Treatment of low-grade malignant bone tumor of limb by half-side cortical resection and inactivated replantation / 中国基层医药

Objective To study the curative effect of side bone cortex resection and inactivated replantation in the treatment of low limb malignant bone tumor.Methods 58 patients who diagnosed and treated for low limb malignant bone tumor were selected as the research subjects,and they were randomly divided into observation group and control group,each group in 29 cases.The artificial joint replacement was used in patients with the ordinary routine therapy,the observation group received side a thorough treatment of the wounded inactivated bone cortex excision.The clinical curative effect,operation indicators,and postoperative infection were compared and analyzed in the two groups.Results The total effective rate of the observation group was 96.55% (17 cases had marked effect,effective in 11 cases,failure in 1 case).The total effective rate of the control group was 72.41% (9 cases had marked effect,effective in 12 cases,failure in 8 cases),the clinical curative effect of the observation group was significantly higher than the control group (χ2=6.44,P<0.05).In addition,the anxiety and the operation indicators between the two groups had statistically significant differences (t1=5.47,t2=5.47,all P<0.05,the former is superior to the latter).Conclusion Side bone cortex inactivated replantation in the treatment of low-grade malignant bone tumor resection patients can effectively shorten the operation time and reduce the intraoperative blood loss,bad mood,and also can alleviate patients to obtain ideal therapeutic effect,clinical should be vigorously promoted.

Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

PURPOSE: This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod. MATERIALS AND METHODS: The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint. RESULTS: The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%. CONCLUSIONS: The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.

Soft tissue consideration in oral rehabilitation using implant in a patient after oral tumor resection / 대한치과보철학회지

After the resection of oral tumor, defected maxillofacial structure caused functional difficulties including phonetics, mastication and esthetic aspects. In this cases, implant retained prosthesis can contribute to the functional enhancement. Regardless of the success rate in grafted bone, however, the soft tissue usually had a shape which was susceptible to inflammation. Moreover, infected graft bone presented rapid destruction. For success of the prosthetic treatment, adequate soft tissue treatment and frequent recall check are the essential factors to the successful implant prognosis.

Quantification of the Effect of Vertical Bone Resection of the Medial Proximal Tibia for Achieving Soft Tissue Balancing in Total Knee Arthroplasty

BACKGROUND: Degenerative osteoarthritis of the knee usually shows arthritic change in the medial tibiofemoral joint with severe varus deformity. In total knee arthroplasty (TKA), the medial release technique is often used for achieving mediolateral balancing. But, in a more severe varus knee, there are more difficult technical problems. Bony resection of the medial proximal tibia (MPT) as an alternative technique for achieving soft tissue balancing was assessed in terms of its effectiveness and possibility of quantification. METHODS: TKAs were performed in 78 knees (60 patients) with vertical bone resection of the MPT for soft tissue balancing from September 2011 to March 2013. During operation, the medial and lateral gaps were measured before and after the bony resection technique. First, the correlation between the measured thickness of the resected bone and the change in medial and lateral gaps was analyzed. Second, the possibility of quantification of each parameter was evaluated by linear regression and the coefficient ratio was obtained. RESULTS: A significant correlation was identified between alteration in the medial gap change in extension and the measured thickness of the vertically resected MPT (r = 0.695, p = 0.000). In the medial gap change in flexion, there was no statistical significance (r = 0.214, p = 0.059). When the MPT was resected at an average thickness of 8.25 +/- 1.92 mm, the medial gap in extension was increased by 2.94 +/- 0.87 mm. In simple linear regression, it was predictable that MPT resection at a thickness of 2.80 mm was required to increase the medial gap by 1.00 mm in knee extension. CONCLUSIONS: The method of bone resection of the MPT can be considered effective with a predictable result for achieving soft tissue balancing in terms of quantification during TKA.

Temporal bone squamous cell carcinoma - Penang experience

Temporal bone squamous cell carcinoma (TBSCC) is rare and poses difficulties in diagnosing, staging and management. We describe a case series with six patients who were diagnosed TBSCC, from January 2009 to June 2014, with median age of 62 years old. All patients presented with blood-stain discharge and external auditory canal mass, showing that these findings should highly alert the diagnosis of TBSCC. Three patients staged T3 and another three with T4 disease. High-resolution CT (HRCT) temporal findings were noted to be different from intraoperative findings and therefore we conclude that MRI should be done to look for middle ear involvement or other soft tissue invasion for more accurate staging. Lateral temporal bone resection (LTBR) and parotidectomy was done for four patients with or without neck dissection. Patients with positive margin, perineural invasion or parotid and glenoid involvement carry poorer prognosis and postoperative radiotherapy may improve the survival rate. One patient had successful tumor resection via piecemeal removal approach in contrast with the recommended en bloc resection shows that with negative margin achieved, piecemeal removal approach can be a good option for patients with T2-3 disease. In general, T4 tumor has dismal outcome regardless of surgery or radiotherapy given.

Squamous Cell Carcinoma of the External Auditory Canal: Treatment Results of 15 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The management of external auditory canal (EAC) squamous cell carcinoma (SCC) is very difficult because the structure of the temporal bone is complicated. We aimed to analyze the surgical results of EAC SCC and propose a treatment protocol. SUBJECTS AND METHOD: Fifteen patients with EAC SCC who underwent operations between July 1984 and June 2001 were analyzed. We divided the patients into five classes according to the extent of tumor progression. In patients classified under Class I, the tumor involved the cartilaginous ear canal. Tumors of patients within Class II involved the bony ear canal or mastoid cortex. Tumors that involved the deep structures of the temporal bone but limited involvement of within the middle ear cavity were classified under Class IIIA. In Class IIIB, tumors involved the facial canal, the base of the skull, or mastoid air cells. In Class IIIC, tumors involved the cochlea, the medial wall of middle ear, dura, sigmoid sinus, or other structures such as the parotid gland, carotid canal, or petrous apex. We analyzed data concerning patients and tumors, surgical methods, and surgical outcomes. RESULTS: The number of patients classified under Class I, Class II, Class IIIA, Class IIIB and Class IIIC were 3, 3, 2, 1, and 6, respectively. Surgical approaches were local canal resection, partial temporal bone resection (TBR), subtotal TBR, and total TBR. Follow up period was 5 to 138 months with a mean (+/-SD) of 40 months (+/-37.5), and the five-year disease free survival rate was 40.6%. CONCLUSION: From this study, we suggest the treatment modality for the EAC SCC. We recommend a partial TBR for surgery of Class I or Class II EAC SCC cancers, a subtotal TBR for Class IIIA, and a total TBR when it is close to Class IIIB or Class IIIC.

Modification of femoral resection in primary total knee arthroplasty and the corresponding clinical results / 中华创伤杂志

Objective To modify femoral resection method in primary total knee arthroplasty and verify the operative results of this modification through measurement of the thickness of the bone resection and clinical follow up. Methods The femoral resection measurement guide was modified so that the resection of the posterior femoral condyle was increased 3 mm in thickness. A total of 81 cases undergoing total knee replacement were divided into varus group and valgus group, in which the thickness of various resections were measured and compared with that of the prosthetic implants. The average follow-up time was 27.1 months. Results On average, the thickness of bone resection in both the flexion and the extension gaps was smaller than that of the prosthesis. In both groups, except for the thickness of the posterior femoral condyle, there were significant differences in other indices ( P