A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital...A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital, Xi'an Medical Nniversity. Firstly, the internal tumor tissue was resected and curstted thoroughly, and the osseous shell was kept to attach to the normal bone tissue. Then, a plastic bag was used to encase the osseous shell in, deactivation was done with 95 per cent alcohol. the remainder osseous shell was used as a support, a pulp canal steel needle was inserted into it, and the bone cement was filled up in. In this way, a ' prosthesis' in pulp canal was formed, which was not only firm, reliable, less expensive convenient for drawing material, and satisfactory for achieving the goal of treating the tumor and keeping the limb, but also easy to move for the patient and to recover the function of the limb rapidly after operation because of not amputating the normal bone tissue and partly keeping the continuity of it. Now 25 cases have been treated with this new method, and in 90 per cent patients, the limbs have been preserved.展开更多
Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, a...Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods： Between December 1995 and January 2003, 33 cases of preserving epiphysis procedure had been done. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing＇s sarcomas, 2 chondrosarcomas, and 2 aggressive osteoblastomas. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. The modified protocol T10 was taken. Radiography and MRI were used to determine the margins of the tumors preoperatively and histological examination was used to corroborate the evidence intraoperatively. The tumors were staged clinically. Among them, there were 2 cases in ⅠA, 2 cases in ⅠB, 17 cases in ⅡA, and 12 cases in liB. According to the MRI analysis, the metaphyseal tumors in children were classified into 3 types. Type Ⅰ, with the tumor close to but not contacting epiphyseal plate, and the distance between the two over 2 cm, was taken as absolute indication for the technique. Type Ⅱ, with the tumor near or contacting epiphysis plate, and the distance between the two less than 1 cm, was taken as relative indication for the surgery. For type Ⅲ, the tumor contacted the epiphyseal plate partially, and was over 2 cm beyond the joint. In the cohort, 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The size of the residual epiphyseal bone segment differed after different excision protocols which were taken according to the clinical classifications. Bone defects after tumor resections were repaired with massive intercalary allograft bone, followed by internal fixation by intramedullary nails and cancellous screws. Results： Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clinical data. Postoperative follow-up was 12-72 months. Recurrences were seen in 3 cases, with one local recurrence in type Ⅲ cases one year post tumor resection, other 2 recurrences around the femoral vessels in type Ⅱ cases 15 months and 30 months after the tumor resection respectively. The recurrence rate accounted for 10.34%. Amputation was performed for the cases with recurrences. But pulmonary metastasis developed and the patients died. In this cohort, 9 cases died. Five-year survival rate constituted 57.94% demonstrated by Kaplan-Meier survival analysis. The median survival time for male patients was 64.36 months, and that for female patients was 56.00 months （P = 0.0403）. The sites, stages and types were not associated with the survival time. Four cases reported 5 complications （17.24%）. The complications included fracture of the allograft, limb length discrepancy, nerve injury, breakage of nails, and loosening of the screws. No patient reported skin necrosis, hematoma, infection, rejection to the allograft, and nonunion at the end of the follow-up. According to the functional evaluation criteria after surgical treatment of malignant tumors of the extremities introduced by Enneking, excellent functional results were reported in 11 cases, good in 13 cases, fair in 3 cases, and poor in 2 cases. The excellent or good result rate was 83%. The excision interface involved partial epiphysis in 4 cases, involved the epiphyseal plate in 8 cases. Intact epiphysis was preserved in 17 cases. Five cases with poor postoperative functional results were in types II and III. Average time of bone union was 2.5 months for epiphyseal end and 3.8 months for diaphyseal end. According to the International Society of Limb Salvage （ISOLS） radiological implants evaluation system, excellent reconstruction was observed in 23 cases, good reconstruction in 4 cases, fair reconstruction in 1 case, and poor reconstruction in 1 case. All patients in the group had satisfactory joint stability. No patient reported joint dislocation, valgus or varus deformity, and osteoarthritis. The average limb length discrepancy was 3.2 cm, ranging 2-6 cm. Conclusion： The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children and adolescents guarantees the patient＇s satisfactory postoperative limb functional results. Preoperative effective adjuvant chemotherapy and prevention of postoperative complications deserve great attention.展开更多
BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of l...BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.展开更多
目的通过分析原发性恶性骨肿瘤患者在瘤段切除后经不同重建方式治疗的随访资料,探讨手术方案的选择对临床疗效的影响。方法以2016年7月1日至2022年7月1日东部战区总医院单中心收治的四肢原发性恶性骨肿瘤患者为研究对象,根据瘤段切除后...目的通过分析原发性恶性骨肿瘤患者在瘤段切除后经不同重建方式治疗的随访资料,探讨手术方案的选择对临床疗效的影响。方法以2016年7月1日至2022年7月1日东部战区总医院单中心收治的四肢原发性恶性骨肿瘤患者为研究对象,根据瘤段切除后重建方式分为肿瘤型假体置换组和生物重建组。回顾患者的临床随访资料,对比2组患者至随访截止时间的复发率、转移率、生存率以及最终保肢率,并总结生物重建失败的影响因素。同时,采用美国肌肉骨骼肿瘤协会评分(MSTS)、多伦多保肢评分(TESS)评价并比较不同组间患者术后功能的恢复情况。结果共收集并筛选入组患者87例,其中男52例,女35例,年龄8~71岁,平均(38.3±21.2)岁。随访15~70个月,平均随访时间26.5个月。至随访截止时间,共存活67例,死亡20例,总生存率为77.01%;无瘤存活45例,无瘤生存率为51.72%。其中,假体置换组74例、生物重建组13例(瘤体骨灭活再植钢板重建2例、自体腓骨移植钢板重建11例)。生物重建组术后1年的MSTS评分及TESS评分均明显高于假体置换组(28.33±2.09 vs 24.16±4.51、85.62±6.71 vs 80.82±3.85,P<0.01)。假体置换组术后生存率达到了75.68%。而生物重建组患者术后生存率更达到了84.62%,且根据多因素Cox比例风险回归分析结果,不同的手术方式对无瘤生存(TFS)、总生存(OS)均无显著影响(P>0.05),复发和转移发生与否才是影响OS的预测因素(P=0.003和P=0.001)。而进一步的研究显示,两种不同手术方式的选择与患者的生存率(P=0.0843)、复发率(P=0.5206)、转移率(P=0.3217)无显著相关性。假体置换组与生物重建组的二次手术率(29.73%vs 38.46%)及最终保肢率(83.78%vs 84.62%)比较,差异均无统计学意义(P>0.05)。行瘤段切除后自体腓骨移植钢板重建的患者有11例,其中出现移植骨骨不连2例;愈合时间与年龄、术前肿瘤生长部位、术中截骨长度、取骨部位及植骨量均有相关性(P<0.05)。结论随着治疗理念和手术技术的不断进步,针对原发性恶性骨肿瘤瘤段切除后的骨缺损,采用术前精准测量和周密设计的生物重建手术,可以发挥其在关节稳定、肢体功能、保障疗效等各方面的优势,从而取得较假体置换手术更佳的治疗效果。展开更多
文摘A new operating programme was designed by us, based on keeping the whole limb in 1988. A successful operation on one patient with this new method was achieved on Dec. 17 in the same year at the First Teaching Hospital, Xi'an Medical Nniversity. Firstly, the internal tumor tissue was resected and curstted thoroughly, and the osseous shell was kept to attach to the normal bone tissue. Then, a plastic bag was used to encase the osseous shell in, deactivation was done with 95 per cent alcohol. the remainder osseous shell was used as a support, a pulp canal steel needle was inserted into it, and the bone cement was filled up in. In this way, a ' prosthesis' in pulp canal was formed, which was not only firm, reliable, less expensive convenient for drawing material, and satisfactory for achieving the goal of treating the tumor and keeping the limb, but also easy to move for the patient and to recover the function of the limb rapidly after operation because of not amputating the normal bone tissue and partly keeping the continuity of it. Now 25 cases have been treated with this new method, and in 90 per cent patients, the limbs have been preserved.
文摘Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods： Between December 1995 and January 2003, 33 cases of preserving epiphysis procedure had been done. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing＇s sarcomas, 2 chondrosarcomas, and 2 aggressive osteoblastomas. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. The modified protocol T10 was taken. Radiography and MRI were used to determine the margins of the tumors preoperatively and histological examination was used to corroborate the evidence intraoperatively. The tumors were staged clinically. Among them, there were 2 cases in ⅠA, 2 cases in ⅠB, 17 cases in ⅡA, and 12 cases in liB. According to the MRI analysis, the metaphyseal tumors in children were classified into 3 types. Type Ⅰ, with the tumor close to but not contacting epiphyseal plate, and the distance between the two over 2 cm, was taken as absolute indication for the technique. Type Ⅱ, with the tumor near or contacting epiphysis plate, and the distance between the two less than 1 cm, was taken as relative indication for the surgery. For type Ⅲ, the tumor contacted the epiphyseal plate partially, and was over 2 cm beyond the joint. In the cohort, 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The size of the residual epiphyseal bone segment differed after different excision protocols which were taken according to the clinical classifications. Bone defects after tumor resections were repaired with massive intercalary allograft bone, followed by internal fixation by intramedullary nails and cancellous screws. Results： Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clinical data. Postoperative follow-up was 12-72 months. Recurrences were seen in 3 cases, with one local recurrence in type Ⅲ cases one year post tumor resection, other 2 recurrences around the femoral vessels in type Ⅱ cases 15 months and 30 months after the tumor resection respectively. The recurrence rate accounted for 10.34%. Amputation was performed for the cases with recurrences. But pulmonary metastasis developed and the patients died. In this cohort, 9 cases died. Five-year survival rate constituted 57.94% demonstrated by Kaplan-Meier survival analysis. The median survival time for male patients was 64.36 months, and that for female patients was 56.00 months （P = 0.0403）. The sites, stages and types were not associated with the survival time. Four cases reported 5 complications （17.24%）. The complications included fracture of the allograft, limb length discrepancy, nerve injury, breakage of nails, and loosening of the screws. No patient reported skin necrosis, hematoma, infection, rejection to the allograft, and nonunion at the end of the follow-up. According to the functional evaluation criteria after surgical treatment of malignant tumors of the extremities introduced by Enneking, excellent functional results were reported in 11 cases, good in 13 cases, fair in 3 cases, and poor in 2 cases. The excellent or good result rate was 83%. The excision interface involved partial epiphysis in 4 cases, involved the epiphyseal plate in 8 cases. Intact epiphysis was preserved in 17 cases. Five cases with poor postoperative functional results were in types II and III. Average time of bone union was 2.5 months for epiphyseal end and 3.8 months for diaphyseal end. According to the International Society of Limb Salvage （ISOLS） radiological implants evaluation system, excellent reconstruction was observed in 23 cases, good reconstruction in 4 cases, fair reconstruction in 1 case, and poor reconstruction in 1 case. All patients in the group had satisfactory joint stability. No patient reported joint dislocation, valgus or varus deformity, and osteoarthritis. The average limb length discrepancy was 3.2 cm, ranging 2-6 cm. Conclusion： The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children and adolescents guarantees the patient＇s satisfactory postoperative limb functional results. Preoperative effective adjuvant chemotherapy and prevention of postoperative complications deserve great attention.
基金Supported by The Beijing Science Foundation for Distinguished Young Scholars,No.JQ21025。
文摘BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.
文摘目的通过分析原发性恶性骨肿瘤患者在瘤段切除后经不同重建方式治疗的随访资料,探讨手术方案的选择对临床疗效的影响。方法以2016年7月1日至2022年7月1日东部战区总医院单中心收治的四肢原发性恶性骨肿瘤患者为研究对象,根据瘤段切除后重建方式分为肿瘤型假体置换组和生物重建组。回顾患者的临床随访资料,对比2组患者至随访截止时间的复发率、转移率、生存率以及最终保肢率,并总结生物重建失败的影响因素。同时,采用美国肌肉骨骼肿瘤协会评分(MSTS)、多伦多保肢评分(TESS)评价并比较不同组间患者术后功能的恢复情况。结果共收集并筛选入组患者87例,其中男52例,女35例,年龄8~71岁,平均(38.3±21.2)岁。随访15~70个月,平均随访时间26.5个月。至随访截止时间,共存活67例,死亡20例,总生存率为77.01%;无瘤存活45例,无瘤生存率为51.72%。其中,假体置换组74例、生物重建组13例(瘤体骨灭活再植钢板重建2例、自体腓骨移植钢板重建11例)。生物重建组术后1年的MSTS评分及TESS评分均明显高于假体置换组(28.33±2.09 vs 24.16±4.51、85.62±6.71 vs 80.82±3.85,P<0.01)。假体置换组术后生存率达到了75.68%。而生物重建组患者术后生存率更达到了84.62%,且根据多因素Cox比例风险回归分析结果,不同的手术方式对无瘤生存(TFS)、总生存(OS)均无显著影响(P>0.05),复发和转移发生与否才是影响OS的预测因素(P=0.003和P=0.001)。而进一步的研究显示,两种不同手术方式的选择与患者的生存率(P=0.0843)、复发率(P=0.5206)、转移率(P=0.3217)无显著相关性。假体置换组与生物重建组的二次手术率(29.73%vs 38.46%)及最终保肢率(83.78%vs 84.62%)比较,差异均无统计学意义(P>0.05)。行瘤段切除后自体腓骨移植钢板重建的患者有11例,其中出现移植骨骨不连2例;愈合时间与年龄、术前肿瘤生长部位、术中截骨长度、取骨部位及植骨量均有相关性(P<0.05)。结论随着治疗理念和手术技术的不断进步,针对原发性恶性骨肿瘤瘤段切除后的骨缺损,采用术前精准测量和周密设计的生物重建手术,可以发挥其在关节稳定、肢体功能、保障疗效等各方面的优势,从而取得较假体置换手术更佳的治疗效果。
