ABSTRACT
The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.
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Objective To investigate the surgical technique,postoperative function and dislocation incidence of proximal humerus reconstruction with metallic endoprostheses and polypropylene knitted nonabsorbable mesh after proximal humeral tumor resection.Methods Twenty patients with proximal humeral tumor were retrospectively reviewed.They were performed proximal humerus reconstruction with proximal humeral prosthesis and polypropylene knitted non-absorbable mesh from February 2006 to January 2009.There were 5 women and 7 men with a mean age of 38 years(range,21-55 years)at the time of surgery,and giant cell tumor in 9 patients(including Campanacci Ⅱ for 3,Campanacci Ⅲ for 6),osteosarcoma in 1(Enneking ⅡB).and chondrosarcoma in 2 (Enneking ⅡA).The operative time,blood loss,and shoulder movement postoperation were analysed.According to the assessment system by MSTS,the function of limb after surgery was assessed.Results Patients were followed clinically and radiographically for a minimum of 24 months (mean,35 months;range,24-52 months).The mean operative time was 172 min(range,150-200min).The mean blood loss was 254 ml (range,150-500 ml).There were no shoulder dislocations at final follow-up.The mean shoulder flexion was 41°(range,20°-60°)and mean shoulder abduction was 42°(range,20°-70°).The mean postoperative functional assessment score of the limb was 66%(range,53%-77%).None of the Datients had a wound infection,traction neuropraxia or died after the surgical procedure.Conclnsion The data suggests that the use of a polypropylene knitted non-absorbable mesh for proximal humerus reconstruction may reduce dislocations and facilitate soft tissue attachment after tumor resection.
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Objective To introduce the technique.indication and outcome of treatment of degenerative Achilles'rupture with transfer of flexor hallucis longus tendon and V-Y tendinous flap. Methods From October 2003 to May 2006,21 cases of degenerative Achilles'tendon rupture were treated in our department using transfer of flexor hallucis longus tendon and V-Y tendinous flap.Rivets were used in 17 cases and surface screws in 4.They were followed up for 12 to 18 months(average,14). Results According to the Arner-Lindholm criteria for curative results,19 of the 21 cases were excellent and 2 good.Follow-ups revealed no Achilles'tendon re-rupture,infection,skin necrosis,stiff ankle,or injury to nerves and vessels.Walking gaits nearly recovered to normal.The repair strength allowed early functional exercise of the Achilles'tendon. Conclusion Transfer of flexor hallucis longus tendon combined with V-Y tendinous flap can cure the degenerative Achilles'tendon ruptures and defects of Achilles'tendon within 3 cm.
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Objective To primarily study the possible biological significance of yon Willebrand factor (vWF) expression at the fracture site in the mechanism of fracture healing. Methods A total of 28 male SD rats were selected to set up femoral fracture models. Then, tissue samples from fracture site were randomly taken at days 2, 3, 5, 7, 10, 14 and 21 after establishment of the models, with 4 rats at each time point, vWF expression at fracture site and the relationship of vWF expression with osteoblasts and chondroblasts were observed by using computer image analysis system. The biological significance of vWF expression at fracture site in mechanism of fracture healing were analysed based on the results of vWF expression of in vitro cultured rat osteoblasts. Results The expression of vWF at every time point was positive and distributed disproportionally irregular at bone trabecula and soft tissue of the fracture site. vWF expressed positively in the extracellular matrix around the chondroblasts. Conclusions During the course of fracture healing, there may be vWF-platelet activation pathway that can regulate differentiation and proliferation of local osteoblasts and chondrocytes and activate platelets secreting growth factors such as PDGF, IGF-1, EGF and TGF-a, as creates a sound microenvironment for fracture healing.
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Objective To evaluate the effects of treatment for the distal radial osteoporotic fractures in elder patients with Volar Locking Compression Plating (LCP)fixation. Methods 30 old patients who suffered from the severe osteoporotic distal radial fractures were treated with LCP. In this group all the fractures were more severe than type 2B according to Melone classification. The results of treatment were evaluated by comparing pre and post operative functions and X rays of involved wrists. Results 26 of the 30 patients experienced no wrist pain and were satisfied with the functions of the suffered wrists in their daily postoperative activities. 2 patients still felt wrist pain and needed to take some pain killers and other 2 experienced mild finger movement limitations. These data were improved postoperatively to the average palmar tilt of 3.38 degrees, radial inclination of 18.9 degrees and the radial length 0.9cm longer between the ulnar head and the tip of the radial styloid. The radial length was found 0.2 mm shorter in 2 cases in the latest follow up than that measured before. No severe complications were found in this group. Conclusion For the unstable distal radial osteoporotic fractures in the elderly patients, Volar Locking Compression plating (LCP)fixation is one of the effective treatments, because this procedure can restore and sustain the distal radial length and smooth articular surface after the fracture reduction.