比于对照组,试验组的手术时间、术中出血量及切口长度明显更有优势,对比差异明显(P<0.05);试验组切口感染、愈合不良、延迟愈合的例数分别为1例、1例、1例,对照组切口感染、愈合不良、延迟愈合的例数分别为4例、4例、3例,试验组并发症发生率明显低于对照组,相互对比存有差异性(P<0.05)。结论:在骨肉瘤治疗中,3D-MR重建技术的实施效果确切,尤其在控制手术时间、术中出血量、术后并发症方面具有直接作用。

长春新碱对人骨肉瘤细胞的效应及其作用机制研究

骨肉瘤的发病率近年来呈快速增长的趋势,并且日益年轻化,骨肉瘤的恶性程度高,进展快,化疗或放疗效果欠佳,数月内即可出现肺部转移预后较差[1]。寻找行而有效的骨肉瘤治疗方案仍是目前研究的焦点。建立骨肉瘤细胞系是对骨肉瘤生物学特性的深入研究的好办法。长春新碱（vincristine VCR）是一类二聚吲哚类生物碱,在治疗恶性肿瘤方面具有显著的疗效,迄今为止仍是主要的抗肿瘤药物之一[2-4],但其对骨肉瘤的应用研究尚不明确。

第五届国际骨肉瘤保肢治疗新进展高级研讨会

骨肉瘤是危害人类健康,尤其是青少年健康的严重疾病。虽然发病率不高,但死亡率高,社会危害大。如何更好地治疗骨肉瘤一直是骨科医师面临的重大挑战。近些年来,新的治疗方法不断出现,患者的肢体功能及生存率均有明显提高。但不同地区间诊治水平与治疗理念仍有差异。为了进一步规范骨肉瘤的治疗,提高诊疗水平,为国内外学者提供良好的学术交流平台,

第五届国际骨肉瘤保肢治疗新进展高级研讨会

骨肉瘤是危害人类健康,尤其是青少年健康的严重疾病。虽然发病率不高,但死亡率高,社会危害大。如何更好地治疗骨肉瘤一直是骨科医师面临的重大挑战。近些年来,新的治疗方法不断出现,患者的肢体功能及生存率均有明显提高。但不同地区间诊治水平与治疗理念仍有差异。为了进一步规范骨肉瘤的治疗,提高诊疗水平,为国内外学者提供良好的学术交流平台,

天然产物在骨肉瘤体外研究中的现状

骨肉瘤化疗的整体有效率仍大约在60%,主要原因是化疗药毒副作用和肿瘤细胞耐药问题。其他问题包括二线化疗药的缺少、化疗风险评估、化疗新方案等问题也仍待解答。天然产物作为自然界中由活生物产生的具有药理学或生物学活性的化学物质,可被用于药学上的药物研发与药物设计，其优势在于细胞毒性小。

VEGF和PCNA反义寡核苷酸联合治疗裸鼠骨肉瘤的实验研究

目的探讨血管内皮生长因子（VEGF）反义寡核苷酸和增殖细胞核抗原（PCNA）反义寡核苷酸单用或联用对裸鼠骨肉瘤生长的抑制作用。方法制备Balb／c裸鼠皮下骨肉瘤模型24只，随机分为4组：VEGF反义寡核苷酸（ASODN）治疗组、PCNA反义寡核苷酸治疗，组、联合治疗组和对照组，6只／组。接种MG-63人成骨肉瘤细胞后24h内分别用VEGF反义寡核苷酸或（和）PCNA反义寡核苷酸皮下注射进行治疗，对照组只注射生理盐水，2次／周，连续4周；观察各组裸鼠肿瘤的生长情况、裸鼠的一般情况与生存期。断颈处死裸鼠，游标卡尺测量肿瘤体积大小，天平称量肿瘤的重量。结果VEGF-ASODN治疗组、PCNA—ASODN治疗组和联合治疗组裸鼠骨肉瘤的生长均受到不同程度的抑制，抑瘤率分别为44．56％、46．53％和72．71％。结论VEGF和PCNA两种反义寡核苷酸均对骨肉瘤的生长具有抑制作用，两种反义寡核苷酸联合应用比单用的疗效更为显著。

高剂量甲氨蝶呤治疗骨肉瘤致白细胞降低的风险因素分析

研究高剂量甲氨蝶呤治疗骨肉瘤致白细胞降低不良反应的风险因素。方法 回顾性分析本院于2020年1月至2022年3月收治的骨肉瘤化疗患者70例,骨肉瘤化疗患者按照是否发生白细胞降低不良反应进行分组,对照组未发生白细胞降低不良反应,观察组发生白细胞降低不良反应。骨肉瘤化疗患者采用高剂量甲氨蝶呤治疗,其中治疗后存在白细胞降低骨髓抑制不良反应的患者采用对症治疗。结果 观察组骨肉瘤化疗患者肿瘤位置中上肢、胫骨、股骨、其他分别占5例、14例、10例、3例,化疗致白细胞降低不良反应占比分别为15.625%、43.750%、31.250%、9.375%,对比结果差异显著(P<0.05);观察组骨肉瘤化疗患者病理类型中成骨、成软骨、成纤维、其他分别占25例、3例、3例、1例,化疗致白细胞降低不良反应占比分别为78.125%、9.375%、9.375%、3.125%,对比结果差异显著(P<0.05);观察组骨肉瘤化疗患者癌症AJCC分级中ⅡA、ⅡB、Ⅲ级分别占9例、17例、6例,化疗致白细胞降低不良反应占比分别为28.125%、53.125%、18.750%,对比结果差异显著(P<0.05);观察组骨肉瘤化疗患者肿瘤坏死率中:≥90%、<90%、未知分别占8例、20例、4例,化疗致白细胞降低不良反应占比分别为25.000%、62.500%、12.500%,对比结果差异显著(P<0.05);观察组骨肉瘤化疗患者Ki-36免疫组化指标中:≥20%、<20%、未知分别占30例、2例、0例,化疗致白细胞降低不良反应占比分别为93.750%、16.250%、0.000%,对比结果差异不显著(P>0.05)。结论 女性、Ki-36免疫组化指标≥20%、贫血、24h甲氨蝶呤给药浓度≥1.0μmol/L是高剂量甲氨蝶呤治疗骨肉瘤致白细胞降低的风险因素。

骨肉瘤组织CRM1基因表达预后意义的分析

目的:分析CRM1基因在骨肉瘤手术标本中的表达及其预后价值。方法:采用蛋白质印迹法检测57例骨肉瘤手术标本和5例正常软骨组织标本中的CRM1基因表达,并进一步分析其对于骨肉瘤患者的预后价值。结果:CRM1基因在骨肉瘤组织中的表达显著高于在正常组织中的表达;CRM1基因高表达和血清碱性磷酸酶水平升高显著相关(P=0.001),但和血清乳酸脱氢酶水平升高无关(P=0.065)。单因素分析表明,CRM1基因高表达和肿瘤大小以及病理学分级之间显著相关(P值分别为0.014和0.003),而和其他临床病理特点无关。Kap-lan-Meier生存分析表明,CRM1基因高表达对于骨肉瘤患者的无进展生存期和总生存期差异有统计学意义(P值分别为0.016和0.008)。而多因素分析表明,CRM1基因高表达对于骨肉瘤患者是一个独立预后因素(95%CI,1.27～5.39)。结论:CRM1基因高表达与骨肉瘤患者的血清碱性磷酸酶水平升高、肿瘤大小以及病理学分级显著相关;是骨肉瘤的独立预后因素。

骨关节肿瘤型假体的研究与应用现状

1骨肿瘤的治疗现状 从20世纪70年代开始的骨肉瘤综合治疗已成为骨肉瘤治疗的基本原则,5年生存率由原来单纯手术的20%提高到60%-70%。 2骨肿瘤的保肢手术技术 保肢手术治疗模式：新辅助化疗-手术-辅助化疗。肿瘤瘤段切除灭活再植、同种异体骨移植、自体骨带血管移植、旋转成形术、关节融合术、关节置换术。

Inactivated Bone Replantation with Preservation of the Epiphysis in Children with Osteosarcoma:Clinical Report of Two Cases

Objective: To evaluate the value of inactivated bone replantation with preservation of the epiphysis following the effective chemotherapy in avoiding postoperative discrepancy of the affected limb in children with osteosarcoma. Methods: Two children (aged 5 and 10 years, 1 male and 1 female) with osteosarcoma underwent inactivated bone replantation with preserving epiphysis following chemotherapy (MMIA protocol, including high-dose methotrexate, adriamycin and ifosfamide). After two cycles of preop-erative chemotherapy, pain vanished, the local mass shrank and there was no pain on pressing the affected parts. Sera AKP and LDH were reduced to normal levels; marked shrinkage and sclerotic changes and good margin of lesions were seen on plain radiographs and MR images. Two courses of the same protocol as preoperative chemotherapy were administered postoperatively. Results: Postoperative histological examination of the specimens demonstrated absence of vital tumor cells. Incisions healed well and no complications occurred. The replanted inactivated bone healed with host at 6 months after operation. In the two patients, no evidence was seen of metastasis and recurrence and discrepancy of the affected limbs in postoperative 36 and 48 months. Functions of the affected limbs were satisfactory. Conclusion: Inactivated bone replantation with preserving epiphysis was a viable option for osteosarcoma in children. The long-term outcomes remain to be further proven.

Expression of Survivin Gene and Its Relationship with Clinical Multidrug Resistance in Osteosarcoma

Objective: To study the expression of survivin and its relationship with clinical multidrug resistance in osteosarcoma. Methods: By using immunohistochemistry (S-P) method, the expression of Survivin in osteosarcoma, osteochondroma and normal osseous tissue, and the expression of P-glycoprotein in osteosarcoma was detected. Results: Survivin positive expression rate was 65.71% in osteosarcoma, but no expression of Survivin was detectable in osteochondroma and normal osseous tissue. The positive expression rate of Survivin was significantly associated with Enneking clinical stages and histological typing (WHO), but no relationship was found among Survivin expression and age, sex and tumor location. The positive expression rate of P-glycoprotein was 45.71%. There was a significant correlation between Survivin and p-glycoprotein. Conclusion: Survivin overexpression was significantly associated with clinical multidrug resistance in osteosarcoma. It could be a potential target for treatment of osteosarcoma.

我国骨肿瘤循证临床诊疗指南2015最新解读 恶性骨肿瘤化疗等相关新药进展综述(中)

北京大学人民医院骨与软组织肿瘤治疗中心主任郭卫教授率课题组历经十余年,建立了全身各不同部位原发恶性骨肿瘤的规范化切除及功能重建方法,取得了系列成果,为6000余例患者成功保留了肢体功能。他开创性地解决了骨盆肿瘤整块切除及骨盆环重建、儿童保肢、骶骨肿瘤整块切除等世界性难题;在提高肿瘤治愈率的同时,最大限度地保留了患者的术后功能,显著提高了患者的生活质量。

Influence of neoadjuvant chemotherapy on proliferation, apoptosis and multi-drug resistance in osteosarcoma cells

Objective: To study the influence of neoadjuvant chemotherapy on the expression of cyclin D1, Bcl-2, PCNA and P- gp in osteosarcoma cells and the relationship between the expression and tumor cell necrosis rate (TCNR) after chemotherapy. Methods: By using immunohistochemistry, the expression of cyclin D1, Bcl-2, PCNA and P-gp was detected in 23 cases of osteosarcoma and TCNR were calculated. Results: The pre-chemotherapy positive expression rate of cyclin D1, Bcl-2, PCNA and P-gp was 73.9%, 69.6%, 91.3% and 21.7%, respectively, and that post-chemotherapy positive expression rate was 52.1%, 34.8%, 43.5% and 56.5%, respectively. The positive expression rate of Bcl-2 and PCNA after chemotherapy was much lower than that before chemotherapy (P=0.039, 0.034). After chemotherapy, the expression rate of P-gp was higher (P=0.021) and the expression of cyclin D1 had no statistically significant difference (P=0.180) comparing with that before chemotherapy. No correla- tion existed between the expression of cyclin D1, Bcl-2, PCNA, P-gp and TCNR before chemotherapy (P=0.155, 0.371, 1.000 and 0.640). There was a negative correlation between the expression of Bcl-2, PCNA, P-gp and TCNR (P=0.009, 0.012 and 0.015), but no relationship existed between the cyclin D1 and TCNR (P=0.100) after chemotherapy. Conclusion: Chemotherapy could inhibit proliferation and induce apoptosis of osteosarcoma cells. At the same time, due to the overexpression of the P-gp, the drug resistance of the osteosarcoma cells was increased. The detection of cyclin D1, Bcl-2, PCNA and P-gp in osteosarcoma samples before chemotherapy might not be used to predict the curative effect of the chemotherapy.

Neoadjuvant chemotherapy for osteosarcoma of the extremity: Outcome of the Chinese 1st protocol in a single institute

Objective： The aim of this study was to determine stand protocol for patients with extremity osteosarcoma by case following up after neoadjuvant chemotherapy and limb salvage operation. Methods： Between January 2000 and January 2007, 121 patients with extremity osteosarcoma were eligible for this analysis. After being graded according to Enneking classification, all patients were preoperative chemotherapy （methotrexate, cisplatin, doxorubicin, and ifosfamide. Some patients with liB tumors received extra interventional embolism）. And postoperatively, the same protocols were employed, but poor responders （tumor necrosis 〈 95%） received more treatment cycles than good responders and took some new medicine in place of the former one. Most of patients underwent limb salvage operation （99/121）, and the Musculoskeletal Tumor Society Score （MSTS） was used to evaluate the recovery of their limb functions. Results： The followed up last for average 37.3 months （range： 16-101 months）. Most patients （76/121） survived, and the overall survival （OS） was 62.8%. Forty-seven of the 121 patients underwent osteoarticular allografts, among which 12 cases of disunion between the host bone and graft bone, 4 cases of allograft absorption and 3 local recurrences appeared. The mean MSTS score was 22.6 ± 4.13, with an excellent limb function in 17 patients, good in 19 patients, fair in 6 patients and poor in 7 patients. The overall excellent and good function outcome was obtained in 76.6% of the patients. Fifty-two of 121 patients underwent custom-made or modular tumor endoprosthesis replacememt, among which 1 case of aseptic loosening, 1 case of peri-prosthesis infection and 4 local recurrences appeared. The mean MSTS was 24.32 ＋ 3.85, with an excellent limb function in 28 patients, good in 16 patients, fair in 5 patients and poor in 3 patients. The overall excellent and good function outcome was obtained in 84.6% of the patients. Conclusion： Neoadjuvant chemotherapy and limb salvage surgery are effective methods to treat osteosarcoma at present, although some patients still dying from postoperative metastases. Therefore, early diagnosis individualized treatment and exploring for new and effective therapeutic strategy should be the key to an ideal treatment for osteosarcoma.

The experiment study on LMWH inhibiting the expression of Livin and inducing the apoptosis of osteosarcoma cells

Objective: To investigate the inhibitory effects of LMWH suppressing the expression of Livin and inducing the apoptosis of the osteosarcoma cells. Methods: Osteosarcoma cells line MG-63 was cultured in vitro. MTT assay and flow cytometry were used to study the effect of LMWH with different concentration suppressed the prolifetation and induced apop- tosis in osteosarcoma cells line MG-63. The expression of Livin of osteosarcoma cells line MG-63 was analysed by the im- munohistochemistrical method and PT-PCR. Results: Low molecular weight heparin could inhibit the growth of osteosarcoma cell line MG-63. With the LMWH's increasing, the apoptosis rate was increased significantly. Immunohistochemistrical method and PT-PCR showed that the expression of Livin of osteosarcoma cells line MG-63 declined obviously than that before medi- cation. Conclusion: LMWH has very strong anti-tumor effect in vitro. The possible mechanisms of LMWH anti-tumor effect are associate with the effect of suppressing the expression of Livin and inducing cell apoptosis.

REPEATED RECURRENCE OF OSTEOSARCOMA TREATED BY RESECTIONS AND CHEMOTHERAPY

This paper presents 5 patients with repeated recurrence of osteosarcoma (RROS). The primary focus of 3 patients were in the distal portion of femur, and 2 patients were in the proximal Portion of tibia. Three patients, whose chest X ray film were negative, were treated by amputation and chemotherapy. Two patients had isolated metastatic focus l. 5 cm in diameter in lung, were treated by amputation after 1 week of chemotherapy and then treated by lobectomy after 2 weeks of chemotherapy. After operation, the chemotherapy was carried out for 3 courses of treatment. The roentgenogram of chest and affected limb were taken once every two months. There were metastatic focuses found in the lung of 1 patient and in the distal portion of femur of 2 patients. One patient was operated on for 4 times. UP to now, 3 patients have been living for 5 yeara and 2 patients for 6 years after operation.

GAS7 expression and its significance in human osteosarcoma

Objective： To detect the expression of GAS7 in osteosarcoma and discuss its significance. Methods： Immunohistochemistry SABC method was applied to detect GAS7 expression in specimens of 54 osteosarcoma and 15 osteochondroma cases. Results： The positive expression rate of GAS7 was 74.7% （40/54） in the group of osteosarcoma and 0% （0/15） in the group of osteochondroma. There was a significant difference in the comparison of GAS expression in these two groups （P 〈 0.05）. GAS7 was higher expressed in the samples which complicated with relapse or pulmonary metastasis than the control group （P 〈 0.05）. There was no significant association between GAS7 expression and the size of tumor, the gender or the age of the patients （P 〉 0.05）. Conclusion： The hyper-expression ot GAST may play an important role in the initiation and development of human osteosarcoma.