ABSTRACT
Objective To investigate treatment and prognosis of patients with osteosarcoma of the extremities.Methods A total of 311 patients with osteosarcoma of the extremities,who had undergone treatment in our institute from 1998 to 2008,were enrolled in this retrospective study.Kaplan-Meier survival curve and Cox regression model were used to analyze the correlation between survival rate and variables including patients' demographics,chemotherapy,surgery,complications,and tumor metastasis.Results Among 311 patients,there were 206 males and 105 females,aged from 5 to 56 years (average,18.6 years).A total of 282 patients underwent aggressive or radical surgery,including 149 cases of limb salvage surgery and 133 cases of amputation surgery.One hundred and five patients underwent standard chemotherapy and 206 patients underwent non-standard chemotherapy.The 5-year survival rate was 57.4％ in patients treated with standard chemotherapy,36.3％ in patients treated with non-standard chemotherapy,16.8％ in patients with lung metastasis,50.7％ in patients without lung metastasis,56.6％ in patients who underwent limb salvage surgery,31.8％ in patients who underwent amputation surgery,44.6％ in patients with Enneking stage Ⅱ B and 33.1％ in patients with Enneking stage Ⅲ.For patients treated by amputation surgery,because non-standard chemotherapy which was performed in most of them and other confounding factors,the 5-year survival rate of them was lower.The Cox regression analysis showed that lung metastasis and non-standard chemotherapy were associated with inferior outcomes.Conclusion Neoadjuvant chemotherapy combined with aggressive or radical surgery could cure about 60％ of patients with osteosarcoma of the extremities.Lung metastasis and non-standard chemotherapy are risk factors that severely affect prognosis.
ABSTRACT
Objective To discuss clinical effects and indications of minimally invasive tension band technique in treatment of transverse patella fractures.Methods Thirty-eight patients with transverse patella fracture (close or slightly polluted open ones) were treated with minimally invasive tension band technique from July 1997 to June 2005 in our department.Twenty-six were fixated with percutaneous Kirschner wire tension hand and 12 with percutaneous cannulated screw tension band.The reduction,movement range and function of the knee were analyzed.Results Surgeries went on uneventfully.All the cases were followed up from six months to 6.5 years (average,32 months).Fracture healing time lasted from 6 to 12 weeks,averaging 7.7 weeks.No such compli- cations as traumatic arthritis occurred.Reduction was excellent in 21 cases,good in 11 and fair in six,with the good-to-excellent rate being 84.2%.All the affected knee joints could move in normal range.The functional re- covery was assessed as excellent in 34 cases and good in four.Conclusions Internal fixation with minimally invasive tension band technique is good for treatment of transverse patella fractures.It is chiefly fit for close or slightly polluted open fractures with limited wound,and can also be used for the comminuted fractures if the bone fragments are no more than three and the fracture site is suitable.