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Objective To approach the effective treatment for simple bone cyst in adult. Methods Forty-eight cases were divided into two groups by visiting order, 20 cases (steroid group) were treated by prednisolone acetate and 28 cases (open resection and allograft group) were treated by open resection and allograft. The curative effect were contrasted between two groups. Results The follow-up time was 5-46(26.58 ± 10.81) months. Aecording to the Chigira's healing criteria for simple bone cyst, grade Ⅰ , Ⅱ , Ⅲ,V were 1, 2, 10 and 7 cases respectively in steroid group, contrasting to 0, 3, 5 and 20 cases respectively in open resection and allograft group. The recovery rate was 85.0%(17/20) in steroid group and 89.3%(25/28) in open resection and allograft group, which was no statistically significant difference between two groups (P＞0.05). Conclusions Although the two remedies are no obvious difference in curative effect,simple bone cyst at lower extremity of weight-bearing with obvious osteolysis in adult is recommended to open resection and allograft, otherwise or at upper extremity to steroid injection.
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OBJECTIVE:To evaluate the feasibility and initial outcome of reconstructing the defect femur by unicondylar osteoarticular altograft after resection of distal femur tumor.METHODS:Between July 2003 and August 2008,a total of 12 patients with distal femur tumor treated by unicondylar resection and fresh-frozen unicondylar osteoarticular allograft reconstruction of bone defects were retrospectively reviewed at the Department of Orthopedics,General Hospital of Chinese PLA.Of 12 patients,5 medial and 7 lateral femoral condyles were involved.There are 8 patients suffering from giant cell tumor,including 2 patients complicating with pathologic fracture,3patients suffering from osteosamoma and 1 patient suffering from low-grade fibrosarcoma.Before transplantation,MRI and/or CT were used to determine that the tumor was definitely limited in half condyle.Three cycles of chemotherapy preoperatively and six cycles of chemotherapy postoperatively were conducted in patients suffering from osteosarcoma and fibrosarcoma.Patients with giant cell tumor did not receive any intraoperative adjuvant treatment.The surgical margin of resected tumors was evaluated by histological examination.All patients were followed by radiograph or CT.Postoperative function was evaluated by Musculoskeletal Tumor Society (MSTS) scoring system at the time of the latest follow-up.RESULTS:All patients were followed up.The patients were followed up mean 35 months after transplantation.None of the patient died.No local recurrences and metastases were found at the latest follow-up.No evident immune rejection and deep infection were seen.No plate loosening or breakage was observed.All patients had their grafts retained at the time of the latest follow-up.Three patient's allograft showed subchondral bone collapse and articular deterioration,but the function was good.Instability of the knee joint was noted in 3 patients.The mean MSTS functional score (totally 30 points) was 26 points.CONCLUSION:For some patients with giant cell tumor or malignant tumors with clearly defined margins after chemotherapy.When the lesions were limited in half condyle and enough surgical margins can be achieved,reconstruction of bone defect with unicondylar osteoarticular allografts after bone tumors were resected appears to be a reliable alternative.
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Objective\ Treatment of spondylolisthesis using freeze dried femoral ring allografts plus morselled cancellous autografts (called as composite cortical ring) by anterior lumbar interbody fusion (ALIF). Methods\ Fourteen patients were treated by this procedure, there were six males and eight females. The age of the patients range from 40 to 56(average 46). Ten segments were of grade Ⅱspondylolisthesis, five segments were of gradeⅠ. Ten patients were treated with RF as internal fixation, four patients with short Harrington rod as internal fixation. Results\ The fusion rate and clinical results of ALIF were analyzed by comparing the findings on the X-ray films taken preoperatively and 6 months postoperatively as well as by JOA score. The fusion rate of 15 segments of 14 patients(two segments of 1 patient was fused) is 85.7%, the average improvement rate of JOA score is 73.3%at an average follow up of 26.6 months. Conclusion\ ALIF with composite cortical ring could successfully restore the spinal structure, maintain the interspace height distracted intraoperatively, obtain high fusion rate and excellent clinical results.\;
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Objective To study the clinical, imageological and pathologic characters of primary synovial chondromatosis of hip joint, and effect of open surgery. Method 12 cases of primary synovial chondromatosis of the hip joints admitted from May 1973 to May 2004 were retrospectively studied in respect to clinical manifestations, X-ray picture, and pathological findings. The effects of operation were followed up. Results Intermittent pain, swelling, limitation of hip joints were the main complaints. Mass and myatrophy near involved hip joint were discernible in a few patients. Although there was no obvious image of calcification, swelling of articular capsule was seen in X-ray film in 4 patients. CT scan showed arthroedema, loose bodies and bone erosion of the femoral head in the hip joint. The X-ray films of the other 8 patients showed obvious calcified loose bodies. All cases were diagnosed by pathology after operations. 8 cases were categorized Milgram Ⅱstage, and 4 cases Milgram Ⅲ stage. Eight patients were followed-up for a period of 1 to 7 years (mean 5 years). Recurrence occurred in 2 cases. Conclusion The diagnosis should be based on clinical characters, X-ray films and pathologic findings, and the pathology is most reliable. In order to decrease recurrence, CT or MRI examinations should be taken before the operation. X-ray monitoring should be carried out during the operation of the patient in whom loose bodies were found in X-ray film before the operation.