ABSTRACT
BACKGROUND: In recent years, the progression of transplantation of allografts has put forward to a new way to repair massive bone and joint defect caused by various reasons, which was a difficult subject in the past.OBJECTIVE: To probe into the effect of massive allograft and interlocking intramedullary nail on rebuilding bone and joint after bone tumor resection.DESIGN: Self-control observation SETTING: Department of Orthopaedics, Yunnan Provincial Tumor Hospital PARTICIPANTS: From April 1998 to January 2003, totally 18 patients with 15 cases of malignant bone tumor and 3 of osteoma-like disease, accepted bone tumor focus removal followed by intrmedullary nailing and allogenic bone transplantation, consented to join the study, were recruited.INTERVENTIONS: Allografts were taken from fresh cadaveric bone (Prepared and stored in Yunnan Provincial Tumor). The bone segment of osteoma was cut completely and the allografts were transplanted at the bone defects. The proximal and distal intrmedullary nailing were inserted in order. Auto cancellous bone particles were transplanted at the bone joint to promote the healing at bone end. The upper part of shoulder bone was transplanted to perform reconstruct of retotar and triangular muscle; half knee joint was transplanted to attach important muscle and ligament. After external fixation of 4 to 6 weeks following operation, the functional exercise was conducted in order sequence. Evaluating the curative effect of functional recovery of the limbs at postoperative 3,6 and 12 months as well as follow-up was carried out according to the criteria of Mankin(excellent ,good , moderate , unsatisfied).MAIN OUTCOME MEASURES: ①Functional recovery of limb of the patients. ② Adverse and side effectRESULTS: Date of totally 18 patients was entered result analysis. ①Functional recovery result of the limbs: According to evaluated criteria put forward by Mankin. In this group, 7 cases of excellent, 6 of good, 4 of moderate and 1 of unsatisfied. Bony callus and the concentration of nuclide were increased gradually in the examination at month 6 and 12. About 10-14 months after operation, the osteotylus would cover the end of allograft, substituted the allograft gradually. ② Adverse events and side effect:In this group, no tumor was survived in 16 cases, two cases died of primary lesion and pulmonary metastasis at postoperative 12 months and 18 months respectively. No infection, bone nonunion, flexible internal fixation or ruptures were found in the limbs of other patients. No one was found with shortened limbs. The patient with part joint transplantation has limitation in joint move, but the joint was stable.CONCLUSION: This operation has the highest stabilization .The patients can do exercise earlier to recover function, and injury arthritis could be prevented. It is suitable to rebuild the bone after bone tumor resection.
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.
ABSTRACT
Objective To study clinical results of percutaneous vertebroplasty(PVP) for the treatment of symptomatic vertebral hemangiomas.Methods A total of 10 patients with vertebral hemangioma (thoracic vertebrae,6 patients;lumbar vertebrae,4 patients) were treated from December 2002 to April 2005.Under the guidance of digital subtraction angiography(DSA),a needle was advanced into the vertebral body via a unipedicular or bipedicular approach.The preparation of polymethylmethacrylate(PMMA) was mixed with 3 doses of powder,2 doses of liquid,and 1 dose of contrast until a doughy,cohesive consistency similar to toothpaste was obtained.Then the PMMA cement was injected into the vertebral body by using a high-pressure plunger.The total injection volume ranged 4~6 ml(mean,4.8 ml) in the thoracic vertebrae and 5~8 ml(mean,6.0 ml) in the lumbar vertebrae.Results The procedure was completed smoothly in all 10 patients.The operation time was 25~60 min(mean,39.5 min) and the intraoperative blood loss was 10~50 ml(mean,19.6 ml).No incidence of cement leakage or pulmonary embolism occurred.The 10 patients were followed for 2~30 months(mean,18 months).In 9 patients,free of signs and symptoms was achieved and no vertebral compression fracture or recurrence of hemangioma was observed.One patient with L_3 hemangioma still complained of mild and paroxysmal loin pain at 1 year after procedure,but the patient's normal activities were unaffected and no nervous dysfunction was found.Conclusions Percutaneous vertebroplasty is a safe and effective treatment for symptomatic vertebral hemangiomas.