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Objective:To evaluate the clinical effectiveness of the reconstruction of the thoracic and lumbar spine using the 3D-printed vertebral body after total en bloc spondylectomy.Methods:From December 2016 to September 2019, 33 patients with spinal tumors were treated with total en bloc spondylectomy, including 25 males and 8 females with an average age of 58.0 years(range, 15 to 76). The locations of the lesions contained: 29 in the thoracic and 4 in the lumbar. The surgical segments includeda single vertebra in 30 cases, 2 vertebrae in 2 cases, and 3 vertebrae in 1 case. The tumor type: the primary malignant tumor in 6 cases, the metastatic tumor in 27 cases. The preoperative Tomita score was 2-5 points (mean 3.9 points), while Tokuhashi score was 9-15 points (average 11.1 points). Divided into two groups according to different reconstruction methods during total spinal resection, 33 patients with thoracolumbar vertebral body malignant tumors were divided into 3D printed artificial vertebral body reconstruction group (21 patients, 3D printed artificial vertebral body was used for anterior column reconstruction) and titanium Mesh reconstruction group (12 cases, titanium mesh implanted with allograft bone was used for reconstruction). The main observation indicators included the degree of spinal nerve damage and pain recovery, the local tumor control rate, and the incidence of prosthesis sinking. The visual analogue scale (VAS) at 24 hours and 3 months after operation was compared with that before operation using paired design t test. Results:All cases were followed up for 3 to 31 months. There was no statistically significant difference in intraoperative blood loss ( t=2.042, P>0.05), surgical time ( t=0.591, P>0.05), and postoperative drainage ( t=0.118, P>0.05) between the two groups. The visual analogue scale (VAS) between the two groups at preoperative, 24 hours and 3 months after operation was not statistically different ( P<0.05). The Frankel grading of 31 patients (97.0%) had at least one grade improvement 3 months after operation. During the follow-up period, 12 patients (41.7%) who underwent reconstruction with titanium mesh showed different degrees of subsidence in imaging, and 21 patients who used 3D printed artificial vertebral reconstruction did not exhibit prosthetic deposition. Chi-square test results of postoperative sink rate of the two methods was statistically different (χ 2=10.313, P=0.013). Conclusion:This preliminary report suggests the 3D-printed vertebral body has good biocompatibility and mechanical stability, which can be used for reconstruction after total en bloc spondylectomy.
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BACKGROUND:Removing the posterior ligamentous complexes during posterior lumbar interbody fusion (PLIF) may influence motion and load bearing characteristics of the adjacent segments,contributing to the postoperative instability at the adjacent segment,which is one of the important factors for adjacent segment degeneration.OBJECTIVE:To evaluate the clinical effectiveness of the PLIF plus screw implantation preserving posterior ligamentous complexes under microscope.METHODS:Thirty-six patients with single-level lumbar degenerative disease were enrolled,which were allotted to experimental (n=17) and control (n=1 9) groups,followed by treated with PLIF plus screw implantation preserving posterior ligamentous complexes,and traditional PLIF plus screw implnatation,respectively.The Visual Analogue Scale scores and Oswestry Dysfunction Index at baseline and postoperative 3 months were assessed.The adjacent segment degeneration was observed through radiology during follow-up.RESULTS AND CONCLUSION:The Visual Analogue Scale and Oswestry Dysfunction Index scores in the two groups were significantly lower than those before treatment (P ＜ 0.01),and the postoperative scores in the experimental group were significantly lower than those in the control group (P ＜ 0.01).The adjacent segment degeneration occurred in two cases in the experimental group and 8 cases in the control group during follow-up.Radiology revealed that the internal fixative was stable,none of screw loosening,rupture or pullout.These results suggest that PLIF plus screw implantation with posterior ligamentous complexes can effectively relieve the pain and dysfunction in the lumbar degenerative patients,and reduce the incidence of adjacent segment degeneration.
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Objective To evaluate the clinical effectiveness of the treatment for spinal metastases by cooled microwave ablation combined with percutaneous vertebro plasty(PVP).Methods From February 2014 to January 2017,24 patients with spinal metastases were treated with cooled microwave ablation combined with PVP,including 14 males and 10 females with an average age of 58.2 years (range,32 to 73).Preoperatively all the patients suffered with the local pain and the spinal cord or nerve root compression symptoms.The locations of the lesions included:14 in the thoracic and 10 in the lumbar.The primary tumors type:lung cancer 6 cases,breast cancer 3 cases,liver cancer 2 cases,kidney cancer 2 cases,gastric cancer 1 case,prostate cancer 1 case,ovarian cancer 1 case,osteosarcoma 1 case,fibrosarcoma 1 case,colon cancer 1 case,and unknown source tumor 5 cases.The preoperative Tomita score was 4-7 points (mean 6.3 points),and the Tokuhashi score was 8-11 points (average 9.3 points).23 patients with the spinal metastatic were treated with cooled microwave ablation combined with PVP.1 patient were treated with cooled microwave ablation only.The clinical outcomes were evaluated using visual analogue scale (VAS) and Frankel grading.The local control rate was evaluated by imaging.Resuits All cases were followed up for 5 to 36 months.The tumor volume size was 3.2-12.1 cm3 by preoperative measurement.Each lesion was heated to 3-7 hot zones.Each hot zone was heated for 5 minutes.The total heating time was 15-35 minutes (mean 22.1 minutes).The temperature inside the lesion was (56.2±5.83) ℃.The temperature inside the spinal canal was (33.6±5.14) ℃.The visual analogue scale (VAS) of the 24 patients at 24 hours and 3 months after operation was statistically different from the preoperative visual analogue scale (VAS).The Frankel grading of 19 patients had at least one grade improvement 3 months after operation.6 cases died due to systemic multiple metastases 5-8 months after surgery.9 patients had more than one organ metastasis or bone metastasis during follow-up,and survived with tumors.The remaining 9 cases did not recur or transfer during the follow up period.No nerve damage or other complications were observed in all patients.Conclusion The cooled microwave ablation combined with PVP could relieve the pain in spinal metastases,relieve the nerve compression,and reconstruct the stability,which is a safe and effective palliative surgical method.
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Objective To evaluate the clinical effectiveness of the treatment for the proximal femur malignant bone tumor by conducting intercalary diaphyseal endoprosthetic reconstruction.Methods Form June 2011 to July 2014,7 patients who had proximal femur malignant bone tumor were treated with intercalary diaphyseal endoprosthetic reconstruction.There were 3 males and 4 females,61.8 years old on the average (ranging from 28 to 76 years).The tumors involved:4 case of the limbs primary malignant tumor,1 case of osteosarcoma,1 case of juxtacortical osteosarcoma,1 case of malignant lymphoma with pathological fracture,and 1 case of malignant fibrous histiocytoma with pathological fracture,as well as 3 cases of the Metastatic breast cancer of the proximal femur.All patients were evaluated by plain radiography,CT and MRI before operation.After these 7 patients were examined with MRI and the level of osteotomy was determined,prosthesis fitting is ready.The exposures of all the tumors were via the femur lateralis surgical approach.According to the general principles of tumor surgery,expose the tumor segment and soft tissue tumors.The segment of involved bone was then removed,with a surrounding cuff of normal tissue overlying the tumor.The level of osteotomy was determined as the result of preoperative imaging measurement.The proximal and distal femur intramedullary canals are reamed.The prosthesis is assembled and installed after the cement used.Results The duration of surgery was from 45 min to 120 min (90 min on average).The blood loss was from 200 ml to 800 ml (400 ml on average).All patients were followed-up for 6 months to 2 years (14 months on average).1 case with osteosarcoma died due to pulmonary metastases 18 months after surgery.The remaining 3 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.1 case with the metastases was comprehensive treated in another hospital,and survival with tumors.The remaining 2 cases with the metastases did not recur or transfer during the follow-up period.Conclusion The clinical results demonstrated that the intercalary diaphyseal endoprosthetic reconstruction was an ideal treatment for the proximal femur malignant bone tumor.
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Objective To evaluate the clinical effectiveness of the treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs by microwave heliotherapy combined with prosthesis replacement.Methods From June 2001 to April 2012,19 patients with intramedullary broad dissemination of malignant bone tumor of limbs were treated with microwave heliotherapy combined with prosthesis replacement.There were 12 males and 7 females,47 years old on the average (ranging from 11 to 65 years).The tumors involved:primary malignant tumor 11 cases,metastases of the scapula 8 cases.Locations of tumors involved:the distal femur 8 cases,the proximal tibia 6 cases,the proximal humerus 3 cases and the proximal femur 2 cases.After the patients were examined with MRI and the level of osteotomy was determined,the prostheses were custom-made.The exposures of the all tumors were via the conventional surgical approach.The lesions were heated at 50 ℃ for 20 min by 2 450 MHz microwave,with surrounding soft tissue protected by copper mesh.The level of osteotomy was determined by the result of preoperative imaging measurement.The prosthesis was installed after the microwave heliotherapy.Results The duration of surgery was from 60 min to 150 min (100 min on average).The blood loss was from 300 ml to 1200ml (600 ml on average).All patients were followed-up for 10 months to 5 years (2.7 years on average).1 case with chondrosarcoma relapsed 18 months after surgery,and survived with tumors.1 case with malignant fibrous histiocytoma died due to multiple metastases 8 months after surgery.1 case with Ewing sarcoma died due to pulmonary metastases 23 months after surgery.The remaining 7 cases with the primary malignant bone tumors did not recur or transfer during the follow-up period.6 cases with the metastases died due to metastases 5 to 20 months after surgery.The functions of shoulder joint of 3 proximal humerus tumor patients were restricted,while 16 patient's function weren't restricted.Conclusion The clinical results demonstrated that the microwave heliotherapy combined with prosthesis replacement was an ideal treatment for the intramedullary broad dissemination of the malignant bone tumor of limbs.
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BACKGROUND:Segmental bone defects resulting from osteoporotic fractures, trauma, congenital bone dysplasia and progressive bone disorder are very common, and bone tissue engineering provides a new approach to bone defect repair. Growth factors related to bone tissue engineering bone have been reported a lot and have achieved some results. How to mimick the natural timing of different growth factors with different bioactivities has become the current hotspot in bone repair. OBJECTIVE: To review the new developments in vascular endothelial growth factor and bone morphogenetic protein in bone tissue engineering. METHODS: The first author searched CNKI (1990/2015) and Medline database (1990/2015) for related articles using the key words of “osteogenic factors, angiogenic factors, tissue engineering bone, bone repair, vascularization, vascular endothelial growth factor, bone morphogenetic protein, sequential release, seed cels, cytoskeleton” in Chinese and English, respectively. Mechanism of action and research direction about vascular endothelial growth factor and bone morphogenetic protein were summarized. RESULTS AND CONCLUSION:Totaly 313 papers were searched initialy, and finaly 87 papers were enroled in result analysis. The results show that different growth factors play different roles in bone repair. Vascularization and osteogenesis are the most important processes in bone repair. The osteogenic factors play an important role in maintaining bone structure and bone formation. The angiogenic factors can provide oxygen and nutrients for tissue growth, differentiation and functionalization. The combination of osteogenic and angiogenic factors has a better osteogenic effect than osteogenic or angiogenic factors used alone. However, the most important problem is how to control the exogenous osteogenesis and the release dosage of angiogenic factors in bone repair.
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Objective To study clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum with less limb damage and complications.Methods From October 1999 to August 2009,18 patients with pelvic tumors around acetabalum (zone Ⅱ of Ennekingl were treated with tumor resection and femoral head exclusion,including 16 males and 2 females with an average age of 54 years(range,18-72).The diagnosis were chondrosarcoma(4 cases),osteosarcoma(2),giant cell tumor of bone(4),synoviosareoma(1),malignant fibrous histiocytoma(1),Ewing sarcoma(1),and metastatic carcinoma(5).Throe cases were treated by selective arterial embolization before operation and 4 cases by temporary block of lower abdominal aorta or common iliac arte.Regular follow-up in clinic was done to observe function of joint and radiographic imaging.Results All patients were followed up for 55 months(range,3-118).The mean surgical time was 170 min(range,120-350 min).The mean blood loss was 1200 ml(range,600-2200 ml).All wounds were healed without infection.One patient with osteosarcoma and 3 with metastatic carcinoma died of multiple organ metastases during 6 months to 2 years after operation.The others had no local relapse.The mean limb discrepancy was 5.0 cm (range,2.0-7.5 cm).The mean Enneking score was 23 (range,20-27).All patients needed custom-made shoes with heightened heel of 2-3 cm.Osteonecrosis of the femoral head was not found in radiographic images.Eight cases had formed artificial acetabulum.One case had gentle lumbar scoliosis.Conclusion The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum had low complications,less pain,low relapse,better function in the recent period.
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Objective To investigate the clinical outcomes of microwave heliotherapy in situ on the primary or metastatic malignant tumors of the pelvis.Methods From February 2000 to April 2009,18 patients with primary or metastatic malignant tumors of the pelvis were treated with microwave heliotherapy in situ,and followed a total or partial tumor resection.There were 11 males and 7 females with an average age of 45 years(range,16-72).Twelve cases were diagnosed as primary malignant tumor and 6 as metastases.Locations of tumors involved:the Ⅰ region 6 cases.the Ⅱ region 10 cases.and the Ⅲ region 2 cases.The exposures of all tumors were via aTtype or ilioinguinal approach.The lesions were heated at 50℃ for 20 min by 2450 MHz microwave,with surrounding soft tissue protected by copper.mesh.The necrotic tumor tissues were total or partial excised after treatment,with preservation of the anatomical continuity of the pelvic ring.Results The duration of surgery was 60-180 min (110 min on average).The blood loss was 400-800ml(480 ml on average).All patients were followed-up for 0.5-7 years(3.5 years on average).Tumor local recurred in 1 case with chondrosarcoma,and was survival in tumor-bearing after 6 months follow up.One case with malignant fibrous histiocytoma died due to brain,pulmonary,and all body metastases.One case with osteosarcoma died due to pulmonary metastases.Five cases with the metastases died due to non-pelvis metastases.Functions of hip joint in 18 patients were as follows:flexion 80°-130°,extension 0°-10°,abduction 25°-35°,and adduction 18°-23°.Conclusion The clinical result demonstrated that the advantages of microwave heliotherapy in situ were quick increase of temperature,sensitive responses,easy control of temperature,and effective inactivation of tumor cells in the malignant bone tumors of pelvis.
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Objective To investigate the methods and therapeutic effects of image-guided percutaneous needle iniection of methylprednisolone and injectable calcium sulfate for simple bone cysts.Methods Thirty-seven patients with simple bone cysts from 0ctober 2006 to August 2010 were analysed retrospectively in our hospital,including 26 males and 11 females with the average age of 13.2 years(range,8-22 years).Five cases of proximal femus lesions,with proximal thigh pain,limp and other symptoms.Thirty-two cases of proximal humeral lesions,16 patients had proximal pain and other symptoms of upper arm,the other 16 cases were asymptomatic.Preoperative AP and lateral X-ray.CT and MRl were taken.Under the C-arm X-ray monitor.two needles were inserted into the proximal and distal of cysts respectively,Omnipaque contrast was iniected to confirm the two needles is interlinked,then repeated rinsing with normal saline,then 120 mg methylprednisolone and iniectable calcium sulfate were injected,till the cysts were full up.Patients after treatment were assessed according to modified Neer X-ray criteria.Resuits The average hospitalization was 2.3 days (range.1-3 days).X-ray was reviewed every month,additional injection was performed if bone cysts stopped decreasing for 2 consecutive months,iniection 2 times in 6 eases,and 31 cases were injected only once.After 3 months follow.up 37 cases,according to modified Neer X-ray criteria,6 eases regarded as grade Ⅱ,8 as grade Ⅲ,23 as grade Ⅳ;after 6 months,31 patients were followed up,including 2 cases as grade Ⅱ,4 cases as grade Ⅲ,25 as grade Ⅳ;after 24 months of follow-up 26 cases,3 as grade Ⅲ,23 as grade Ⅳ;after 36 months follow-up,19 cases were all grade Ⅳ.Conclusion Imaging-guided percutaneous iniection of methylprednisolone and inieetable calcium sulfate for simple bone cysts has demonstrated,with less trauma,lower complications incidence and quicker recovery.
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Objective To evaluate the clinical effectiveness of the treatment for hip osteoid osteoma by CT-guided percutaneous microwave ablation. Methods From August 2006 to January 2010, 8 patients with the osteoid osteomas of the hip were treated with CT-guided percutaneous microwave ablation, including 5 males and 3 females with an average age of 18.8 years (range, 12 to 25). The history of local pain was ranging from 2 months to 10 years, with aggravation of pain at night. The locations of the lesions contained: 4cases in the neck of femur, 2 in the lesser trochanter, 1 in the greater trochanter and 1 in the femoral intertrochanteric line. After localization of the nidus with CT, osseous access was established with a Gallini puncturatio needle. After scanning the nidus with CT, a trocar was used to obtain specimens for pathological examination. Subsequently, a microwave probe was introduced through the biopsy needle to the nidus. Microwave ablation was performed at 90 ℃ for 4 to 6 minutes. Prophylactic antibiotics were used two days postoperatively. Results Three patients were diagnosed as osteoid osteoma with the pathological confirmation after the operation, 5 cases were not diagnosed by the pathological confirmation. All the cases were followed up for 6 to 21 months. All the patients reported alleviated pain in the first 24 hours postoperation. One case with lesion in the right proximate femur retained mild pain without nonsteroidal antiinflammatory drugs 5 month after operation. The same procedure was done once more on this patient, and the outcome was good. No osteonecrosis of the femoral head and other complications were observed in all patients. Conclusion By CT-guided percutaneous microwave ablation for osteoid osteomas of hip reliably relieves pain with few complications and recurrences. The short-term efficacy is satisfactory. It is a safe and effective technique for treatment of osteoid osteoma.
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Objective To investigate the clinical Results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tu-mors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average (ranging from 13 to 59 years). The tumors included: the primary malignant tumor of the scapula (12 cases), the metastases of the scapula (5 cases). Locations of tumors included: the SI region (14 shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃ fur 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes (120 minutes on average). The blood loss was from 300 ml to 1000 ml (460 ml on average). All patients were followed up for 3 months to 10 years (4.2 years on average). Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died due to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient's superduet function of shoulder joint was re-stricted. Conclusion The clinical Results demonstrated that the advantages of microwave heliotherapy in-cluded quick increase of temperature, sensitive responses, easy control of temperature, and effective inacti-vation of tumor cells in the malignant bone tumors of scapula.