Difficulties and Related Factors Experienced by Nurses in Caring for Patients with Recurrent and Metastatic Malignant Musculoskeletal Tumor

Purpose: To elucidate the actual state of difficulties and related factors of nurses in caring for patients with recurrent and metastatic malignant musculoskeletal tumor. Methods: The subjects were 315 nurses from 12 institutions that treat malignant musculoskeletal tumor. We researched the difficulties of nurses regarding cancer nursing and care of patients with malignant musculoskeletal tumor. We examined the related factors by multiple regression analysis. Result: 165 nurses responded (effective response rate 52.4%). Among “Nurses’ difficulty with cancer care”, the level of difficulty regarding communication was the highest and in own knowledge/technology, system/regional cooperation was also high. Among “Nurses’ difficulty with care for patients with malignant musculoskeletal tumor”, there was a high degree of difficulties regarding the target characteristics of care. Related factors were facility characteristics, nursing experience, nursing experience of musculoskeletal tumor, learning methods for musculoskeletal tumor nursing, and multi-professional conferences. Conclusion: Nurses caring for patients with malignant musculoskeletal tumor have specific difficulty due to total pain, age of onset, and rarity. Educational support based on related factors is therefore required.

Reconstruction Options after Surgical Resection in Muskuloskeletal Tumors of the Extremity / 대한정형외과학회잡지

Recently limb sparing surgery is accepted as an alternative method in the management of muskuloskeletal tumors of the extremity without undue compromise to the patient s life. But the limb sparing procedure results in large osseous and soft tissue defects. To fill these defect, several options have been used such as tumor prosthesis, temporary spacer with cementation, allograft, and autograft(fresh, autoclaved, low heat treated, and extracorporeal irradiated). To identify the indica- tions ot' individual option, we studied 66 cases of musuloskeletal tumors of extremity which were treated with wide or marginal resection and reconstructive surgery from June, 1990 to June, 1997, in which 48 cases were osteosarcomas, 3 chondrosarcomas, 2 synovial sarcomas. I liposarcoma, 1 giant cell tumor, I malignant lymphoma, and 10 metastatic bone tumors. The location of the lesion were distal femur in 24, proximal tibia in 24, proximal femur in 9, proximal humerus in 6, tibial midshaft in 1. distal radius in 1, and calcaneus in 1. In Enneking stages about primary bone tumors 6 cases were IIA, 42 IIB, and 8 III. We reconstructed the osseous defect with tumor prosthesis in 22 cases, temporary spacer in 9(later, 4 cases was changed to tumor prosthesis for staged operation), allograft in 25, and autograft in 14(low heat treated in 2, irradiated in 12). Total functional result by Enneking system was 71.5% . 80.8% with tumor prosthesis, 50.5% with temporary spacer, 70% with allograft, 75.3% with autograft. Infections were occurred in 18% of the patients treated with tumor prosthesis, 34% with allograft, 0% with temporary spacer or low heated autograft, and 18% with irradiated autograft. Delayed union or nonunion was occurred in l5% of the patients treated with allograft, 40% with autograft. There were 2 cases of metal failure and 2 cases of graft fracture using autograft. In conclusion, we propose that the indication of the tumor prosthesis is for the skeletally matured patient, patient with high-grade malignant tumor, older patients, and patient who have limited life expectancy. The reconstruction with allograft have several advantages for the patients with henign bone tumor and locally aggressive or low-grade malignant tumor. The temporary spacer may be used as staged operations for the skeletally immature patient and patient who have an extreme hone and soft tissue defects after limb sparing operation. The recycling autograft may be applied to the patients at any age with minimal bony involvement of tumor. The low heat treated autograft may be useful in the patients requiring intercalary reconstruction, and the irradiated autograft may he useful in the patients with periarticular involvement.

The Evaluation of Magnetic Resonance Imaging Application in Treatment of Tumors in Orthopedics / 대한정형외과학회잡지

It is essential to define the accurate location and extent of tumors for the treatment planning and evaluation of the prognosis of the musculoskeletal tumors. Since Magnetic Resonance Imaging(MRI) provides excellent tissue contrast and multiplsnar image. MRI could be applied to the diagnosis and the treatment planning of musculo-skeletal tumors. Thirty-one patients with bone and soft tissue tumors underwent MRI at Department of Orthopedic Surgery, Seoul National University Hospital, since Jun. 1986, and the applicability of MRI in treatment planning of bone and soft tissue tumors was evaluated. Multiplanar image and excellent tissue contrast between soft tissue made it possible to define the location and the extent of tumor accurately. Tl weighted image was advantageous in intramedullary tumor extent, while T2 weighted image was helpful in soft tissue invasion. It was possible to guess histologic diagnosis of tumor in such cases as hemangioma, aneurysmal bone cyst, lipoma, and desmoid tumor. Above advantages guided the treatment planning and determination of biopsy site. Especially in two cases of osteosarcoma, which were highly malignant, limb salvage operation was performed instead of amputation.