Massive allograft implantation for limb salvage: a clinical study of 20 cases.

From January 1986 to October 1991, the resection of tumorous bone conditions and large allograft implantations were performed in 20 patients at the Department of Orthopaedics and Rehabilitation Medicine, Ramathibodi Hospital, Bangkok, Thailand. The allografts were provided by Bangkok Biomaterial Center at Siriraj Hospital. There were 3 basic groups of grafts: osteoarticular 14, intercalary 3, and allograft-prosthetic composite 3. The diagnosis included 11 osteosarcomas, 1 secondary chondrosarcoma, 1 primary lymphoma, 5 giant cell tumors and 2 metastatic tumors. The average age of the patients was 23.5 years. The average length of the grafts was 14.9 cms. The average follow-up period was 36 months. At the time of evaluation, 70 per cent of the patients had excellent or good results. The complication rate was about 35 per cent but only 15 per cent needed amputation. Rejection of the graft was detected in only 1 patient. The use of large fresh frozen allografts is still necessary in this country because it provides a simple, inexpensive and effective technique of limb salvage in Thailand.

Risk factors for neural deficit in spinal tuberculosis.

From 1975 through 1989, retrospective study of 155 patients with spinal tuberculosis was carried out at Ramathibodi Hospital to study predisposing factors to neural deficit and results of treatment. Two groups of patients who had no neural deficit and had neural deficit were compared. Clinical characteristics of the patients between the two study groups were similar with regard to sex, duration of symptoms, number of vertebrae involved, angle of gibbus deformity and erythrocyte sedimentation rate. There were statistical differences in age, cephalad level of infection, loss of vertebral body and clinical evidence of cold abscess. For patients with neural deficit, the results generally are good with anterior decompression and stabilization.

Limb salvage for extremity sarcoma in Ramathibodi Hospital.

From May 1986 to July 1991, a retrospective review of 27 patients treated with limb salvage surgery for extremity sarcomas, was evaluated by our team. There were 12 males and 15 females with a mean age of 22.7 years (ranging from, 9 to 53 years). The mean of the follow-up period was 27.6 months. (ranging from 6 to 62 months). Twenty-four patients had bone sarcomas which included 20 osteosarcomas, 3 chondrosarcomas and one adamantinoma. The locations of bone sarcomas were the proximal tibia (6 cases), distal femur (5 cases), proximal humerus (4 cases), proximal fibula (3 cases), scapula (3 cases), proximal femur (1 case), tibial shaft (1 case) and pelvis (1 case). The remaining three patients had malignant fibrous histiocytomas located in scapular, tibialis anterior muscle, and knee regions. In total there were 1 stage IA, 2 stage Ib, 1 stage IIA and 23 stage IIB. Twenty-four cases had wide excisions; two had marginal excisions and one radical excision. There were 17 bone reconstructions consisting of 11 allografts and 6 autografts. At the most recent follow-up examination, 74 per cent of the patients are alive and the overall disease free survival was 63 per cent. Local recurrences occurred in 11 per cent. The major complication rate was 3 per cent and the minor complication rate was 33 per cent. With respect to a functional outcome, 84 per cent of the patients achieved excellent or good results.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant osteoblastoma versus osteosarcoma: a case report.

A 33-year-old male developed a slow-growing mass at the anterior aspect of the left tibia for 8 months. The radiologic finding revealed a well-circumscribed osteolytic mass and appeared benign to most radiologists. The lesion was then excised locally. The histology revealed bizarre osteoblasts and osteoclast-like giant cells interspersing in the vascularized stroma and trabeculated osteoids; the periphery of the lesion showed sclerotic mature bones. Malignant osteoblastoma was, therefore, entertained and the patient was treated as such without aggressive surgery and chemotherapy. He has survived for 11 years. However, the diagnosis of malignant osteoblastoma was still a contradiction because of the presence of cartilage foci.