Résumé
Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of distal tibia,explore the operation indication and the risk factors for recurrence and limb function.Methods From October 2000 to June 2014,Fifteen patients with GCT in the distal tibia from domestic three bone tumor centers were involved in this study.They included 8 males and 7 females,with an average age of 35.9± 10.4 years.There were 11 cases of Campanacci Ⅱ and 4 cases of Campanacci Ⅲ.Two cases of Campanacci Ⅱ occurred pathologic fracture.Expanded curettage surgery was performed in 11 cases and tumor resection with revascularization was performed in 4 cases.Factors influencing the choice of surgery,recurrence and limb function were analyzed.These included tumor size,ankle condition,Campanacci grade,pathological fracture.Results A1l patients were followed up with a mean duration of 62.3±25.2 months,ranging from 26 to 60 months.One of 11 patients treated with extended curettage underwent local recurrence.One of 4 patients treated with marginal excision underwent local recurrence.The effect of Campanacci classification and pathological fracture on selection of operation scheme was analyzed.The effects of pathological fractures,Campanacci classification,surgical methods and postoperative functional score (MSTS score) on postoperative recurrence rate were analyzed.Single factor analysis showed that the pathological fractures did not affect the selection of GCT surgical treatment plan (P=1.000).Campanacci classification affected the selection of GCT surgical treatment plan (P=0.001).Pathological fractures,Campanacci classification and surgical methods were not related to the local recurrence rate (P ＞ 0.05).Expanded curettage of Campanacci grade Ⅱ patients with better postoperative MSTS score than tumor segment resected Campanacci grade Ⅲ patients (t=3.385,P=0.005).There was no significant relationship between pathological fracture and postoperative MSTS score.Conclusion Distal tibia GCT Campanacci classification and whether combined with pathological fracture or not affects the choice of surgical procedure and postoperative functional recovery.
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Objective To introduce a classification of infection interfaces associated with existing implants which was used to guide the treatment algorithms for implants and infection.Methods From January 2006 to April 2016,197 patients were treated at Department of Bone Tumor Osteopathology,Zhengzhou Orthopaedics Hospital for early infection associated with an existing implant.They were 147 males and 50 females,aged from 12 to 63 years (average,47.3 years).After bacterial cultures and drug sensitive tests and other laboratory examinations,their infection interfaces were classified into 3 types.In type Ⅰ of 89 cases,the infection was confined to the soft tissue and spread to only part of the implant;in type Ⅱ of 75 cases,the infection spread to the internal implant but ended at the implant and bone surface,involving no intramedullary cavity;in type Ⅲ of 33 cases,the infection spread to the intramedullary cavity with defects at broken ends.In primary surgery,plating was performed in 126 cases,external fixation in 48 and intramedullary nailing in 23.Type I cases were treated by systemic intravenous infusion combined with local antibiotic therapy and/or limitedly extended debridement while the implants were reserved,type Ⅱ cases by extended debridement while the implants were reserved,and type Ⅲ cases by extended debridement and external fixation while the implants were removed.Antimicrobial therapy was conducted before and after surgery according to their pathogen examination results.Antibiotics were used after surgery according to their pathogen examination results.Their therapeutic outcomes were evaluated according to their systemic and local symptoms,signs,blood routine indexes,erythrocyte sedimentation rate and level of C reactive protein.Results All the patients were followed up for 2 to 5 years (mean,3.4 years).After antibiotic therapy,debridement and vacuum sealing drainage,the implants were reserved in 150 cases,of which 84 were type I and 66 type Ⅱ,and removed in 47 cases,of which 5 were type Ⅰ,9 type Ⅱ and 33 type Ⅲ.By the criteria described in Surgery for Pyogenic Infection of Bone and Joint,the therapeutic outcomes were rated as cured in 185 cases,as effective in 7 and ineffective in 5.Conclusions A classification of infection interfaces associated with existing implants is significant for scientific,reasonable,standardized and individualized treatment algorithms for implants and infection,avoiding not only incidence of osteomyelitis but also unnecessary removal of implants with effective control of inflammation.
Résumé
[Objective]To retrospectively analyze 39 cases of surgical treatment of fibrous dysplasia of proximal femur,in order to propose a partition method which can be used to guide the surgical treatment,and probe the surgical treatment strategy according to the partition method of fibrous dysplasia of proximal femur. [Methods]The data on 39 cases of fibrous dysplasia of proximal femoral from 1998 to 2009 were retrospectively analyzed.The study determined extent of the lesion according to preoperative X-ray film and proposed partitioning method in accordance with the scope of proximal femoral involvement,analyzed the relation of partition type and surgical treatment,and evaluated the effect of surgical treatment through the postoperative localized lesions control and functional score(MSTS 93).[Results]According to the scope of 39 cases of lesions,combined with characteristics of proximal femoral anatomy,proximal femur was divided into four zones: area I,femoral shaft(below small protuberance);area II,intertrochanteric(small rotor to the neck base division);area III,femoral neck;area IV,the femoral head.Based on the above partition,lesions were divided into 7 types,type I,type II,type III,type I + II,type II + III,type II + III + IV,type I + II + III,type I + II + III + IV.Surgical treatment was performed mainly with curettage of bone lesions,bone grafting and fixation.Internal fixation included DHS,intramedullary nails,and artificial joint replacement,DHS was most common in area II involvement(57.58%),followed by area III involvement(24.24%).Intramedullary nail was most common in area I involvement(64.70%) and area II involvement(35.30%).For lesions involving ≥3 zones,joint replacement was carried out.The patients were all followed up,with a median time of 6.3 years(0.5-11 years).Local recurrence rate was12.82%(5 / 39),local deformity was not found deterious.The followed up results were satisfactory.The selected treatment was reasonable.[Conclusion]When making a surgical treatment regimen for fibrous dysplasia of the proximal femur,Surgeons should consider lesion characteristics,and choose a reasonable internal fixation to achieve better surgical results.Partition method proposed in this paper can be formulated as one of preoperative surgical treatment options.