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Objective:To propose and verify a surgical classification system for the axial primary malignant and aggressive benign tumor.Methods:The CZH surgical classification system was originally developed for the axial primary malignant and aggressive benign tumor. The CZH surgical classification system includes seven types, according to the anatomic features and the extension of tumor violation. A total of 136 patients (79 males and 57 females) with axial primary malignant and aggressive benign tumor from multiple tertiary centers who received surgery from July 2006 to July 2019 were included. The average age was 44.40±17.55 years (8-83 years) old. There were 99 malignant tumors and 37 aggressive benign tumors included. The number of patients with each classification was presented as followed, Type I 13, Type II 15, Type IIIa 3, Type IIIb 20, Type IVa 43, Type IVb 12, Type Va 21, Type Vb 3, Type VI 2, Type VIIa 3 and Type VIIb 1. Surgical procedures were selected according to different types in classification. The inter- and intra-observer consistencies were evaluated by the Kendall's W test. The VAS, Frankel score, overall survival and recurrence free survival were recorded during the follow-up. Results:The inter- and intra-observer consistent coefficient was 0.973 and 0.996, respectively ( P<0.05). The single posterior approach was adopted for the Type II tumors. Other patients underwent surgery by the combined antero-posterior approach. The majority in anterior approach (113 cases) was the modified submandibular approach. The reconstruction modes included anterior "T" shape titanium mesh (112 cases) or the 3D printed prothesis (7 cases) combined with the posterior occipto-cervical fusion (92 cases) or the pedicle screw system (44 cases). The average surgical duration and the volume of intraoperative bleeding was 348.40±136.14 min (60-760 min) and 1 225.69±859.40 ml (80-4 000 ml), respectively. The operation duration and volume of intraoperative bleeding among each type were with statistical difference. The patients with Type IV, V tumors had longer operation duration than those with Type II tumors. Those with Type V and VII tumors had longer operation duration than those with Type I tumors. The patients with Type V tumors had more intraoperative bleeding than those with Type I-IV tumors. The average preoperative VAS score was 4.15±2.25 and then was reduced significantly to 0.62±0.71 and 0.38±0.59 at one and three months after operation, respectively. The Frankel score was also significantly ameliorated at one and three months postoperatively. There were 22 postoperative complications (16.2%). The complications included cerebral spinal fluid leak (12.5%), dysphagia and/or dysphonia (7.4%), dyspnea (5.1%), wound infection (3.7%), wound hemorrhage (2.2%) and pharyngeal dehiscence (1.5%). The incidence of postoperative complication was 25.9% in Type IV-VII tumors, while 11.8% in Type I-III tumors. Conclusion:CZH surgical classification system was verified with high observer consistency. This classification system could assist surgeons to select proper surgical approaches, resection modes and reconstruction modes, and thus ensure the safety of surgery and reduce the recurrence. The tumors in Type IV, V and VII may be with more challenging for surgeons. The incidence of postoperative complication in Type IV-VII tumors may be higher than that in Type I-III tumors.
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Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes.Methods From March 2011 to December 2013,21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed.The patients included 9 males and 12 females,with a mean age of 47.1± 15.6 years old (range,15-71 years old).This series included 12 cases of primary bone tumors and 9 cases of solitary metastases.Preoperative evaluation according to clinical,imaging and pathologic features was performed meticulously to select patients.The length of surgery,estimated blood loss,surgical margins,instrumentation failure,perioperative complications,Frankel scale,visual analogue scale (VAS) for pain,local control rate and overall survival were reviewed and analyzed.Results Total en bloc spondylectomy was performed successfully in all patients.Average operative time and estimated blood loss were 297.6±44.6 min (range,225-420 min) and 2 247.1±904.5 ml (range,900-4100 ml),respectively.The mean follow-up time was 50.4± 17.1 mons (range,24-79 mons).All patients encountered nerve roots stretch and 5 patients (23.8％) showed lower extremeties neurological dysfunction.All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow -up.Cerebrospinal fluid leak was found in 4 patients (19.0％).The VAS score was 1.5±1.4 at post-operation,which was significantly lower than the 6.2± 1.6 in average at operation (P=0.008).Three patients with metastatic tumors died during the follow-up.Titanium mesh cage subsidence was observed in 7 patients (33.3％).No implant failure was occurred during the follow-up.Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible.However,there are many intraoperative neurological complications and the indications for TES are extremely limited.
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Osteosarcoma is a clinically common primary malignant bone tumor.Its treatment is still not ideal because of the high de-gree of malignancy and early metastasis.Understanding the molecular mechanism and the biological characteristics of malignant os-teosarcoma,and exploring the effective treatment have become the focus of osteosarcoma research at home and abroad.A long non-coding RNA,lncRNA,is involved in the regulation of a variety of cellular functions and plays an important role in the development of osteosarcoma.Recently,lncRNA has been increasingly reported in osteosarcoma research.It has been found to affect the proliferation, invasion,and migration of osteosarcoma cells by interacting with proteins,mRNAs,and miRNAs.This article reviews the research on ln-cRNA based on recent reports regarding its role in the molecular mechanism of osteosarcoma.
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Objective To investigate the safety and feasibility of en-bloc resection of a primary sacral chordona based on a 3-dimensional printing model.Methods 31 patients with primary sacral chordoma underwent en-bloc resection via a onestage posterior approach or combined anterior and posterior approaches in our oncology department from January 2013 to December 2014.They comprised 21 males and 10 females of mean age (49.2±12.5) years (range,26-67 years).Preoperative 3-D printing models were created by 3D printing technology,it included tumor tissue,the around vascular and nerves involved in sacral chordoma.The sacral chordomas were en-bloc resection with decompression and internal fixation.Results With the mean (29.0±6.8)months follow-up (range from 19 to 41),all patients underwent en bloc excision via 26 cases with posterior approach,5 cases combined posterior and anterior approaches in one stage.The mean operative time and estimated blood loss were (275.0±58.1) min and (3 250.0±1 304.4) ml,respectively.The visual analogue scale (VAS) score was (5.6±1.9) in average (range from 3 to 9) at preoperation,and (2.0±1.5) at post-operation,which was significantly lower than that of preoperation,and the pain was relief obviously.There were 13 cases in grade C,11 cases in grade D,7 cases in grade E of American Spinal Injury Association (ASIA) grade neurological function before surgery,compared with the pre-operation,there were 5 cases in grade C,6 cases in grade D,20 cases in grade E of post-operation,which was significantly improved.MSTS (Musculoskeletal Tumor Society) 93 score was 6-29 points (20.0％-96.7％) at the follow-up 3 months after surgery,with the average of (19.8 ± 5.8) points,which excellent in 8 cases,good in 14 cases,general in 5 cases,poor in 4 cases.Two cases of dysporia for the reasons of resecting on one side of the S1,2 nerve roots involved by the sacral chordoma,after sacrificing the nerve root of complete tumor resection,the urine left dysfunctional,while the pain of other 29 patients were thoroughly relief after surgery.The ones were relieved with the disturbance of sensation of the perineum before the operation.2 cases were recovery of leakage of cerebrospinal by the drainage of lumbar cistern with normal temperature.One hypostatic pneumonia patient was cured by anti-inflammatory.One with the urinary infection got better by the effective bladder irrigation,which had diabetics mellitus with the bladder stoma before.1 case of skin necrosis due to vascular thrombosis before operation,recevied flap translocation half month after surgery,got recovery 3 months later.Only one underwent tumor resection for the recurrence at 15 months follow-up.Conclusion It is feasible and safe to perform en bloc resection of primary sacral chordoma.This is the most effective means of managing method of the marginal resection of the tumor.Preoperative 3-D printing modeling enables better anatomical understanding of the relationship between the tumor,and can avoid vascular and nerves tissue injury,which can also assist in planning the surgical procedure,and be worth recommendation.
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Objective To investigate the role of Beclin 1 in the genesis and development of osteosarcoma and the effect of Beclin 1 overexpression on the growth of the in vitro osteosarcoma cell line MG63.Methods Real time-polymerase chain reaction (RT-PCR) and Western blot were used to detect the expressions of Beclin 1 in MG63 and hFOB1.19 at mRNA and protein levels ; A eukaryotic clone of plasmid pEGFP/Beclinl fusion with protein EGFP/Beclin 1 was constructed and was transfected into human osteosarcoma cell line MG63 by using lipofectamine 2000.The effect of Beclin1 overexpressions on the proliferation of MG63 cells was evaluated by MTT assay.Cell apoptosis was measured by flow cytomerty(FCM).Results The mRNA and protein expression of Beclin1 in human osteosarcoma cell line MG63 was significantly lower than that in the human osteoblast cell line hFOB1.19(0.17 ±0.06 vs 0.43 ±0.11,t =29.493,P ＜0.01 ; 0.13 ±0.05 vs.0.25 ± 0.08,t =6.325,P ＜ 0.01).The transfection of pEGFP/Beclinl increased the mRNA levels of human osteosarcoma(5.34 ± 0.50) times in transfected tumor cells MG63.The rate of cell apoptosis was low in control or transfected with lipofectamine 2000 only cells at an average of(0.10 ± 0.05) ％.The apoptosis rate was significantly higher in pEGFP/Beclin1 transfected cells than control cells ((4.3 ± 0.8) ％,t =5.752,P ＜ 0.05).Conclusion Compared with control cells,Bedin1 is down-regulated in the human osteosarcoma cell line MG63,which indicate the role of Beclin 1 in regulating the malignant behaviors of osteosarcoma.Beclin1 overexpressions inhibits cell proliferation and induces apoptosis in MG63 cells.
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Objective To evaluate the validity and reliability of simplified Chinese version Scoliosis Research Society-22 (SRS-22) questionnaire on assessment of life quality of adolescent idiopathic scoliosis (AIS) patients at different time points pre-and post-operation. Methods Translation and cross-cultural adaptation of the English version of SRS-22 questionnaire was done. 177 AIS patients were involved in present study and the life quality before and 6-and 12-months after operation was assessed by SRA-22 and Short Form-36 (SF-36) questionnaire, of them 145 cases (26 males and 119 females; 11.1-17.9 years old, averaged 15.8; Cobb angle 41?-109?, averaged 63?) completed all the 3 steps. To evaluate the reproducibility, 65 patients were assessed twice in an interval time of 4-6 days (averaged 4.6 days) before operation and 55 valid questionnaires were received, 65 patients were assessed twice in an interval time of 7-21 days (averaged 14.7 days) at 12 months following up and 57 valid questionnaires were received. The two measures of reliability as internal consistency and reproducibility were determined by Cronbach's ? coefficients and intraclass correlation coefficient (ICC), respectively. Concurrent validity was measured by comparing with SF-36 questionnaire. Measurement was made using the Pearson correlation coefficient (r). Results The Chinese version SRS-22 questionnaire had a satisfactory validity and reliability, with average Cronbach's ? coefficients of 0.79-0.85 and average ICC of 0.77-0.87. Considering concurrent validity, 2 domains had excellent correlation (r=0.75-1.00), while 12 had moderate correlation (r=0.50-0.75). The function/activity (SRS-22) and role-physical or physical functioning (SF-36), pain (SRS-22) and pain index (SF-36), mental health (SRS-22) and mental health (SF-36) had good correlation (r=0.70-1.00). For the 145 patients, there were some differences in 5 various domains between the three measurements (pre-operation and 6 and 12 months post-operation). The scores of all domains 12 months after operation increased significantly than those of pre-operation and 6 months post-operation (P