ABSTRACT
To investigate the effect of semi-joint prosthesis replacement in treating osteosarcoma around the knee joint,15 children with osteosarcoma around the knee joint underwent semi-joint prostheses replacement and removal of the section with tumor from October 1998 to July 2006.Imageology showed that tumor of 9 children was located at the distal femur,and 6 cases at the proximal tibia.The pathologic changes involved the upper segment of the tibia 9-11 cm in length.All the children had been diagnosed with osteosarcoma by pathological examination,which was graded as stage Ⅱ a according to Enneking staging system.All the patients underwent neoadjuvant chemotherapy preoperatively for 1-2 courses.The size of prosthesis was determined based on preoperative X-ray,CT and MRI.The length of the prosthesis should be 1.0-2.0 cm longer than that of the excised bone.Patellar and collateral ligaments were reconstructed in the artificial semi-knee joint prosthesis.All the 15 patients had a successful semi-joint prosthesis replacement.During the follow-up of 2 to 6 years,body height of the children increases by 4-6 cm,and the affected limbs shortened 1-3 cm.All children could live and study normally.There were 7 excellent,5 good,2 fine and 1 poor according to Enneking evaluation system.The semi-joint prosthesis replacement in the limb salvage surgery for child osteosarcoma around the knee joint can reconstruct knee joint function,remain normal osteoepiphysis,minimize affected limb crispation after operation,and create the condition for total knee replacement in adults.
ABSTRACT
Objective To study the technique and clincal value of biopsy during percutaneous vertebroplasty for the diagnosis of spine lesions.Methods From January 2003 to November 2005,94 patients that had been diagnosed with spinal tumors were admitted to our hospital.In these cases,totally 120 vertebrae were involved,including 3 cervical vertebrae,41 thoracic pieces,72 lumbar segments,and 4 vertebrae.Among the vertebrae,lyric lesions were found in 91,blastic in 9,and mixed in 20.Before operation,primary lesion of the spinal metastatic tumor had been confirmed in 76 patients (87 vertebrae).All the cases received percutaneous vertebroplasty,and biopsy was perfromed during the surgery.The positive rate of the pathological diagnosis was then analyzed.Results The percutaneous vertebroplasty and biopsy were completed in all the cases with a success rate of 100%.Of the 120 vertebrae,the primary diagnosis was confirmed in 114 (positive rate 95.0%),and the positive rate for metastasis cases were 93.1% (81/87).No injuries to the nerve and vessels were found in this series,no patient developeed hematoma or infection after the operation.A mean of 36.4-month follow-up was achieved in 80 patients (range,4 to 68 months),during this period,no tumor cells spreaded along needle tract or implanted into the skin.Conclusions Biopsy during percutaneous vertebroplasty can not only shorten treatment time and save medical cost,but also increase the safty of the surgical treatment as well as the aecruracy of pathological exmaination.