How to Fill the Cavity after Curettage of Giant Cell Tumors around the Knee? A Multicenter Analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intralesional excision with curettage is the standard method of giant cell tumor (GCT) treatment, but the ideal filling material after curettage remains controversial. The purpose of this study was to compare the oncological and functional outcomes which underwent cementation or bone grafting after GCT curettage around the knee.</p><p><b>METHODS</b>We reported 136 cases with GCTs in distal femur or proximal tibia who accepted curettage from five clinical centers during the last 15 years. All patients were divided into two groups according to filling materials. Recurrence-free survival proportions were used to evaluate oncological outcomes while the Musculoskeletal Tumor Society (MSTS) 93 functional score was used to evaluate functional outcomes. Other parameters including surgical complication, general condition, and radiological classification had been analyzed. The valid statisitical data was analyzed using SPSS 13.0 software.</p><p><b>RESULTS</b>After GCT curettage, 86 patients (63.2%) accepted bone grafting while 50 patients (36.8%) accepted cementation. There was no statistical difference in age, gender, tumor location, radiological classification, fixation, follow-up time, and MSTS 93 functional score between cementation group and bone grafting group. The recurrence-free survival proportions showed that the recurrence rate in bone grafting group was higher than it in cementation group (P = 0.034). Surgical complication was lower in cementation group than that in bone grafting group but without statistically significant difference (P = 0.141).</p><p><b>CONCLUSIONS</b>Parameters including patients' age, gender, tumor location, and radiological classification did not affect surgeons' treatments in cavity filling after GCT curettage. Cementation should be recommended because of easy usage, the similar postoperative knee function with bone grafting, and the better local tumor control than bone grafting.</p>

Clinical characteristics and treatment of AO/OTA A2.3 intertrochanteric fractures with posterior coronal plane fractures / 中国骨伤

<p><b>OBJECTIVE</b>To explore the characteristics, the operative techniques and effect of AO/OTA A2.3 intertrochanteric fractures with posterior coronal fractures.</p><p><b>METHODS</b>From January 2011 to January 2014, 33 patients suffered from AO/OTA A2.3 intertrochanteric fractures with posterior coronal fractures were treated with proximal femoral anti rotation nail, included 15 males and 18 females, with an average age of (73.1±8.2) years old ranged from 61 to 92 years old. According to AO/OTA classification, all cases were type A2.3 fracture. All cases were closed fractures and treated with limited open reduction and internal fixation. The postoperative hip function was evaluated by Harris score.</p><p><b>RESULTS</b>One case was died at 19 days after operation, 32 cases were followed up from 9 to 24 months with an average of (16.3±5.1) months. Bone union time was from 6 to 9 months with an average of (7.2±1.5) months according to X rays. At the final followed up, Harris scores were 76 to 95 points with an average of (85.3±5.6) points;13 cases were classified as excellent, 16 as good, and 3 as fair.</p><p><b>CONCLUSIONS</b>AO/OTA A2.3 intertrochanteric fracture with posterior coronal fractures is a special type and unstable, it's difficult to reset. It needs to be fixed with proximal femoral anti rotation nail by limited open reduction. It is necessary that postoperative rehabilitation should be chosen individually.</p>

Analysis of clinical effects of iliolumbar fixation in treating sacrum fracture of Denis type II / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical effects of iliolumbar fixation for the sacrum fractures of Denis type II.</p><p><b>METHODS</b>The clinical data of 86 patients with sacrum fracture of Denis type II treated by iliolumbar fixation from January 2008 to January 2012 were retrospectively analyzed. There were 55 males and 31 females, aged from 17 to 55 years old with an average of 39.1 years. Among them, 73 cases complicated with pelvis fracture and 13 cases with acetabular fracture; 37 cases with sacral neurological symptoms and 49 cases without sacral neurological symptoms. Fracture healing time, nerve function, clinical function and complications were observed in the patients.</p><p><b>RESULTS</b>In 86 cases, 6 cases were out of followed-up and 80 cases were followed up from 24 to 71 months with an average of 36 months. The mean fracture healing time was 13 weeks (ranged, 10 to 38 weeks). According to Gibbons scoring to evaluate the neurological function, preoperative nerve rehabilitation, lower limbs feeling, lower limbs activity,bladder and rectum function,total score respectively were 0.62 +/- 0.04, 1.54 +/- 0.35, 1.12 +/- 0.18, 0.23 +/- 0.01, 3.46 +/- 0.47 and postoperative respectively were 0.82 +/- 0.12, 0.36 +/- 0.04, 0.05 +/- 0.01, 0.03 +/- 0.01, 1.25 +/- 0.22, there were statistically significant differences between preoperative and postoperative (P < 0.05). According to Majeed scoring to evaluate the clinical function, postoperative pain, standing, sitting, sexual life, work ability, total score respectively were 22.54 +/- 4.02, 27.93 +/- 5.46, 8.47 +/- 3.61, 2.54 +/- 1.33, 16.46 +/- 4.34, 81.32 +/- 8.73, 60 cases got excellent results, 17 good, 3 fair. The main complications including fracture nonunion of 5 cases,deep incision infection of 1 case, and screw prominence resulting uncomfortable of 8 cases.</p><p><b>CONCLUSION</b>Iliolumbar fixation has the advantages of stable fixation, satisfactory functional rehabilitation, less complications, and is a good method in treating sacrum fracture of Denis type II.</p>

Extremely low frequency electromagnetic field induces apoptosis of osteosarcoma cells via oxidative stress / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of extremely low frequency electromagnetic field (ELF-EMF) on human osteosarcoma cells and its mechanisms.</p><p><b>METHODS</b>Human osteosarcoma MG-63 cells were exposed to 50 Hz,1 mT ELF-EMF for 1, 2 and 3 h in vitro, with or without pretreatment by reactive oxygen species (ROS) inhibitor N acetylcysteine (NAC) or p38MAPK inhibitor SB203580. The proliferation of MG-63 cells was determined by MTT method; the apoptosis rate and ROS level in MG-63 cells were detected by flow cytometry. The expression of p38MAPK in MG-63 cells was determined by Western blotting.</p><p><b>RESULTS</b>ELF-EMF decreased the viability of MG-63 cells, inhibited cell growth, induced cell apoptosis and increased the level of ROS significantly. The apoptosis rate declined significantly after treatment with ROS inhibitor NAC or p38MAPK inhibitor SB203580. After exposure to ELF-EMF, p38MAPK in MG-63 cells was activated, and the phosphorylation level was also inhibited after treatment with NAC.</p><p><b>CONCLUSION</b>ELF-EMF can induce the apoptosis of MG-63 cells. Increased ROS and p38MAPK activation may be involved in the mechanism.</p>

Interlocking intramedullary nailling and micro-invasive internal fixation with plate for multiple segmental tibiofibular fractures: a case-control study / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of interlocking intramedullary nail and micro-invasive internal fixation with plate for the treatment of multiple segmental tibiofibular fractures.</p><p><b>METHODS</b>The clinical data of 39 patients with multiple segmental tibiofibular fractures received treatment from January 2010 to June 2013 were retrospectively analyzed. In the 39 patients, 18 cases were treated by the interlocking intramedullary nail (intramedullary nail group), there were 12 males and 6 females with the mean age of (40.6 ± 9.7) years old (ranged, 24 to 60 years);7 cases were type C2.1, 11 were type C2.2 according to the AO classification. The other 21 cases were treated by micro-invasive internal fixation with plate(plate group), there were 13 males and 8 females with the mean age of (41.7 ± 8.1) years old (ranged, 22 to 52 years), 7 cases were type C2.1, 13 were type C2.2, 1 was type C2.3. Preoperative preparation time, operation time, intraoperative blood loss, postoperative complications, fracture healing time were compared between two groups. Johner-Wruhs evaluation criteria was used to evaluate the clinical effect at last follow-up.</p><p><b>RESULTS</b>All the patients were followed up from 10 to 28 months with an average of 15.2 months. Operative time, intraoperative blood loss in intramedullary nail group were (62.1 ± 5.8) min, (70.9 ± 7.1) ml, respectively; in plate group were (64.3 ± 7.7) min, (74.1 ± 8.5) ml,respectively. There was no significant difference in operation time and intraoperative blood loss between two groups (P > 0.05). However, preoperative preparation time, fracture healing time in intramedullary nail group were (5.3 ± 0.7) days, (11.1 ± 1.9) months, in plate group were (7.1 ± 0.8) days, (14.1 ± 2.2) months, respectively. No postoperative complications were found in intramedullary nail group, and five cases developed with complications in plate group. There was significant difference in preoperative preparation time, postoperative complications and fracture healing time between two groups (P < 0.05). According to Johner-Wruhs criteria at last follow-up, 11 cases got excellent results, 4 good, 3 fair in intramedullary nail group; 11 excellent, 5 good, 2 poor in plate group.</p><p><b>CONCLUSION</b>Interlocking intramedullary nail has advantages of shorter preoperative preparation time, less postoperative complications and faster fracture healing time in treating multiple segmental tibiofibular fractures. But the application scope of interlocking intramedullary nail was inferior to micro-invasive internal fixation with plate , and its indications should be strictly controlled.</p>

Analysis of the relevant factors for ischemic necrosis of the talus fracture / 中国骨伤

<p><b>OBJECTIVE</b>To explore the relationship of the classification of talus fracture and surgery methods with avascular necrosis.</p><p><b>METHODS</b>From March 2009 to November 2013, 78 patients with talus fracture were treated, of them, 43 cases were followed up from 2 to 5 years. There were 27 males and 16 females, aged from 17 to 65 years old with the mean of 38.6 years. Thirty-nine cases had talar neck injury and 4 cases had talar body injury. Different treatments were performed according to different injury conditions. The time from injury to treatment was from 6 to 48 hours. The effect of classification of talus fracture and surgery methods on avascular necrosis was analyzed.</p><p><b>RESULTS</b>In 43 cases,19 cases occurred avascular necrosis, including talar neck fracture of type I in 2 cases, type II in 5 cases, type III in 5 cases, type IV in 5 cases and talar body fracture in 2 cases (combined with talar neck fracture). And 29 patients were treated with operation, there was no statistically significant differences in avascular necrosis with different operations.</p><p><b>CONCLUSION</b>Compared with talar body fracture, talar neck fracture is more easily to develop into avascular necrosis. In the 4 types of talar neck fracture, the possibilities of type III and IV were the most ones.</p>

Clinical study of cervical anterior and posterior decompression and internal fixation in the revision of anterior cervical fixation failure / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects and prevent the complications of posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure.</p><p><b>METHODS</b>From 2008 January to 2011 December, 17 patients with cervical anterior internal fixation failure were treated with posterior and anterior decompression and internal fixation. There were 12 males and 5 females, aged from 26 to 68 years old with an average of 44.1 years. The lower screw loosening was found in 6 cases, the upper screw loosening in 5 cases, titanium mesh caving in 3 cases, the upper screw breakage in 2 cases, the lower screw breakage in 1 case. Informations of bone fusion were observed by X-ray, CT, MRI. Clinical effects were evaluated by modified JOA score.</p><p><b>RESULTS</b>All the revision operations were successfully completed. One case with poor blood coagulation function before operation resulted in postoperative hematoma and occurred neurological symptoms; after hematoma removal and fresh frozen plasma infusion later, neurological symptoms of the patient disappeared. All patients were followed up from 6 to 38 months with an average of (22.4±10.0) months. Postoperative at 2 weeks, 3 months, and final follow-up, JOA score had obviously improved and respectively was 13.1±1.6, 13.4±1.6, 14.2±1.5. All internal fixation locations were good after revision,and obtained bone fusion at 10 months after operation, with an average fusion time of 6 months.</p><p><b>CONCLUSION</b>The combined posterior and anterior decompression and internal fixation in the revision of cervical anterior internal fixation failure is safe, can achieve thoroughly decompression, maintain the cervical curvature, reconstruct the three column stability, and it may be used for the patients of cervical anterior fixation failure.</p>

Factor analysis of the failed treatment for limb fracture nonunion after autologous bone transplantation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the cause of failure after autogenous bone graft with limb fracture nonunion,to explore the major influencing factor of the treatment, and to research the evidence for improving the treatment of nonunion.</p><p><b>METHODS</b>A retrospective analysis was done with 367 cases suffering from autogenous bone graft surgery after limb fracture nonunion between January 1995 to December 2011. Among them,there were 198 males and 169 females aged 12 to 89 years (means 53.5 years) with duration of 23 to 49 months. The treatment effect assessed with X-ray and CT after grafting in the treatment, and 32 cases were detected nonunion again, and others' fixations were dismantled by operation after fracture healing. The following correlation including factorsages,gender,smoking, nutritional status during therapy,classification of primary fracture,location of fracture, type of nonunion, changing the type of fixation,type of fixation and complicating disease were evaluated by Logistic stepwise regression to discover the influencing factors of the failure of union.</p><p><b>RESULTS</b>The treatment failure rate was 8.72% in the patients with surgery and graft included in the statistics for the late re-admitted in 6 to 12 months followed-up. Smoking, classification of primary fracture, type of nonunion, changing the type of fixation, complicating disease had influence to incidence rate of union after autogenous bone graft.</p><p><b>CONCLUSION</b>Autogenous bone graft is the utility method for limb fracture nonunion. Smoking, classification of primary fracture, classification of nonunion,changing the type of fixation, complicating disease are the risk factors of nonunion after graft. Patients should be advised to stop smoking in the nonunion bone graft. And at the same time, the treatment of related diseases, analysis of the original fracture and nonunion,aggressive treatment of infection, and developing better surgical solutions before surgery, as well as changing the fixation methods can reduce the risk of failure of the graft.</p>

Treatment of radial neck fracture in children with elastic stable intramedullary nails / 中国骨伤

<p><b>OBJECTIVE</b>To investigate effects of elastic stable intramedullary nails for the treatment of radial neck fracture in children.</p><p><b>METHODS</b>From July 2006 to December 2011, 25 children with radical neck fractures, which included 16 males and 9 females aged from 7 to 15 years old (means 10.7), were treated with elastic stable intramedullary nails. According to Judet classification, 6 cases were type II, 17 cases were type III and 2 cases were type IV (including 1 case with type IVa and 1 case with type IVb). The fracture healing, pain, deformity and range of motion of elbow were recorded.</p><p><b>RESULTS</b>All patients were followed up for 6 to 24 months with an average of 14 months. Twenty-five patients were obtained bone healing. According to Tibone and Stoltz evaluation standard, 18 cases got excellet results, 4 cases in good and 3 cases in moderate.</p><p><b>CONCLUSION</b>Elastic stable intramedullary nails for the treatment of radial neck fracture in children has advantages of simple operation,less trauma and good results.</p>

Case-control study on double screws system and compressed three canulated screws in treating femoral neck fractures / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical effects of double screws system and compressed three canulated screws in treating femoral neck fractures.</p><p><b>METHODS</b>From January 2007 to June 2009, the clinical data of 67 patients with femoral neck fractures underwent operation were retrospectively analyzed. There were 38 males and 29 females,aged from 31 to 71 years with an average of 50.6 years, left was in 41 cases and right was in 26 cases. The patients were divided into two groups (group A and B) based on the different fixation method. Of them, 30 cases (group A,19 males and 11 females) were treated with double screws system and 37 cases (group B, 19 males and 18 females) with compressed three canulated screws. In group A, Pauwells angle was more than or equal 50 degrees in 16 cases and Pauwells angle less 50 degrees in 14 cases; in group B, Pauwells angle was more than or equal 50 degrees in 22 cases and Pauwells angle less 50 degrees in 15 cases. Duration of hospitalization, operative time, intraoperative blood loss, postoperative time in bed, infection of incision, postoperative complication, quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis, incidence of failure fixation, joint function (Harris score) were compared between two groups.</p><p><b>RESULTS</b>All patients were followed up from 30 to 59 months with an average of 42 months. There was no significant differences in aspect of duration of hospitalization, infection of incision, intraoperative blood loss, walking time, postoperative complications between two groups(P>0.05). Operative time of group A [(31.1 +/- 9.7) min]was less than that of group B [(40.4 +/- 12.7) min] (P<0.05). There was no significant differences in quality of fracture reduction, position of internal fixation, incidence of non-union and femoral head necrosis between two groups (P>0.05). In the patients with Pauwells angle more than or equal 50 degrees in group A, there was no retreated screws, broken screws, screw cut-off from the femoral head;a head;and in group B, retreated screws occurred in 2 cases, screw cut-off from the femoral head occurred in 2 cases, screws not completely getting in femoral head occurred in 2 cases; there was significant differences between two groups (P<0.05). The patients with Pauwells angle less 50 degrees in group A, screw loosening occurred in one case; and in group B, screw retreating occurred in one cases; there was no significant differences between two groups (P>0.05). All patients who suffered from screw loosening, retreating or cut-off from the femoral head were more than 65 years old. There was no significant differences in the joint function between two groups at 6 and 30 months after operations (P>0.05).</p><p><b>CONCLUSION</b>Double screws system has advantages of minimal invasion, easy operation, reliable fixation in treatment of femoral neck fractures. Compared with the traditional compressed three canulated screws,double screws system has less fixation failure rate and higher hip function scoring. It has a good clinical effect especially for the patients with Pauwells angle more than or equal 50 degrees.</p>

Nitidine chloride-induced apoptosis of human osteosarcoma cells and its mechanism / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the apoptosis-inducing effect of nitidine chloride in human osteosarcoma MG-63 cells and explore its mechanism.</p><p><b>METHODS</b>The effect of nitidine chloride on the proliferation of MG-63 cells was detected by colorimetric MTT assay, and the morphological changes of cells treated with nitidine chloride were observed using fluorescence and electron microscope. Flow cytometry was performed to analyze the apoptotic rate of the cells, and the protein expression levels of caspase-3, caspase-9, Bcl-2 and Bax were detected by Western blotting.</p><p><b>RESULTS</b>Nitidine chloride inhibited the proliferation of MG-63 cells in a dose- and time-dependent manner. Fluorescence and electron microscopy revealed distinct apoptotic changes of the cells after nitidine chloride exposure. Flow cytometry indicated that nitidine chloride induced the apoptosis of MG-63 cells in a dose-dependent manner. Exposure to nitidine chloride, as shown by Western blotting, resulted in increased expressions of cleaved caspase-3, cleaved caspase-9 and Bax and decreased expressions of pro-caspase-3, pro-caspase-9 and Bcl-2.</p><p><b>CONCLUSION</b>Nitidine chloride can inhibit the proliferation of osteosarcoma cell line MG-63 by inducing cell apoptosis, the mechanism of which might be related with the activation of the caspase-dependent pathway.</p>

Application of damage control orthopaedic for the treatment of comminuted fractures of superior tibia in complex injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the treatment of comminuted superior tibial fracture in complex injury according to damage control orthopaedic.</p><p><b>METHODS</b>From Jan. 2007 to Jun. 2009,11 patients suffered from comminuted superior tibial fracture with complex injury, including 8 males and 3 females with an average age of 35.2 years. The external fixator were used to fix tibial fracture in emergency treatment, after 6 weeks when the condition of patients were improved, fix the external tibia by LISS plate through litter incision, fix interior tibia by reconstructed plate or sustained plate. The effect evaluated by Lysholm standard, marking system on the basis of limp, walking stick, angina, knee unsteady, pain, swell, up and down floor, squat.</p><p><b>RESULTS</b>All the postoperative CR showed that the superior tibial fractures were acquired functional reduction, the incision got well and no infection occurred. All 11 patients were followed-up for 12 to 18 months with an average of 14.7 months. According to an evaluation standard of Lysholm, the results were excellent in 5 cases, good in 4 cases, fair in 1 case, poor in 1 case.</p><p><b>CONCLUSION</b>According to damage control orthopaedic, the treatment of comminuted superior tibial fracture by external fixation and LISS plate is a suitable method for the patient with complex injury who undergo comminuted superior tibial fracture.</p>

Resection pseudoarthrosis for pelvic malignant tumors around acetabular / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the resection pseudoarthrosis for pelvic malignant tumors around acetabular.</p><p><b>METHODS</b>From May 1997 to June 2005, 25 patients with malignant tumors around acetabular were treated surgically with resection pseudoarthrosis. The series comprised 15 males and 10 females with an average age of 42 years old (range from 16 to 75 years old). There were 4 osteosarcomas, 12 chondrosarcomas, 1 Ewing's sarcoma, 1 neuroectodermal tumor, 1 myeloma, 1 malignant fibrohistiocytoma, 2 synovial sarcomas, and 3 metastases. Pseudoarthrosis was performed after resection of pelvic malignant tumors around acetabular. The affected side was protected postoperatively by skin traction with 2 - 3 kg weight for 6 to 8 weeks. After then, the patients walked gradually with a cane.</p><p><b>RESULTS</b>Among 25 patients, 6 had complications (24%). At a follow-up ranging from 3 to 10 years, 11 patients died of lung metastases, 2 relapsed, 12 remained alive free of disease. There was an average crispation of 5 cm (range from 2.5 to 7.5 cm). The patients were functionally evaluated according to Enneking's MSTS criteria in 1993. The average MSTS functional score was 17 points (12 to 19 points). After 3 months postoperative, the patients could sit normally, walk with a cane, and even walk limpingly without cane.</p><p><b>CONCLUSIONS</b>Resection pseudoarthrosis for pelvic malignant tumors around acetabular results in good clinical results at the time of mid-term and long-term follow-up. And pseudoarthrosis is advisable especially for patients with malignant highly tumors around acetabular, poor soft tissue reconstruction condition, high risk for infection, poor economy.</p>

Treatment of unstable pelvic fractures with minimally invasive internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of minimally invasive internal fixation in the treatment of unstable pelvic fractures.</p><p><b>METHODS</b>From January 2005 to January 2009, the data of 48 patients with unstable pelvic fractures were retrospectively analyzed. There were 31 males and 17 females. The age ranged from 12 to 66 years with an average of 37.8 years. Among them, 29 cases were caused by traffic accident, 14 by fall from height and 5 by crush injury. According to Tile's classification, type B1 was in 4 cases, B2 in 3, C1 in 25, C2 in 14 and C3 in 2. All patients were treated with minimally invasive internal fixation of percutaneous reconstruction plate (including 20 cases with percutaneous pubic ramus screws fixation and 8 cases with pubic tubercle screws fixation) and percutaneous sacroiliac screws (including 16 cases with percutaneous pubic ramus screws fixation and 4 cases with pubic tubercle screws fixation). With X-ray films to observe the reduction of fractures and according to Majeed standard to evaluate the clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 12-39 months with an average of 17 months. No infection of incision,nerve injuries, loosening or breakage of the screw was found. All cases attained bone union. Anatomical reduction achieved in 29 cases,satisfactory reduction 18 cases, and unsatisfactory reduction 1 case. According to the Majeed standards, 29 cases obtained excellent results, 15 good and 4 fair, the rate of excellent and good was 91.7%.</p><p><b>CONCLUSION</b>Treatment of unstable pelvic fractures with minimally invasive internal fixation had advantages of minimal trauma, less bleeding, less postoperative complications, high bone union rate, reliable fixation and satisfactorily functional recovery after operation, but the method demanded skillful surgical techniques.</p>

Long-term result of fibula grafting for reconstruction of the distal radius after giant cell tumor excision / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the long-term result of fibula grafting for reconstruction of the distal radius after giant cell tumor excision.</p><p><b>METHODS</b>From March 1994 to November 2004, 31 cases of fibula grafting for reconstruction of the distal radius for giant cell tumors performed were analysed. There were 12 males and 19 females. The patients were from 19 to 48 years old, and the mean age was 31 years. Twenty-four patients had Campanacci grade 3 lesions, and 7 patients had Campanacci grade 2 lesions. There were 6 cases of vascularized fibular grafting and 25 cases of non-vascularized fibular grafting. All cases were evaluated by clinical and radiologic examinations; the movement of the wrist and the grip strength was measured; the MSTS score and Mayo Wrist scores were calculated.</p><p><b>RESULTS</b>Clinical follow-up time after reconstruction averaged 86.3 months, range from 41 to 169 months. The mean time for bone union at the host-graft junctions was 5.1 months range from 3 to 9 months in vascularized group and 10.3 months range from 7 to 15 months in non-vascularized group. One patient who had non-vascularized fibula grafting developed non-union at the host-graft junction, and one patient had local recurrence (3.2%). Five patients developed an wrist dislocation after surgery. The average movements of the wrist were: 67.3 +/- 9.4 degrees of extension, 31.2 +/- 5.1 degrees of flexion, 14.1 +/- 4.7 degrees of radial deviation, 19.4 +/- 3.9 degrees of ulnar deviation, 33.8 +/- 6.6 degrees of pronation, 15.3 +/- 4.0 degrees of supination. Average grip strength was 33.1 kg range from 15.5 to 52.1 kg. Compared with the contralateral side, there were accounted for 73%. MSTS score averaged 25.5 from 23 to 29, Mayo wrist score averaged 56 from 40 to 65.</p><p><b>CONCLUSIONS</b>En bloc resection of giant cell tumor of the distal radius followed by reconstruction with a fibula graft is proved to be an effective method and results in a good functional outcome at long term follow-up evaluation. The stability of wrist is achieved by reconstruction of the capsule.</p>

The surgical therapy of periacetabular malignant tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To study the limb salvage methods and treatment outcomes in malignant periacetabular bone tumors.</p><p><b>METHODS</b>The data of 31 patients of periacetabular malignant tumors who had limb salvage surgery between January 1999 and December 2006 was retrospectively reviewed. There were 14 females and 17 males with a mean age of 53 years (range, 42-75 years). Twenty-four patients had chondrosarcomas, 4 patients had Ewing sarcomas, 1 patient had osteosarcoma, and the remaining 2 patients had metastatic disease. Sixteen patients had Types II pelvic resections, 5 patients had Types I and II pelvic resections, another 5 had Type I and III pelvic resections, and Type I , II and III pelvic resections in the remaining patients. Seventeen patients had reconstructions after tumor resection.</p><p><b>RESULTS</b>The mean follow-up time for all patients was 52 months (range, 12-84 months). Fourteen patients were alive with no evidence of disease, 4 patients were alive with disease at the most recent follow-up, and 13 patients died of disease. The local recurrence rate and mortality rate in 24 patients with chondrosarcomas was 20.8% and 33.3% respectively. Two patients with metastatic disease died at 11 and 34 months postoperatively. One patient with osteosarcoma and 2 patients with Ewing sarcoma died of lung metastases. Enneking scoring system was used to evaluate the functional outcome in 18 alive patients. In 13 patients who had reconstructions, 6 were in excellent, 6 were in good, and 1 was in poor. While in 6 patients who had no reconstructions, 3 were in excellent, 2 were in good, and 1 was in poor. Minor complications occurred in 6 patients.</p><p><b>CONCLUSIONS</b>Clear margin tumor resection with decreased local recurrence rate is critical for limb salvage surgery in periacetabular sarcomas. The ranges of tumor invasion and resection, the principle of individual treatment should be considered in functional reconstruction.</p>

Endoprosthetic reconstruction after wide resection of primary bone tumor around the knee / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect and complication of the endoprosthetic reconstruction after wide resection of primary bone tumor around the knee.</p><p><b>METHODS</b>The retrospective analysis was performed on 83 patients undergoing the prosthetic reconstruction after the resection of the primary tumor around the knee between December 1995 and December 2005. All the diagnoses were pathologically confirmed (58 patients with osteosarcoma, 2 with osteosarcomatosis, 1 with parosteal osteosarcoma, 4 with malignant fibrous histiocytoma, 13 with giant cell tumor of bone, 1 with leiomyosarcoma, 2 with Ewing's sarcoma, 2 with chondrosarcoma). The distal femur group was involved in 44 patients, proximal tibia group in 34 (including 33 deficit in proximal tibia, 1 deficit both in proximal tibia and distal femur), total femur replacement group in 5. After operation, the Musculoskeletal Tumor Society (MSTS) score was used to evaluate the recovery of their corresponding functions.</p><p><b>RESULTS</b>The follow-up for 12 - 130 months (with a median of 41 months) revealed that the 3-year survival rate of the prosthesis was 88.2%, and the 5-year survival rate was 82.1%. As for the complications, local recurrence developed in 6 patients, peri-prosthesis infection in 2 patients, aseptic loosening in 2 patients. The mean MSTS core was 25.0 (19.0 - 29.0) in the distal femur group, 24.4 (17.0 - 28.0) in the proximal tibia group, and 19.0 (16.0 - 21.0) in the total femur replacement group. As to the statistical analysis, the function of the former two groups were greater than the latter one (F = 11.666, P < 0.001), however, there was no significant difference between the former 2 groups (F = 0.813, P = 0.370).</p><p><b>CONCLUSIONS</b>Taken together, the tumor prosthesis gives a satisfactory functional outcome after the tumor around the knee is removed with a lower incidence of complication.</p>

The choice strategy of surgical treatment for giant cell tumor close to the knee / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively study and analyze the methods of the surgery management for giant cell tumor close to the knee.</p><p><b>METHODS</b>A retrospective analysis was performed in 121 patients who underwent surgical treatment for giant cell tumor close to the knee between 1978 and 1997. There were 71 cases had been managed with an intralesional procedure of the tumor (curettage, freezing with liquid nitrogen and autograft or allograft, Group 1), 50 cases with a semi-arthroplasty using allograft after en bloc resection (Group 2). According to the relation of the clinical signs and symptoms, tumor character, operative method and local recurrence, limp function, complication were evaluated. Based on the figure of tumor lesion on CT, a new formulation of treatment was given: (1) I diameter of tumor <or= 1/2, choice of an intralesional procedure; (2) II 1/2 approximately 3/4, an intralesional procedure additional inter fixed; (3) III > 3/4, en bloc resection and reconstruction. The prospectively collected records of 65 cases of patients, 45 cases with curettage, heat cauterization with electrocautery and phenol, autograft and cement (Group 1), 20 cases with arthroplasty using prosthetic (Group 2), who had a giant-cell tumor closed knee, were reviewed to determine feasibility of the new formulation of treatment.</p><p><b>RESULTS</b>The first duration, the rate of the local recurrence between 2 groups showed no statistical difference. There were less complication rate and better limp function after using two different surgical treatment. The second duration, there were no statistical difference with the rate of the local recurrence, complication, and limp function. The number of patients who managed with en bloc resection and reconstruction decreased.</p><p><b>CONCLUSIONS</b>The choice strategy of surgical treatment for giant cell tumor close to the knee should be based on the figure of tumor lesion on CT. It gives a new formulation of treatment to choice of an intralesional procedure and en bloc resection. An effective intralesional procedure should be the method of the first choice.</p>

Adenovirus mediated antisense c-myc gene on the chemotherapy sensitivity of osteosarcoma cells to cisplatin / 中华外科杂志

<p><b>OBJECTIVE</b>To construct the recombinant adenovirus encoding antisense c-myc fragment and to investigate its effect on the chemotherapy sensitivity of osteosarcoma MG-63 cells to cisplatin.</p><p><b>METHODS</b>The recombinant adenovirus (Ad-Asc-myc) encoding antisense c-myc fragment was constructed by cloning c-myc cDNA of about 720 base pairs in a reverse direction into adenovirus vector, then undergoing recombination, amplifying and being complemented in vivo. The osteosarcoma MG-63 cells were transfected by the Ad-Asc-myc in vitro, and Wright staining, Acridine Orange staining, Western Blot, MTT, Flow Cytometry (FCM) were used to study cell morphology, expression of c-myc protein, tumor cell proliferation in vitro, apoptosis and cell cycle change.</p><p><b>RESULTS</b>Ad-Asc-myc encoding antisense c-myc fragment was obtained with the titer of 2 x 10(9) pfu/ml. Ad-Asc-myc down-regulated the expression of c-myc protein after transfected MG-63 cells for 48 h, combined with the treatment of 2.0, 5.0 microg/ml cisplatin for 2 h could inhibit tumor cells proliferation in vitro by 33.4% and 54.2% respectively, which were significantly difference compared with control recombinant adenovirus (Ad-LacZ) groups (P < 0.05). Acridine Orange staining and FCM analysis showed that Ad-Asc-myc could induce apoptosis of transfected cells, which was enhanced by the treatment of cisplatin cell. Cycle analysis showed that obvious G2/M phase arrested in transfected cells.</p><p><b>CONCLUSION</b>Ad-Asc-myc increases the chemotherapy sensitivity of osteosarcoma MG-63 cells to cisplatin as well as induced apoptosis.</p>

Cytotoxicity and apoptosis of human osteosarcoma U2OS cells induced by recombinant soluble AZURIN / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effects of recombinant AZURIN protein of P. aeruginosa on growth and apoptosis of U2OS cells.</p><p><b>METHODS</b>The AZURIN gene was amplified from the genome of P.aeruginosa by PCR, and cloned into prokaryotic expression vector pQE30. The soluble AZURIN protein was expressed in E. coli cells M15, then purified and refolded. After treatment of AZURIN, the cell cycle, proliferation and apoptosis were determined by morphological observation, MTT assay, flow cytometry(FCM) and DNA fragmentation assay. Mitochondrial membrane potential(DeltaPsim) was measured by FCM.</p><p><b>RESULTS</b>The purity of recombinant protein AZURIN reached to 99.1%. Proliferation of U2OS cells were significantly inhibited 12 h after AZURIN (100-200 mg/L) treatment. Apoptosis peak and DNA ladder were observed. Mitochondrial membrane potential decreased gradually from 12 h to 72 h after AZURIN treatment.</p><p><b>CONCLUSION</b>The recombinant AZURIN inhibit the growth of the human osteosarcoma U2OS cells and inducs apoptosis in vitroìwhich may be associated with the decrease of mitochondrial membrane potential.</p>