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Objective:To investigate the early and middle term clinical efficacies of 3D-printed metal prostheses in the reconstruction of bone defects after osteotomy in malignant bone tumors.Methods:A total of 34 patients with malignant bone tumors of lower extremity femur and tibia who underwent 3D printing individualized metal prosthesis replacement surgery in the Department of Bone and Soft Tissue of Affiliated Cancer Hospital of Zhengzhou University from March 2019 to March 2022 were retrospectively analyzed. There were 23 males and 11 females, with an average age of 19.1±15.2 years (range, 7-80 years). There were 22 children and adolescents younger than 18 years old. There were 3 cases in the proximal femur, 15 cases in the middle and distal femur, 10 cases in the proximal tibia and 6 cases in the distal tibia. According to the final pathological diagnosis, 24 cases of osteosarcoma, 6 cases of Ewing's sarcoma, 2 cases of undifferentiated sarcoma, 1 case of osteosarcoma, and 1 case of malignant giant cell tumor of bone were enrolled in this study. Postoperative complications, wound healing, periprosthetic fracture and aseptic loosening, tumor outcome (evaluated by tumor control evaluation criteria), and length difference of lower limbs were recorded. Response evaluation criteria in solid tumor (RECIST) was used to evaluate tumor outcomes. Prosthetic-bone interface healing was evaluated postoperatively, and the function was evaluated based on Musculoskeletal Oncology Society (MSTS) 93.Results:The length of lesions was 70-240 mm in 34 patients, with an average of 125.5±35.4 mm. The length of osteotomy was 80-275 mm, with an average of 160.2±33.9 mm. No tumor was found on the osteotomy surface. The customized prosthesis was firmly installed and closely matched with the side of the preserved articular surface. There were 2 patients with local incision fat liquefaction and 4 patients with superficial wound infection, which healed after debridement and antibiotic treatment. One distal tibia osteosarcoma case developed severe periprosthetic infection 2 months after surgery, resulting in prosthesis implantation failure, limb movement pain and poor ankle function. After removal of the prosthesis, infection control and osteogenesis with the Ilizarov technique, the infection was completely controlled and local osteogenesis was possible. The remaining 33 patients had a good prosthetic-bone interface union. One case was found to have localized bone resorption on the contact surface of the prosthesis 7 months after operation, but the metal prosthesis and screws were not loose. The incisions healed well in other patients, without infection, prosthesis loosening, fracture or other complications. All patients survived and were followed up for 13.8±5.6 months (range, 7-27 months). During the follow-up, there was no recurrence of tumor at the osteotomy end in all patients, but 5 patients developed lung metastasis. At the end of the last follow-up, all patients survived. Among them, 16 patients had unequal length of lower limbs, including 10 cases within 2 cm, 3 cases between 2-5 cm, and 3 cases over 5 cm. With the exception of one patient whose prosthesis was removed due to infection, the MSTS 93 of the other patients was 24.9±2.2 (range, 19-28), and were rated as excellent in 26 cases and good in 7 cases. According to the RECIST evaluation criteria, 26 of 34 patients had complete response, 5 had disease progression, and 3 had stable disease.Conclusion:3D printed metal prosthesis is one of the effective methods for the treatment of bone defects after resection of malignant bone tumors in lower limbs, which is safe, reliable and has satisfactory early curative effect.
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Objective To explore the role of two-dimensional speckle tracking echocardiography in evaluating left ventricular function of patients with multi-vessel coronary artery disease (MVD).Methods 40 patients with MVD without obviously abnormal ventricular wall activity admitted to our hospital from June 2017 to January 2018 were selected as the study objects,and were classified as MVD group,and 42 normal persons were selected as the control group.The left atrial end systolic diameter (LAd) and left ventricular end diastolic diameter (LVEDD) were measured by echocardiography,and then the dynamic gray scale images of all patients were collected.The left ventricular global systolic longitudinal strain (GLS),left ventricular global radial strain (GRS),global circumferential strain (GCS),left ventricular basal global longitudinal strain (Bas-GLS),basal global circumferential strain (Bas-GCS),basal global radial strain (BasGRS),middle global longitudinal strain (Mid-GLS),middle global circumferential strain (Mid-GCS),middle global radial strain (Mid-GRS),global longitudinal strain of apical segment (Ap-GLS),global circumferential strain value of apical segment (Ap-GCS),and global radial strain value of apical segment (Ap-GRS) were measured by two-dimensional speckle tracking technique.Results In MVD group,84.21％ of patients with coronary artery occlusion or subtotal occlusion showed collateral formation on coronary angiography;there was no significant difference in the indexes detected by conventional echocardiography (P ＞ 0.05).The GLS,Bas-GLS,Mid-GLS,Bas-GCS,Mid-GCS,GRS,and Bas-GRS in MVD group were significantly lower than those in control group,with statistically significant differences (P ＜ 0.05).Conclusions Compared with echocardiography,two-dimensional speckle tracking technique can detect myocardial lesions more sensitively in patients with coronary multi-vessel disease without abnormal wall activity,and find out the dysfunction of myocardial contraction,especially the damage of longitudinal myocardial contraction and the damage of basal myocardium.
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Objective To investigate the clinical effect of using pedicled flap to reconstruct skin and soft tis-sue defect after resection of sarcoma around extremities joint. Methods Retrospectively analysis 103 cases of sar-coma around extremities joint who was treated from June, 2012 to June, 2017 and used the pedicled fasciocutaneous flaps or pedicled musculocutaneous flaps to reconstruct the defect after sarcoma resection. There were 61 males and 42 females, with a mean age of 52.3 (14-82 ) years old. Among these patients, there were 32 initial diagnosis, 30 had been resected in other units, and 41 recurrent tumor. There were 13 patients that tumor around wrist:reconstructed by radial wrist upper branch fasciocutaneous flap, dorso-ulnar flap based on supracarpal perforator, and posterior in-terosseous artery flap. Eight patients with tumor around elbow: reconstructed by lateral arm flap and media arm flap. Eight patients with tumor around shoulder: reconstructed by latissimus dorsi musculocutaneous flap and lateral tho-racic flap. Fourteen patients with tumor around hip: rectus femoris musculocutaneous flap, tensor fascia lata musculo-cutaneous flap, and posterior thigh fasciocutaneous flap. Sixteen patients that tumor around knee:reconstructed by an-terolateral low leg flap, and sural calf fasciocutaneous flap. Forty-four patients that tumor around ankle: reconstructed by saphenous neuro-veno-fasciocutaneous flap, sural neuro-veno-fasciocutaneous flap, lateral supramalleolar flap, and medial plantar flap. The defect area after tumor resection were:3 cm ×4 cm-18 cm×25 cm. After surgery, observe the situation and fitness of flap, complication, joint mobility, and tumor recurrence and metastasis. Results Allflaps survived except 6 died or partial died, with a survival rate of 94.2％, of which dead flap were replaced by a new flap or covered by free skin graft. Infection occurred in 4 cases (2 in donor site and 2 in recipient site), were cured by dressing and antibiotic. Except for 12 cases dropped, all rest 91 cases were followed-up by 33 months on average (1-5 years), flaps' shape and texture were good, without swollen and fester, and fit well. Superficial sensibility of direct fasciocuta-neous flaps and musculocutaneous flaps were normal, protective sensation of reverse fascial flaps were recovered. The mobility of affected joint show no difference compared with the other side. No ulcer occurred on flaps of plantar and but-tocks, that helps normal sit position and gait. There were 17 recurrences and 32 metastasis occurred, 21 patients died so far. There was a statistical difference between recurrent cases with first shot(10.3％) second widely resection(11.5％) and recurrent resection(30.6％)(P<0.05). Conclusion Using pedicled flap to reconstruct skin defect after the resection of sarcoma around extremities joint, can get good clinical result, with simple and reliable operation. It is worth to popularize.
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Objective To analyze of the efficacy of minimally invasive surgery combined with medication in the treatment of ureteral calculi.Methods From June 2013 to June 2015,124 patients with ureteral calculi which confirmed by X-ray in our hospital were collected as subjects.According to the treatment method,they were divided into control group and observation group,patients in the control group were treated with simple medication,while the observation group were treated with minimally invasive surgery combined with drug therapy.The effects of treatment and the levels of MCP-1,TFF1 and HMGB1 in urine between two groups were compared.Results The stone expulsion rate and the net rate of the observation group was higher than those of the control group,the differences were significant(P<0.05).The stone expulsion time of observation group was shorter than that of the control group,the formation rate of the observation group was lower than that of the control group,the differences were significant(P<0.05).Adverse reactions occurred in 11 cases of the observation group,in 29 cases of the control group,the incidence of adverse reactions in the observation group was lower than that in the control group,the difference was significant(P<0.05).After the treatment,17 cases of adverse drug reactions occurred in the observation group,which was more than 5 cases of adverse drug reactions in the control group,the difference was significant(P<0.05).After treatment,the levels of MCP-1 and HMGB1 in urine of two groups were decreased compared with those before treatment,the level of TFF1 was increased,the differences were significant(P<0.05);while the levels of MCP-1 and HMGB1 of the observation group after treatment were lower than those of the control group,the level of TFF1 was higher than that of the control group,the difference was significant(P<0.05).The effective rate of the observation group was 88.71％,which higher than 69.35％ of the control group,the difference was significant(P<0.05).Conclusion On the basis of medication,combined with extracorporeal shock wave lithotripsy for ureteral calculi can not only improve the therapeutic effect,but also reduce the risk of adverse reactions.
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BACKGROUND:There are many complications of limb salvage surgery in patients with osteosarcoma of the middle tibia, and the limb salvage surgery is one of the current difficulties in clinical treatment. OBJECTIVE:To evaluate the clinical efficacy of reconstruction with massive al ograft bone for osteosarcoma of the middle tibia by retrospectively reviewing relevant cases. METHODS:Seven patients with osteosarcoma of the middle tibia were treated. And we analyzed their clinical data retrospectively. Al patients completed the formal preoperative adjuvant chemotherapy and we confirmed that there was no distant metastasis before surgery. Al patients received large al ogeneic bone transplantation and internal fixation, and the gastrocnemius muscle flap coveraged graft bone in surgery. The average length of al ogeneic bone was 12.5 cm. Five patients received postoperative adjuvant chemotherapy completely, and two patients received partly. RESULTS AND CONCLUSION:The fol ow-up period was 18-36 months. One patient had local tumor recurrence at 1 year after transplantation, and died of lung metastases after amputation. One patient survived after resection of lung metastases that occurred at 1.5 years after transplantation. One patient died of lung metastases at 2 years after transplantation. The rest four patients were tumor-free. The mean Musculoskeletal Tumor Society (MSTS) score was 26.5, the mean International Society of Limb Salvage (ISOLS) graft score was 31. Among four underage patients, one had leg length deformities, with limb shortening 2 cm. There were no postoperative infections and pathological fractures. Using large al ogeneic bone for the repair of bone defects after tumor surgery of the middle tibia can have a good clinical efficacy under the premise of strict indications. Using gastrocnemius muscle flap to cover the bone graft during surgery is an effective measure to reduce postoperative complications.
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PET and PET/CT are the methods of displaying the functional and metabolic changes in tissues. With its high sensitivity and specificity, it can be used as a noninvasive systemic functional examination. There are significant values in its diagnosing, staging, treatment directing and prognosis assessing in the malignant lymphoma.
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Objective To discuss the CT features of primary retroperitoneal tumor(PRT) ,so that to improve the knowledge of these diseases.Methods 24 cases with PRT confirmed by surgery and pathology were assessed retrospectively,and their CT manifestations were analyzed in comparison with pathology. Results All cases included:8 cases of liposarcoma with predominant fat components, 2 cases of fibrosarcoma with evident involvement of adjacent tissues,2 cases of leiomyosarcoma with multiple centers fused, 4 cases of schwannoma localized at paraspine and cystic generation commonly,1 case of ganglioma with hypodense parenchyma,1 case of neuroblastoma with large calcification, 1 case of paraganglioma and 2 cases of chemodectoma and enhanced obviously,1 case of pheochromocytoma enhanced evidently with cystic generation ,1 case of neuroendocrinoma without specific characteristic and 1 case of teratoma with 3 layers of embryo tissues. Conclusion CT acan is able to localize the primary retroperitoneal tumors accurately,but specific CT features only see in some cases.
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Objective To explore the independent design of database for radiologic report.Methods Using the Access2000 to establish the corresponding objects in the database; Using software EasySetup to make the installing software.Results The established software (CT Diagnosis Center, CT-DDC) included menu user-defined, interface of reporting input, interactive interface of query and printing, data sheet editing and backup, it could be carried by floppy disk easily, the installing and running were stable. Conclusion The database for radiolgic report can be exploited independently,using for radio-diagnosis by the clinical doctor,it is economic and available for popularizing use in the basic medical units.
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Objective To evaluate the treatment and p re vention of urethral stricture complicated by transurethral vapo-resection of pr ostate (TVP). Methods Retrospective analysis was conduct ed by reviewing medical records and following up the patients under study.Among 3012 patients with benign prostatic hyperplasia treated with TVP, urethral stric ture occurred 4 weeks to 22 months following surgery in 95 cases (3.15 %), inclu ding anterior in 47 (49.5%),posterior in 31 (32.6 %) and bladder neck contractur e or occlusion in 17 (17.9%).Their mean age was 68.7 years (range, 55 to 85 year s). Results The 95 patients were followed up for 4～36 m o nths (mean,14 months).Of them,65 cases underwent conventional dilation, in them 59 (90.8%) were cured and 6 had failure,then turning to internal urethrotomy;19 cases underwent internal urethrotomy plus dilation,in them,13 (68.4%) were cured and 6 had failure,then turning to urethroplasty;17 cases of bladder neck contra cture or occlusion underwent transurethral resection of bladder neck scar tissue ,with a cure rate of 88.2% (15 were cured and 2 experienced failure). Conclusions Urethral stricture is a common complication after TVP. The key points of managing the strictures are patients’ alert,close follow-up and early effective treatment.