ABSTRACT
Objective To investigate the clinical application and therapeutic effect of reservation cortical expand resection and reconstruction for extremities bone tumor. Method Twelve cases with extremities invasion bone tumor were reviewed,including 6 male and 6 female.The average age was 37.1 years old.According to the MRI,TypeⅠtumor located in metaphysic and growth eccentricity,and was treated with outside tumor osteotomy with reservation of one side as integumentale,the cut line was shape of "匚".Type Ⅱ tumor was with invasion part articular surface,and was operated with part joint osteotomy with reservation of one side as integumentale,the cut line was shape of"L".Type Ⅲ was with invasion total joint surface and as integmentale,all tumor segment including joint could be cut,but the shape of cut close to the diaphysis was echelonment. Result The operation time was 1~3 h,the operative bleeding quantity were 150~400 ml,all incisions were obtained primary healing.Twelve cases were followed up from 6 months to 8 years.The average extremity functional score according to the system of ISOLS(International Society of Limb Salvage):upper extremity was 22.3 and the lower was 25.3 The average bone healing time of returned deactivation bone graft and bone allograft healing with the osteotomy plane was 3 months,original tumor recurrence in local was 1,the recurrence rate was 7.69%,no malignant change and metabasis was found. Conclusion The reservation cortical expand resection and reconstruction could increase the treatment effect of extremities bone tumor,it is key to decrease the recurrence with strict indication,non-neoplasma and aseptic technique.Tumor shell and osteotomy plane should be deactivated thoroughly.
ABSTRACT
[Objective]To investigate the restoration of the axial alignment of the lower extremity during operation for fracture of tibia plateau and to assess the curative effect.[Method]A retrospective analysis of 45 cases of fracture of tibial plateau were conducted from May 2000 to June 2005,25 male cases and 20 female,mean age were 45.3.The type of fracture:3 cases were Schatzker I,10 were type Ⅰ,19 were type Ⅲ,6 were type Ⅳ,5 were type Ⅴ,2 were type Ⅵ.All cases were treated with open reduction,bone graft and internal-fixation with plate and screw under arthroscopy-assisted,and the normal axial alignment of the lower extremity was restored.The restoration standard was in accordance with the uninjured side limb.The way of measurement:the axial line from anterior superior iliac to interdigit of the first and second toe was done,then,the perpendicular distance from the center of patella to this line was calculated,and compared the data with uninjured side limb's.[Result]Forty cases were followed up,from 6 months to 24 months,average 15 months,according to the Rasmussen knee score standard,24 were excellent,11 were good,3 were fair and 2 were poor.The satisfactory rate was 87.5%,the restoration of knee function were close correlated with whether the line normal or not,there were abnormal lines recurrence in some cases,the main causes were:(1)Meniscus to be cut excessive to the loading redistribution in joint;(2)The reduced articular surface collapsed,again due to the affected limb weight loading too early;(3)Fractures were too complicated to be compress fixed with common buttress plate,resulted in displace fracture.[Conclusion]It is very important that the axial alignment of the lower extremity to be corrected during operation to the injured knee function restoration after operation,and the causes result in the axial line abnormal above-mentioned should be considered thoroughly,at the same time,the corresponding measures should be taken.