Comparative analysis of clinical efficacy between posterior percutaneous endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy.@*METHODS@#A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C4,5, 13 cases of C5,6 and 6 cases of C6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C4,5, 14 cases of C5,6 and 5 cases of C6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients.@*RESULTS@#All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups.@*CONCLUSION@#PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.

Application of artificial ligament in treatment of lower abdominal wall reconstruction after pubic tumor resection / 北京大学学报(医学版)

OBJECTIVE@#For patients who had hemipelvectomies involving the resection of a portion or the whole of the pubis, bony reconstruction was not recommended commonly. However, the soft tissue reconstruction of the lower abdominal wall may benefit these patients. The object of the study was to determine the clinical effect of lower abdominal wall reconstruction with LARS ligament after pubic tumor resection interms of patient-reported and objective outcome.@*METHODS@#In this series, we reviewed twenty-five patients who underwent pubic tumor resection followed by reconstruction with LARS ligament between February 2012 and February 2018 retrospectively. We evaluated the clinical outcome and complication of this surgical treatment. The function outcome was evaluated according the musculoskeletal tumor society scores (MSTS) for all the patients at the end of the last follow-up.@*RESULTS@#All the patients were stable during the surgery. There were eight patients who underwent resection of superior ramus of pubis, five patients who had resection of inferior ramus of pubis, and twelve patients who received both superior and inferior ramus of pubis. For all the patients, the mean blood loss was (774±580) mL. The mean operation time was (138±25) min. The mean hospital stay was (19±6) d. For the patients who had resection of superior ramus, inferior ramus, as well as both superior and inferior ramus, the mean blood loss were (763±802) mL, (730±315) mL and (808±485) mL, respectively. The mean operation time were (133±27) min, (135±35) min and (143±20) min, respectively. The mean hospital stay were (18±5) d, (22±9) d and (19±6) d, respectively. The mean follow-up time was (37±21) months. Local recurrence was observed in one patient with chondrosarcoma. One patient with renal cancer metastasis died of the disease. No ligament infection, ligament related complication and incisional hernias were observed. Twenty-three patients could ambulate without assistive devices, and the remaining two could walk by crutches. Postoperative pain was reported as none in nineteen patients, mild in three, and moderate in three. From a functional point, the mean MSTS score was 87±4.@*CONCLUSION@#Lower abdominal wall reconstruction with LARS ligament after pubic tumor resection could have satisfactory clinical outcome. It could prevent the occurrence of herniation, decrease the infection rate by minishing the dead space, and achieve good patient-reported outcome.

Surgical classification and therapeutic strategy for metastases of proximal femur / 中华外科杂志

<p><b>OBJECTIVE</b>To establish a surgical classification system for metastases of proximal femur and discuss the therapeutic strategy with retrospective analysis and literature review.</p><p><b>METHODS</b>The data of 99 patients who underwent a total of 102 operations for femoral metastatic lesions from January 2003 to December 2011 was analyzed. There were 50 males and 49 females, and the median age was 56 years (range 15-87 years). The most common diagnosis was lung cancer (30 cases), followed by breast cancer (17 cases). All femoral lesions were divided into 4 types (I-IV) with different anatomic site and biomechanic characteristic. The patients with various surgical reconstruction mode and postoperative follow-up data were recorded.</p><p><b>RESULT</b>There were 65 side who received widely or marginal resection and 37 side who received intralesional resection. The patients were operated with bipolar hip prosthesis (n = 3), ordinary total hip replacement (THR) (n = 10), bipolar tumor prosthesis (n = 48), THR with tumor prosthesis (n = 8), intramedullary nailing (n = 21), and plate/screw (n = 12). The estimated survival for the 99 patients was 10.3 months. Type I, II, III and IV patients with postoperative American Society of bone and soft tissue tumors-93 rating were 86.5%, 77.3%, 81.3% and 69.1%. Patients with type IV were worse compared with the other 3 groups (t = 4.763, P = 0.031). The 10 operations were followed by complications of any kind. Complication rate of patients with type IV were 3/12, and it was significantly higher than the other 3 groups of patients (χ(2) = 4.018, P = 0.045).</p><p><b>CONCLUSIONS</b>The classifications and corresponsive surgical methods for upper femur metastases had some superiority in hinting prognosis and guiding treatment.</p>

Ewing's sarcoma of bone:treatment results and prognostic factors / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the prognostic factors from the view of clinic and pathology.</p><p><b>METHODS</b>A retrospective analysis was performed on a data set of 78 patients with Ewing's sarcoma treated at Peking University People's Hospital Musculoskeletal tumor center between July 1998 and July 2007. Five-year overall survival (OS), recurrence rate and prognostic factors were analyzed in this study. Univariate and multivariate analysis were performed to determine the prognostic factors for OS.</p><p><b>RESULTS</b>Fifty-three cases were followed up, follow-up time ranged from 8.0 to 101.0 months (median 37.6 months). The 5-year overall survival rate and local recurrence rate were 33.7% and 20.8% respectively. Univariate showed age < 20 years, metastases free at diagnosis, tumor located at extremities, tumor size < 10 cm, adequate surgical margin had better survival rate (all P < 0.05). Multivariate analysis demonstrated that metastases at diagnosis, primary site and tumor size were independent prognostic factors for OS.</p><p><b>CONCLUSION</b>The independent prognostic factors Ewing's sarcoma are metastases at diagnosis, primary site, tumor size.</p>

Evaluation of neoadjuvant chemotherapy for patients with stage II osteosarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively review the effect of chemotherapy and survival rate of osteosarcoma in extremity.</p><p><b>METHODS</b>Between July 1997 and July 2007, 296 patients with osteosarcoma received neo-adjuvant chemotherapy and surgery. There were 184 males and 112 females, with age between 7 and 65 years. The tumors located in proximal femur in 10 patients, diaphyseal of femur in 7, distal femur in 148, proximal tibia in 80, distal tibia in 5, fibula in 11, humerus in 33, and distal radius in 2 patients. According to Enneking stage system, 6 patients were in stage IIA and others in stage IIB. All patients received evaluation of preoperative chemotherapy, and 72 patients had analysis of tumor necrosis after operation.</p><p><b>RESULTS</b>After mean follow-up of 47 months, metastasis developed in 98 (33.1%) patients. The metastatic rate was 15.5%, 31.0%, and 77.1% in patients with substantial effective chemotherapy, partial effective chemotherapy, and no effective chemotherapy, respectively. In tumor necrosis analysis, reduction of tumor volume and more clear margin after preoperative chemotherapy were related to higher tumor necrosis.</p><p><b>CONCLUSIONS</b>The patients with osteosarcoma should receive chemotherapy as soon as possible. More effective chemotherapy means lower metastatic rate and higher no event survival rate.</p>

The surgical treatment of metastatic periacetabular tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively review the experience with different surgical procedures for periacetabular metastasis.</p><p><b>METHODS</b>The data of 43 patients with periacetabular metastasis between July 2000 and July 2007 was reviewed. There were 21 patients with primary malignant tumors at the beginning, and 10 patients diagnosed metastasis by preoperative biopsy. The other 12 patients presented skeletal involved as initial manifestations of metastasis prior to the pathological diagnosis of the primary tumor. Twelve patients had solitary metastasis, and the others had multiple bone metastasis. The surgical procedure included curettage (35 cases) and en-blot excision (8 cases). The techniques of reconstruction of acetabular defect included total hip replacement (THR) with cemented components or titanium acetabular reconstruction cup (12 cases), THR with partial pelvis replacement with Candal Hook (16 cases), THR with Steinmann pins and cement augmented or titanium cup reconstruction (7 cases), and modular hemipelvic prosthesis reconstruction (8 cases).</p><p><b>RESULTS</b>All the patients received successful operations. The average score for preoperative pain of 7.2 was assessed. Forty-one patients (95.4%) were evaluated for relief of pain and resumption of walking, and the pain score improved to 3.5 after surgery. The average functional score was 24.5 postoperatively. Six of 32 patients had local recurrence. Fourteen patients died of diseases. The average blood loss during the operation was 1600 ml in 43 patients and the bleeding exceeded 3000 ml was in 3 patients with renal carcinomas. Major complications included two superficial wound infections, one multiple organ failure and two dislocations.</p><p><b>CONCLUSIONS</b>Although surgery will not typically cure patients of their metastatic disease, surgery that is well planned and well executed can help many people by relieving their suffering and improving their quality of life.</p>

The surgical management of sacral chordoma / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical treatment results and experience of sacral chordoma.</p><p><b>METHODS</b>The data of 51 cases of sacral chordoma surgically treated from July 1997 to July 2007 was retrospectively studied. The age of patients ranged from 21 to 75 years (mean 57 years), including 32 males and 19 females. Forty patients had the first surgery, while other 11 patients were referred to our hospital because of local recurrence from other hospital. Wide resection for all 17 S(3-5) tumors, and wide resection plus piece-meal excision for 34 tumors which involved S(3) above. Reconstruction was performed using pedicle screw and rod device to achieve the continuity between the lumbar spine and the pelvis. The oncologic and functional outcomes of 51 patients were reviewed.</p><p><b>RESULTS</b>After a mean duration of follow-up of 3.5 years (range from 15 to 108 months), 5 of 51 patients died of disease. Seventeen of 40 (42.5%) patients who underwent first surgery recurred during follow-up, 18 of 28 patients (64.3%) got re-relapse after second or third surgeries. Postoperative wound complications were as high as 31.6%.</p><p><b>CONCLUSIONS</b>Chordoma is a biologically aggressive low-grade malignant tumor. Wide resection is a prerequisite for curative treatment of sacrococcygeal chordoma, intralesional curettage causes the risk of high local recurrence for which curative resection in a second or third procedure is more difficult to achieve. In order to preserve near normal bowel and bladder function for the tumor which involves S(3) above, wide en-bloc resection plus piece-meal excision in the cephalad is performed.</p>

Prognostic factors for 72 patients with osteosarcoma of the extremity treated with neoadjuvant chemotherapy / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the prognostic factors that influence survival of patients with non-metastatic, high-grade osteosarcoma of the extremities.</p><p><b>METHODS</b>The data of 72 patients treated between June 2003 and June 2007, was retrospectively evaluated in relation to many factors including gender, age, etc.</p><p><b>RESULTS</b>Tumor necrosis was significantly related to gender, tumor volume change, tumor margin and T2 signal intensity of the extraosseous component of bone sarcomas. Multivariate analysis, tumor necrosis was only related to tumor volume change. Upon multivariate analysis, good histologic response was related to the outcome of patients.</p><p><b>CONCLUSIONS</b>Event free survival is related to the tumor necrosis, the level of alkaline phosphatase and the change of T2 signal of the extraosseous component. Tumor necrosis is related to the volume change after preoperative chemotherapy. These factors must be considered when deciding risk-adapted treatments for patients with osteosarcoma.</p>

The analysis of the treatment of giant cell tumor of the pelvis and sacrum / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the surgical management, local recurrence rate and complications of giant cell tumor (GCTs) of the pelvic and sacrum.</p><p><b>METHODS</b>From December 1997 to December 2005 the data of 46 patients of GCTs of pelvic and sacrum treated were reviewed. There were 25 men and 21 women with the average age of 32 years old ranging from 17 to 64. Out of 46 patients,there were 24 tumors involved the sacrum and the others at the pelvis. According to the site of the tumors on the bone, they was classified into three regions: 8 patients involved region I (ilium), 10 region II (acetabulum) and 4 region III (ischiopubic). Two patients had lesions located at S(1-5), 4 at S(1-4), 12 at S(1-3), 5 at S(1-2) and 1 at S(3-5). Surgical management: 2 patients received 3 times of operations and 7 underwent 2 operations. There were 19 patients managed with intralesional marginal excision and 2 patients with intralesional marginal excision and adjuvant radiotherapy, another 3 patients with widely marginal excision as the treatment of sacral lesions. Nineteen patients underwent the enbloc excision except 2 involved ischium and 1 involved ilium for the managements of pelvic lesions.</p><p><b>RESULTS</b>One recurrent patient with the large, ragged tumor died of serious infection in 2 weeks after the second surgery. The remain 45 patients had followed-up durations ranging from 12 months to 8 years. One patient of malignant giant cell tumor of sacrum died at 15 months after surgery. One patient with postoperation sarcoma underwent reoperation and radiotherapy but died at the 13th month. One patient with sacral lesion occurred pulmonary metastases in two years after surgery, and received chemotherapy with ADM, DDP and IFO. One year later there was no much change in metastatic tumor. One patient with acetabular lesion underwent curettage before local recurrence and pulmonary metastases were found in 2 years. The patient was treated with pulmonary radiation, widely marginal excision and hemi-pelvic prostheses reconstruction. There was no progression in metastatic lesion during the following up. The local recurrence rate of GCT at sacrum was 9/24 (37.5%), and at pelvis was 2/22 (9.1%). However, 2 patients with ischium lesions both recurred after curettage. Nineteen lesions with enbloc excision showed no recurrence at all.</p><p><b>CONCLUSIONS</b>The treatment for GCT of the pelvic and sacrum should be more aggressive because of high incidence of local recurrence after intralesional excision. Although it might induce sacral nerve deficit, widely marginal excision is the best surgical procedure because of its low recurrence rate.</p>

Surgical treatment and outcome of pelvic metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively review the different types of surgical procedures for pelvic metastases, especially for periacetabular metastases.</p><p><b>METHODS</b>Eighty-eight patients with pelvic metastasis received surgical treatment between July 1997 and July 2005. The series included 40 females and 48 males, with an average age of 54 years. The original sites of carcinoma included 23 from breast, 15 from lung, 13 form kidney, 3 from thyroid, 2 from bladder, 3 from prostate, 3 form liver, 7 from gastro intestine, and 3 from gynecological viscera Thirteen cases were diagnosed as unknown primary metastases. Thirty-two patients had solitary metastasis and 56 patients had multiple bone metastases. Eighteen patients had Type I pelvic resections, 50 had type II, and 10 patients had Type III and Type IV each. Surgical treatments included 72 intralesional curettages and 16 en bloc resections. In 29 patients, the bone defect after tumor resection was reconstructed with methyl acrylate alone or combined with Steinmann pins and screw-rod system. Acetabular reconstructions underwent in 50 patients. Local resections with no reconstructions were done in 5 patients, and hemipelvectomy in 4 patients.</p><p><b>RESULTS</b>The mean time of follow-up was 13 months, ranging from 6 to 24 months. Twenty-nine patients were lost follow-up. Postoperative improvements in 86 (97.8%) patients were seen in pain and mobility scores. The average VAS pain scores were 7.2 points preoperatively and 3.5 points postoperatively. Postoperative function was evaluated according to Enneking's criteria, with a mean score of 19.2 points, including 16.4 points for periacetabular lesions and 23.5 for others. Local recurrence was seen in 11 patients, the average recurrence time was 5.6 months after surgery. Surgical complications occurred in 12 patients, including 8 wound complications, 2 multi-organ function failures, 1 pulmonary embolism, and 2 dislocations.</p><p><b>CONCLUSIONS</b>The indications of surgical intervention for pelvic metastasis are severe pain and difficulty in ambulation. The surgical objective is alleviation of pain, restore the mobility and stability of the hip. The surgical procedure for most metastases is curettage and cement filling. Wide resection is an alternative method for solitary pelvic metastasis with good prognosis.</p>

Endoprosthetic reconstruction after resection of the tumor of the proximal femur / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome and complications of endoprosthetic reconstruction after wide tumor excision on the patients with neoplasms at the proximal femur.</p><p><b>METHODS</b>Between July 1998 and July 2005, 81 patients with tumor of the proximal femur were treated by wide excision and endoprosthetic reconstruction. Nine cases received devitalized bone and prosthesis composite reconstruction (among them, 3 patients of fibrous dysplasia had long stem bipolar hip replacement) and 5 cases had allograft prosthesis composite replacement. Two cycles of neoadjuvant chemotherapy were given to all the cases of osteosarcoma and Ewing sarcoma. The functional outcomes were evaluated by MSTS 93 score.</p><p><b>RESULTS</b>Among the 30 patients with metastatic tumor, because all of them were transferred to related department to receive chemotherapy or radiotherapy after surgery, the follow-up was not doing well and the rate of local recurrence was not confirmed. Five patients with metastatic tumors died in 3 months after surgery. Most patients had excellent or good function postoperatively, the average MSTS 93 score was 25 in 6 months after surgery. Among the 51 patients with primary tumor, 2 patients had chronic infection and 2 patients had loosening of the prosthesis during the following time. Allograft bone and host bone nonunion were seen in 2 cases. Two patients with bipolar hip replacement had severe acetabulum abrasion. The other 3 patients also received total hip replacement for hip pain after walk. Five patients had local recurrence 6 months to 2 years postoperatively.</p><p><b>CONCLUSIONS</b>Because of low complication rate and good postoperative function, endoprosthetic replacement is a good option for reconstruction of the proximal femur after tumor resection.</p>

Limb salvage surgery for osteosarcoma around the knee in children and adolescent patients / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the reconstruction methods and treatment effects of osteosarcoma around the knee in skeletal immature children and adolescent patients.</p><p><b>METHODS</b>Between October 1996 and December 2005, 89 children and adolescent patients with osteosarcoma around the knee received limb salvage surgery. The average age was 13 years old. Tumor involved distal femur in 52 cases, proximal tibia in 36 cases, and both parts in one patient. Different limb salvage methods, including tumor recycle bone reimplantation (n = 20), partial endoprosthesis (n = 19) and total knee megaprosthesis replacement (n = 50) were chosen according to both the age of the patient and the skeletal. Expandable and special designed pediatric prosthesis some times might also be considered.</p><p><b>RESULTS</b>After average follow up of 42 months, 4 cases of local recurrence and 11 of metastasis occurred in tumor recycle bone group; 1 case of local recurrence and 4 of metastasis in partial endoprosthesis group; another 4 cases of local recurrence and 9 patients died of disease in total knee megaprosthesis group. The five-year survival rate was 47.1%, 71.7% and 68.2% in 3 groups respectively. There were 3 deep infections in all the cases, 2 subluxations and 1 amputation after operation for limb ischemia in partial endoprosthesis group. The average functional score of MSTS 93 was 21.43 point, 23.40 point and 25.32 point; and the average leg length discrepancy was 5.48, 4.50 and 3.12 cm in 3 groups respectively.</p><p><b>CONCLUSIONS</b>Partial-joint prosthesis or other methods which can avoid injury of the opposite epiphysis should be used to decrease the possibility of limb length discrepancy and ease the following revised arthroplasty. For patient with almost mature skeletal, total knee megaprosthesis may be a proper choice for better function result.</p>

Preliminary report of combination chemotherapy including Arsenic trioxide for stage III osteosarcoma and Ewing sarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the efficacy of Arsenic trioxide combined with other chemo agents in patients with metastatic osteosarcoma and Ewing sarcoma.</p><p><b>METHODS</b>From December 2002 to June 2005, 32 patients with metastatic osteosarcoma and Ewing sarcoma were treated with chemotherapy comprised Arsenic trioxide, including 19 male and 13 female, aging from 7 to 32 years. Diagnoses included 27 cases with osteosarcomas and 5 with Ewing sarcomas. Twenty-five and 7 patients had multiple lung and skeletal metastasis respectively. All patients had received 4 to 6 cycles standard chemotherapy and surgical treatments before the metastatic lesions were found. The chemotherapy protocol consisted of Arsenic trioxide, VP-16 and paclitaxel. Twenty-eight patients accepted 2 cycles, and 4 patients accepted 3 cycles chemotherapy.</p><p><b>RESULTS</b>Five patients (15.6%), whose lung focus disappeared and no new metastases proved, got complete response (CR); Six patients (18.8%) got partial response (PR); In thirteen stable disease (SD) patients (40.6%), the metastatic lesions did not reduce in evidence but completely calcified in 2 patients and partly calcified in 11 patients; Eight patients (25%) whose tumor size was even bigger after the chemotherapy were defined as progress disease (PD). The average follow-up period was 20 months (ranging from 6 months to 3 years). Three patients were eventually died; The disease was progressed in 5 patients, and the tumor growth was controlled in 24 patients.</p><p><b>CONCLUSIONS</b>Arsenic trioxide is a low-toxic and effective remedy for treatment of stage III osteosarcoma and Ewing sarcoma.</p>

Surgical treatment of metastatic spinal tumors by anterial approach / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the efficacy of surgical treatment of the patients with metastatic spinal tumors by anterial decompression and stabilization.</p><p><b>METHODS</b>From December 1997 to December 2003, 93 patients (40 women and 53 men) with metastatic spinal tumors were treated in our department. The locations of the tumor included, thoracic vertebra (53 cases), lumbar vertebra (33 cases), and cervical region (7 cases). The original tumors included lung cancer (21 cases), renal cancer (13 cases), prostate cancer (8 cases), hepatic cancer (5 cases), breast cancer (13 cases), thyroid cancer (5 cases), gastrointestinal tumor (3 cases), and multiple myeloma (8 cases). However, no primary tumor was found in the rest of 17 cases. Among 54 of 93 patients who presented with neurological dysfunction, 16 patients completely paralyzed and others incompletely paralyzed. The follow-up time ranged from 10 to 72 months.</p><p><b>RESULTS</b>Pain was relieved in 87 of 93 patients (93.5%) and neurological function was improved in 47 of the 54 patients. Among 16 completely paralyzed patients, 7 patients experienced a neurological function improvement (from Frankel grade A or B to C or D after decompression). The average amount of blood transfused was 3000 ml. No severe complications were seen in our series. The one-year survival rate was 85% (79 cases).</p><p><b>CONCLUSIONS</b>The integrity of the spinal column structure and neurological function should be considered firstly in the treatment of spinal metastasis. Thorough resection of metastatic tumor and stable internal fixation by anterior approach should be performed when single or two vertebra are involved. In order to alleviate paralysis, promote spinal stability, and improve the quality of life, urgent decompression should be performed on patient with spinal metastasis.</p>

The surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect and complication of spinal operation combined with vertebroplasty in treating for multiple spinal neoplasm.</p><p><b>METHODS</b>During the last two years, 20 patients (13 male and 7 female) with multiple spinal neoplasm including metastases, multiple myeloma and lymphoma were treated by operation combined with vertebroplasty, 2 vertebral body segments were involved in 5 cases, 3 to 4 vertebral body segments were involved in 11 cases, more than 5 segments were involved in other 4 cases. Neurological function deficit and severe pain were seen in all the cases. Patients were evaluated by Tomita prognostic scoring system before the operation; The average point was 7.2 (from 3 to 9 points).</p><p><b>RESULTS</b>The pain relief rate was 85% (17/20), and neurological recovery was found in 10 out of 12 patients who had neurological deficit. According to the system of Frankel and neurological function, 1 patient recovered from grade B to grade C after the operation, and there was no change in another patients who was evaluated as grade A before the operation. The main complication of vertebroplasty was leakage of PMMA. Six patients had leakage of PMMA into adjacent structures in this series.</p><p><b>CONCLUSIONS</b>Better results of pain relief and neurological function recovery and living quality can be achieved by surgical palliation of operation combined with vertebroplasty for multiple spinal neoplasm.</p>

Surgery for multiple myeloma of the bone / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the indication, approach and results of the surgical treatment of multiple myeloma.</p><p><b>METHODS</b>The authors reported 29 surgically-treated patients with solitary or multiple myeloma of the bone between January 1997 and January 2002. There are 17 males and 12 females with average age of 59.5 years (range 38 - 76 years). The primary tumour localizations were: vertebral column in 9, rib in1, humerus in 2, proximal femur in 2, femur shaft in 3, pelvis in 6, sacrum in 6. The 29 patients had undergone the following surgical procedures: vertebral tumours were excited through the anterior or posterior approach, combined with a stabilizing procedure in 7 cases. Tumors on thoracic spine were resected using anterior approach. 4 endoprotheses of replacement were performed, indnding two on proximal femur, one on humerus, and one on pelvis. The pathologic fracture was fixated by internal fixation. Neurological impairment was evaluated according to Frankel system. The study evaluated the complications, neurologic function improvement, life quality, and survival after the surgical treatment.</p><p><b>RESULTS</b>The pain was relieved in all cases and the neurological function was improved after the surgery. Local recurrence were found in three cases during the follow-up time.</p><p><b>CONCLUSION</b>The symptom of the patients can be relieved by the surgery. Our experience suggests that surgical interruption on multiple myeloma in some cases may be rewarding.</p>

Resection and reconstruction for primary pelvic tumors around acetabular / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the resection of tumors, reconstruction of defects and the postoperative complications.</p><p><b>METHODS</b>Thirty-one patients with tumors around acetabular were treated surgically in People's Hospital between July 1997 and July 2003. The series comprised 19 males and 12 females. Twelve patients were diagnosed with chondrosarcoma, 1 with Ewing sarcoma, 3 with osteosarcoma, 1 with lymphoma, 1 with carcinosarcoma, 1 with malignant fibrohistiocytoma (MFH), 2 with myeloma, 9 with giant cell tumor (GCT), 1 with aneurysmal bone cyst. Among 31 patients with peri-acetabular tumors, 8 were reconstructed with hemi-pelvic prosthesis, 7 with saddle prosthesis, 6 with cauterized tumor bone and total hip arthroplasty, 10 with total hip replacement after curettage of lesion and cemented.</p><p><b>RESULTS</b>Among 21 patients who underwent tumor resection and reconstruction in region II, 6 had local relapse. Two of 3 patients with osteosarcoma were dead. Five of 12 patients with chondrosarcoma were free of disease. Twenty-one patients with acetabular reconstruction after resection of lesions in region II could sit and stand normally and walked with a cane, several of which even had normal gait.</p><p><b>CONCLUSION</b>Allograft or pelvic prosthesis can be used to reconstruct the acetabulum after resection of tumors. We must pay more attention on the following points in the surgical treatment of periacetabular tumors: (1) Extensively resect tumors as far as possible; (2) Be acquainted with advantages and disadvantages of different reconstructive methods of acetabulum to prevent the complications; (3) The reconstructed acetabulum is unstable, so the patients must stand with a cane to protect the reconstructed hip joint; (4) Prevent wound necrosis and infection; (5) Surgical treatment of pelvic tumors would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. The destroyed soft tissue caused by chemotherapy or radiotherapy may increase the great tissue tension after implantation of allograft. And the factors of poor blood supply and hematoma in the wound theoretically increase the chance of infection.</p>

The surgical management of sacral tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the way of sacral tumors surgical treatment.</p><p><b>METHODS</b>This retrospective study included 119 cases of sacral tumors surgically treated from July, 1996 to December, 2001. The age of patients ranged from 18 to 80 years (mean 57 years), including of 72 male and 47 female. Out of the patients, there were 52 chordomas, 16 giant cell tumor, 5 neurofibroma, 23 metastases tumors, 9 myeloma, 2 osteoblastomas, 5 aneurysmal bone cysts, 3 osteosarcomas, 4 chondrosarcomas. Posterior approach and combined anterior-posterior approach were used in 83 and 36 cases respectively. Twenty-nine patients had received surgical management at least once and 16 of them had received radiation therapy before came to our department.</p><p><b>RESULTS</b>Three patients died on the complication around the surgery. Most of the patients with metastases tumor or multiple myeloma died 1 to 3 years after the surgery. Out of three osteosarcoma patients, 2 died and one alive with tumor. Three chondrosarcoma patients died, and one alive with tumor. Out of 52 chordoma patients, 3 patients had died of metastatic chordoma, 3 patients died of many times recurrence. Among the other 46 patients who were stay alive, 31 were free from disease with average follow-up time of 42 months. In the patients whose sacral nerve roots had been reserved bilaterally at and above S(3) level, the sphincter muscle function of bladder and bowl was good. While the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S(1) level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed.</p><p><b>CONCLUSIONS</b>Complete resection of tumor (radical surgery when possible) is the most effective way to manage sacral tumors. Postoperative adjuvant radiation therapy can reduce the tumor recurrence rate, but it also can cause troubles that would hinder further surgical managements. Even if the tumor is relatively huge and the upper resection margin is as high as at S(1) or S(2) level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. To the patients with aneurysmal cyst or giant cell tumor on sacrum, for control bleeding purpose, anterior approach should be performed to ligate the bilateral internal iliac artery.</p>

Experimental studies on adriamycin alginate-chitosan microcapsules in the treatment of rabbit VX2 carcinoma in the extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effects of chemoembolization with adriamycin alginate-chitosan microcapsules in the treatment of VX2 carcinoma in the extremity of the rabbit.</p><p><b>METHODS</b>Twenty-four New Zealand white rabbits transplanted with VX2 carcinoma cells into the muscle tissue of the lower right thigh were divided into four groups namely groups A, B, C and D, and received regional infusion from femoral artery. Each group consisted of six rabbits: a group given natural saline (Group A), a group given adriamycin (Group B), a group given blank alginate-chitosan microcapsules (Group C) and a group given adriamycin alginate-chitosan microcapsules (Group D). Three days after treatment, all groups were examined by histology and immunohistochemical detection (TdT-mediated dUTP nick end labeling technique, TUNEL; proliferating cell nuclear antigen, PCNA).</p><p><b>RESULTS</b>The blood vessels of the tumor were almost embolized by the microcapsules. Extensive necrosis, high level of positive cells in TUNEL (60.85% +/- 5.21%) and low level in PCNA detection with in the tumors were observed in Group D.</p><p><b>CONCLUSION</b>Adriamycin alginate-chitosan microcapsules can potentially play roles in two respects, 1 to serve as embolizing agents, and 2 to serve as drug delivery vehicles for local release. Chemoembolization with microparticals is an effective treatment of malignant osseous and soft tissue sarcomas in an experimental model.</p>

Clinical study of solitary bone plasmacytoma / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics and the prognosis of solitary bone plasmacytoma (SBP).</p><p><b>METHODS</b>From June 1997 to June 2002, ten SBP patients were treated in our department. Two lesions were in sacrum, two in pelvis, the other six lesions were in proximal femur, femoral diaphyseal, scapula, thoracic vertebra, proximal humus, and rib respectively. The preoperative laboratory tests were normal. Operation was performed on all patients. The pathologic diagnose was plasmacytoma and then they underwent further laboratory examination, urine Bence-Jone protein is positive in 3 patients, serous IgG value was higher than normal in 2 patients, abnormal M protein was found in electrophoresis in 2 patients. All patients received radiotherapy postoperatively.</p><p><b>RESULTS</b>Four patients were excluded, whose follow-up were lessen than ten months, the other six patients's average follow-up is 28.2 months (from 18 to 48 months), one patient who developed multiple myeloma (MM) six months postoperatively received chemotherapy using M2 protocol and died 21 months after operation. The other five patients had disease-free survive and remain solitary bone lesion after the treatment of surgery and radiology.</p><p><b>CONCLUSION</b>Compared with MM, SBP patients are younger, the therapeutic results and prognosis are better. The main prognostic factors include age, the size of lesion, the axial bone lesion, persistence of myeloma protein after radiotherapy, early diagnosis and treatment, and so on.</p>