It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follo...It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.展开更多
Background： The modular hemipelvic prosthesis has been used in patient of Type I-IV pelvic tumor with good outcomes, but how to keep the stability between the prosthesis and the residual sacrum is a problem. An addit...Background： The modular hemipelvic prosthesis has been used in patient of Type I-IV pelvic tumor with good outcomes, but how to keep the stability between the prosthesis and the residual sacrum is a problem. An additional screw-rod system seems to solve it, but its biomechanical characters are still not well understood, which need experimental evaluation. Methods： Six pelvic specimens were prepared in three conditions （normal intact pelvis, ＂normal＂; the pelvis of left Type I-IV defect and implanted with prosthesis without/with additional screw-rod system, ＂rod-＂ and ＂rod＋＂）. Compressing biomechanical experiments （50-500N） were performed in these three conditions, respectively. Results： The loadings during the experiments are in accordance with the linear elastic control mode. Under the increasing loading, the implanted pelvises displaced asymmetrically, unlike normal intact pelvis. The vertical displacement of ＂rod＋＂ changed significantly, whereas ＂rod-＂ did not. For both implanted pelvis, right side displaced less than left side （P values 〈0.05）. Conclusions： The implanted pelvis showed asymmetric displacement under loading, where healthy side displaced more. The implanted pelvis plus screw-rod system showed less displacement at implanted side but more at contralateral side in comparison with those without screw-rod system.展开更多
BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant op...BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant option for recurrent GCT.However,total patellectomy can lead to disruption of the knee.Therefore,exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling,and was diagnosed as having a GCT in the patella following curettage and autograft.Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture.Based on the combination of histological,radiological,and clinical features,a diagnosis of recurrent GCT in the patella was made(Campanacci grade III).After a multidisciplinary team discussion,three-dimensional(3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism.The patient was followed for 35 mo postoperatively.No evidence of local recurrence,pulmonary metastasis,or osteoarthritis of the right knee was observed.The active flexion arc was 0°-120°,and no extension lag was detected.A favorable patellar tracking and height(Insall-Salvati ratio 0.93)were detected by radiography.CONCLUSION We depict a case of a GCT at the right patella,which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement.The patella normal reconstruction,the precise-fit articular design,and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.展开更多
The advantages of endoscopic retrograde cholangio-pancreatography over open surgery have made it the predominant method of treating patients with choledo-cholithiasis. After sphincterotomy, however, 10%-15% of common ...The advantages of endoscopic retrograde cholangio-pancreatography over open surgery have made it the predominant method of treating patients with choledo-cholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing "irretrievable stones" include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ . To the best of our knowledge the examined endoprosthesis is the oldest endo-prosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ . Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.展开更多
Immediate and late follow-up results of oncomammological application of novel Ukrainian endoprosthesis “Nubiplant”, made of one piece of polyacrylamide gel, for mammary gland malignancies (MGM) radical treatment wit...Immediate and late follow-up results of oncomammological application of novel Ukrainian endoprosthesis “Nubiplant”, made of one piece of polyacrylamide gel, for mammary gland malignancies (MGM) radical treatment with reconstruction were analyzed. This endoprosthesis have proved its unique complex of favorable surgical and oncological properties, such as the shape and size accommodation for mammary gland plasty purposes, absence of shell and textured surface. Of 184 patients, operated on radically for initial stages of MGM, using "Nubiplant" endoprosthesis, postoperative complications have had occur in 18 (9,8%): the wound seroma in 12 (6,5%) and partial necrosis of cutaneous edge of postoperative wound – in 6 (3,8%). The seromas were successfully treated by their punctures and local necrosis - using excision with secondary suture placement. Late follow-up results were obtained in 112 (60,9%) patients: three-year period have had survived 104 (92,6±2,4%), and a five-year one – 84 (75,0±4,0%) of them. A contracture capsule was revealed in 3 (2,6%) patients, and excised with the endoprosthesis change. “Nubiplant” endoprosthesis have advantages over most popular worldwide kinds of such products. It may be used securely and effectively for total or partial reconstruction of mammary gland, including cases with hypoplasia, and is more resistant to trauma, radiation therapy and local complications occurrence, including contracture capsule formation. Its property to absorb the water may be used for purposes of plastic surgery. Prophylaxis of specific immediate surgical complications is trustworthy in MGM patients, using modified endoprosthesis “Nubiplant”, containing insulin, antihistamine and antiseptic medicines.展开更多
目的:评估3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用价值。方法:回顾性分析2015年1月~2018年12月于我中心接受全骶骨切除术的42例患者资料。根据重建方式将患者分为3组:假体重建组(14例)采用3D打印全骶骨假体重建,联合...目的:评估3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用价值。方法:回顾性分析2015年1月~2018年12月于我中心接受全骶骨切除术的42例患者资料。根据重建方式将患者分为3组:假体重建组(14例)采用3D打印全骶骨假体重建,联合重建组(19例)采用包含前方椎体重建的联合重建方案,脊柱骨盆(SPF)重建组(9例)采用单纯SPF重建。比较三组患者的腰-髂稳定性(疼痛及运动功能评分)、内置物生存情况(内置物失败率及生存期)、手术安全性(手术时间、术中出血量及围手术期并发症发生率)。结果:术后平均随访时间为33.6±14.2个月。假体重建组手术平均耗时394.6±128.0min,术中出血量平均为3250.0±1711.4ml,共2例患者发生围手术期并发症。末次随访时,13例患者无需拐杖等辅助行走,12例患者无需使用止痛药。共4例患者发生影像学内置物失败,其中2例需行二次手术,1例因严重疼痛并伴有肿瘤复发接受二次手术,术中因假体与周围骨融合牢固而未取出假体;1例因严重疼痛及运动功能明显受损接受二次手术取出假体。假体重建组平均内置物生存期为49.3(95%CI 40.8~57.9)个月。相较于其他两组患者,假体重建组患者的腰-髂稳定性、内置物生存情况均与联合重建组相近(疼痛评分2.4±0.8 vs 2.3±0.7,P=0.59;运动功能评分2.4±0.6 vs 2.2±0.7,P=0.44;内置物失败率14.3%vs 5.3%,P=0.56;内置物生存期49.3 vs 59.4个月,P=0.28),并显著优于SPF重建组(疼痛评分2.4±0.8 vs 1.7±1.0,P=0.028;运动功能评分2.4±0.6 vs 1.3±0.7,P=0.001;内置物失败率14.3%vs 66.7%,P=0.023;内置物生存期49.3 vs 28.6个月,P=0.01),且不显著增加手术时间、术中出血及围手术期并发症发生率。结论:在全骶骨切除患者中应用3D打印全骶骨假体进行重建能够取得理想的腰-髂稳定性以及满意的内置物生存情况,同时不会增加手术风险。展开更多
文摘It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.
文摘Background： The modular hemipelvic prosthesis has been used in patient of Type I-IV pelvic tumor with good outcomes, but how to keep the stability between the prosthesis and the residual sacrum is a problem. An additional screw-rod system seems to solve it, but its biomechanical characters are still not well understood, which need experimental evaluation. Methods： Six pelvic specimens were prepared in three conditions （normal intact pelvis, ＂normal＂; the pelvis of left Type I-IV defect and implanted with prosthesis without/with additional screw-rod system, ＂rod-＂ and ＂rod＋＂）. Compressing biomechanical experiments （50-500N） were performed in these three conditions, respectively. Results： The loadings during the experiments are in accordance with the linear elastic control mode. Under the increasing loading, the implanted pelvises displaced asymmetrically, unlike normal intact pelvis. The vertical displacement of ＂rod＋＂ changed significantly, whereas ＂rod-＂ did not. For both implanted pelvis, right side displaced less than left side （P values 〈0.05）. Conclusions： The implanted pelvis showed asymmetric displacement under loading, where healthy side displaced more. The implanted pelvis plus screw-rod system showed less displacement at implanted side but more at contralateral side in comparison with those without screw-rod system.
基金National Key Research and Development Program of China,No.2016YFC1102003Science and Technology Research Program of Sichuan Province,No.2020YFS0036+2 种基金Chengdu Science and Technology Program Projects,No.2017-CY02-00032-GXNational Natural Science Foundation of China,No.81801852National Key Research and Development Program of China,No.2017YFB0702604.
文摘BACKGROUND Giant cell tumor(GCT)is a benign lesion and rarely involves the patella.This disease is characterized by a relatively high recurrence rate after primary treatment.En bloc resection has been a predominant option for recurrent GCT.However,total patellectomy can lead to disruption of the knee.Therefore,exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARY A 54-year-old woman presented with right knee pain and swelling,and was diagnosed as having a GCT in the patella following curettage and autograft.Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture.Based on the combination of histological,radiological,and clinical features,a diagnosis of recurrent GCT in the patella was made(Campanacci grade III).After a multidisciplinary team discussion,three-dimensional(3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism.The patient was followed for 35 mo postoperatively.No evidence of local recurrence,pulmonary metastasis,or osteoarthritis of the right knee was observed.The active flexion arc was 0°-120°,and no extension lag was detected.A favorable patellar tracking and height(Insall-Salvati ratio 0.93)were detected by radiography.CONCLUSION We depict a case of a GCT at the right patella,which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement.The patella normal reconstruction,the precise-fit articular design,and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.
文摘The advantages of endoscopic retrograde cholangio-pancreatography over open surgery have made it the predominant method of treating patients with choledo-cholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing "irretrievable stones" include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ . To the best of our knowledge the examined endoprosthesis is the oldest endo-prosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ . Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis.
文摘Immediate and late follow-up results of oncomammological application of novel Ukrainian endoprosthesis “Nubiplant”, made of one piece of polyacrylamide gel, for mammary gland malignancies (MGM) radical treatment with reconstruction were analyzed. This endoprosthesis have proved its unique complex of favorable surgical and oncological properties, such as the shape and size accommodation for mammary gland plasty purposes, absence of shell and textured surface. Of 184 patients, operated on radically for initial stages of MGM, using "Nubiplant" endoprosthesis, postoperative complications have had occur in 18 (9,8%): the wound seroma in 12 (6,5%) and partial necrosis of cutaneous edge of postoperative wound – in 6 (3,8%). The seromas were successfully treated by their punctures and local necrosis - using excision with secondary suture placement. Late follow-up results were obtained in 112 (60,9%) patients: three-year period have had survived 104 (92,6±2,4%), and a five-year one – 84 (75,0±4,0%) of them. A contracture capsule was revealed in 3 (2,6%) patients, and excised with the endoprosthesis change. “Nubiplant” endoprosthesis have advantages over most popular worldwide kinds of such products. It may be used securely and effectively for total or partial reconstruction of mammary gland, including cases with hypoplasia, and is more resistant to trauma, radiation therapy and local complications occurrence, including contracture capsule formation. Its property to absorb the water may be used for purposes of plastic surgery. Prophylaxis of specific immediate surgical complications is trustworthy in MGM patients, using modified endoprosthesis “Nubiplant”, containing insulin, antihistamine and antiseptic medicines.
文摘目的:评估3D打印全骶骨假体在全骶骨切除患者腰-髂稳定性重建中的应用价值。方法:回顾性分析2015年1月~2018年12月于我中心接受全骶骨切除术的42例患者资料。根据重建方式将患者分为3组:假体重建组(14例)采用3D打印全骶骨假体重建,联合重建组(19例)采用包含前方椎体重建的联合重建方案,脊柱骨盆(SPF)重建组(9例)采用单纯SPF重建。比较三组患者的腰-髂稳定性(疼痛及运动功能评分)、内置物生存情况(内置物失败率及生存期)、手术安全性(手术时间、术中出血量及围手术期并发症发生率)。结果:术后平均随访时间为33.6±14.2个月。假体重建组手术平均耗时394.6±128.0min,术中出血量平均为3250.0±1711.4ml,共2例患者发生围手术期并发症。末次随访时,13例患者无需拐杖等辅助行走,12例患者无需使用止痛药。共4例患者发生影像学内置物失败,其中2例需行二次手术,1例因严重疼痛并伴有肿瘤复发接受二次手术,术中因假体与周围骨融合牢固而未取出假体;1例因严重疼痛及运动功能明显受损接受二次手术取出假体。假体重建组平均内置物生存期为49.3(95%CI 40.8~57.9)个月。相较于其他两组患者,假体重建组患者的腰-髂稳定性、内置物生存情况均与联合重建组相近(疼痛评分2.4±0.8 vs 2.3±0.7,P=0.59;运动功能评分2.4±0.6 vs 2.2±0.7,P=0.44;内置物失败率14.3%vs 5.3%,P=0.56;内置物生存期49.3 vs 59.4个月,P=0.28),并显著优于SPF重建组(疼痛评分2.4±0.8 vs 1.7±1.0,P=0.028;运动功能评分2.4±0.6 vs 1.3±0.7,P=0.001;内置物失败率14.3%vs 66.7%,P=0.023;内置物生存期49.3 vs 28.6个月,P=0.01),且不显著增加手术时间、术中出血及围手术期并发症发生率。结论:在全骶骨切除患者中应用3D打印全骶骨假体进行重建能够取得理想的腰-髂稳定性以及满意的内置物生存情况,同时不会增加手术风险。
