Mini-open excision of osteoid osteoma using burrs with the guidance of O-arm navigation / 中华骨科杂志

Objective:To investigate the surgical method and clinical effect of O-arm navigation mini-open burring for osteoid osteoma.Methods:Eighteen patients with osteoid osteoma were treated with O-arm guided grinding drill from June 2021 to May 2022, including 15 males and 3 females, the age was (18.4 ±10.9) years (range 2 to 44 years), and the course of disease ranged from 1 week to 3 years (mean 14.2 months). The lesions sites included 6 cases of proximal femur, 3 cases of distal femur, 4 cases of proximal tibia, 1 case of distal tibia, 2 cases of proximal fibula and 1 case of distal and proximal humerus. During the operation, the O-arm navigation was used to determine the location of the focus, the muscle and soft tissue was peeled off to the bone surface through a 1-4 cm small incision, the channel retractor was placed, and the burr was registered as a navigation recognition device to gradually remove the bone on the surface of the tumor nest, and the tumor nest was scraped with a curette for pathological examination; according to the navigation image, the focus was enlarged removed with burr and the grinding range was confirmed by the O-arm X-ray machine before the end of the operation. The patients were followed up for 6 to 15 months (mean 9.5 months). CT scans were performed before and after surgery for imaging comparison in order to figure out whether it had residual lesions or recurrence. The visual analogue score (VAS) of pain was used as a parameter for evaluating the clinical efficacy.Results:The operation time of 18 cases was 40-175 min, with an average of 89.3 min. The time required to establish navigation image was 18.0 ±4.1 min (range 13 ~ 22 min). The length of the incision was 2.7±1.1 cm (range 1-4 cm). All patients achieved complete curettage of the lesions, and osteoid osteoma was confirmed by pathology after operation. All the patients could move to the ground 24 hours after operation, and the pain was significantly relieved from 3 to 7 d after operation, and the pain almost disappeared 3 months after operation. The VAS score of 18 cases was 5.33±1.24 before surgery, 2.79±1.32 on the 3rd day, 1.86±1.21 on the 7th day, 0.86±0.93 on the 1st month, 0.33±0.48 on the 3rd month, and 0.09±0.29 on the 6th month after operation, and the difference was statistically significant ( F=58.50, P<0.001). There were no serious complications during and after operation, and the success rate of treatment (no recurrence of symptoms, no residual recurrence of imaging lesions, no serious complications after operation) was 100%. Conclusion:Treatment of osteoid osteoma with mini-open excision using burrs under the navigation of O-arm is a simple, safe, minimally invasive and efficient technique. Intraoperative precise positioning and the use of burr with navigation to remove a larger area than the tumor nest are the keys to successful treatment.

3D printed hemipelvic prosthesis for treatment of pelvic malignant tumors resected via sacroiliac joint / 中华骨科杂志

Objective:To analyze the surgical techniques, surgical indications and early clinical effects of 3D printed hemipelvic prostheses in the reconstruction of pelvic malignant tumors resected by the sacroiliac joint.Methods:From January 2016 to March 2020, a retrospective analysis of 9 patients with malignant tumors involving pelvis I+II or I+II+III region were treated with sacroiliac joint osteotomy and 3D printed pelvic prosthesis reconstruction. There were 7 males and 2 females; their age was 51.1±10.5 years (range 27-66 years). Among them, 5 cases were chondrosarcoma, 1 case was pleomorphic undifferentiated sarcoma, 2 cases were metastatic renal cell carcinoma, and 1 case was metastatic primitive neuroectodermal tumor. Resection of pelvic area I+II or I+II+III were according to the extent of tumor involvement. During the resection of pelvic I region, osteotomy was done through sacroiliac joint surface, and 3D printed hemipelvic prosthesis that fits the sacral auricular surface was used for reconstruction. Postoperative imaging examination was used to evaluate the acetabular rotation center deviation of the pelvic prosthesis; the International Bone Tumor Society (Musculoskeletal Tumor Society, MSTS) function score was used for functional evaluation; the patient's oncology outcome and postoperative complications were evaluated.Results:All 9 patients successfully completed the operation. The operation time was 3.5-6 hours, with an average of 4.5 hours. The intraoperative blood loss was 800-3 000 ml, with an average of 1 400 ml. 3 patients underwent resection and reconstruction of pelvis I+II area, 4 patients underwent pelvic resection and reconstruction of I+II+III area, 2 patients underwent pelvic I+II+III area combined with proximal femur resection and reconstruction; all patients were followed up. The follow-up time was 6-50 months, with an average of 16 months. At the last follow-up of 9 patients, the MSTS score was 12-26, with an average of 20.2; the postoperative rotation center horizontal displacement distance was 10.67±7.12 mm, and the vertical displacement was 8.56±4.22 mm. One case of metastatic cancer was found to have multiple metastases throughout the body during chemotherapy 3 months after surgery, and died in 7 months after surgery; 1 case of pelvic metastatic renal cell carcinoma developed multiple metastases within one and a half years after surgery, controlled by targeted drugs, and survived with the tumor; the rest seven cases had no recurrence at the surgical site and no distant metastasis was found.Conclusion:The semipelvic prosthesis with 3D printed auricular surface has potential advantages in reconstructing the bone defect of the pelvis I+II or I+II+III area after the sacroiliac joint osteotomy. The short-term efficacy is relatively satisfactory, and the long-term efficacy remains to be further observed.

The immune microenvironment of giant cell tumor of bone and its role as an indicator to denosumab administration / 中华骨科杂志

Objective:To investigate the alteration of immune microenvironment in giant cell tumor of bone (GCTB) after denosumab treatment from the aspect of immune cellsat single-cell level.Methods:During Nov 2018 and May 2020, fresh tumor excision tissues from GCTB cases were collected and received CyTOF analyses. CyTOF datasets were analyzed and visualized by t-distributed stochastic neighbor embedding (TSNE) method of reduction dimension. The compositions of immune cells in GCTB with or without denosumab treatment were compared. The supernatant of culture medium of ex vivo inoculated primary tumor tissues was harvested to clarify if the culturing supernatant could affect cell growth.Results:A total of 15 primary GCTB cases and three denosumab-treated samples were included in this study and were sent for CyTOF and multicolor FACS assay. GCTB was featured of T-cell and macrophage-like myeloid cell-dominant immune microenvironment. After denosumab treatment, the percentage of T-cells was significantly elevated, while the number of macrophage-like myeloid cells were reduced. Furthermore, the ratio of macrophage-like myeloid cells in total live cells was associated with the treatment period of denosumab. The multinuclear osteoclast like giant cells were characterized by the expression of γδTCR, while most of the intratumoral CD8+ T-cells were activated PD-1+CD69+T-cells. The culturing supernatant of denosumab treatment-free GCTB tissues reinforced cell proliferation in vitro, while this phenomenon was not seen when using denosumab treated tissues.Conclusion:Illustrated the immune cell atlas of GCTB, and preliminarily investigated the potential effects of immune cells on tumor progression in GCTB, providing some theoretical clues for prolonged use of denosumab in unresectable GCTB cases.

Early functional result of modular reverse shoulder tumor prosthesis in the treatment of proximal humerus tumor / 中华骨科杂志

Objective:To summarize the indications, early functional outcome, complications and precautions of modular reverse shoulder tumor prosthesis in the treatment of proximal humerus tumor.Methods:From September 2018 to October 2019, there were 7 patients with proximal humeral tumor underwent tumor resection and modular reverse shoulder tumor prosthesis replacement in our hospital, including 6 males and 1 female. The average age of the patients was 32 years (14-59 years), including 3 cases of giant cell tumors, 2 cases of osteosarcomas, one case of myeloma and one case of renal cancer metastasis. The prosthesis reconstruction was performed after the removal of the proximal humerus tumor according to malawer type I. Postoperative outpatient follow-up included X-ray of shoulder joint, measurement of shoulder joint activity, functional evaluation using Constant-Murley function score and Musculoskeletal Tumor Society (MSTS) function score.Results:All the 7 patients successfully completed the operation, the operation times were ranged from 125 to 215 min, averaged 158 min; the intraoperative hemorrhage were ranged from 100 to 500 ml, the averaged 257 ml; the length of resected proximal humerus were ranged from 10 to 16 cm, averaged 12 cm. All patients were followed up for 4-17 months, with an average of 8 months. At the last follow-up, the average active abduction of shoulder was 108° (80°-175°), and the average active flexion was 124° (90°-175°). Three patients complained of mild discomfort in the shoulder, the rest of the patients had no pain in the shoulder. Sleep was not affected in all patients, and the hands of seven patients could go over the top of head, and they could live and work normally. In 7 patients, the rotation of shoulder joint was limited, the abduction force of shoulder joint was decreased, the Constant-Murley function score was 72% (59%-78%), and the MSTS function score was 84% (67%-93%). None of the 7 patients had incision infection, hematoma and other related complications. There was one dislocation occurred one month after the operation because the humeral adhesion of deltoid was resected. After open reduction, a larger glenoid ball was used and tension of deltoid muscle was tightened, and no dislocation was found.Conclusion:The combined tumor prosthesis of reverse shoulder has the advantages of simple installation, lower operative requirements compared with the common reverse shoulder prosthesis compounded with allograft, easy to control the length of the prosthesis, and also can achieve satisfactory results.

Effectiveness of tranexamic acid in reducing bleeding in limb salvage around knee joints / 中华骨科杂志

Objective:To evaluate the effectiveness and safety of intravenous infusion of tranexamic acid combined with local infiltration in reducing the perioperative bleeding of prosthetic replacement surgery after massive tumor resection around the knee joint.Methods:Retrospective analysethe patients treated in our hospital from December 2014 to November 2018 underwent tumor resection and prothesis replacement surgery for tumors around the knee, according to whether intravenous infusion of tranexamic acid combined local infiltration of tranexamic acid in the incision was divided into tranexamic acid group and control group. Statistical analysis of postoperative drainage volume, total blood loss, number of blood transfusion, hemoglobin and fibrinogen level in 3 days after surgery, drug-related side effects, wound complications. The differences between the measurement data of the two groups used independent sample t test to compare; the comparison between the count data groups was by χ2 test. Results:In all 116 patients, preoperative intravenous infusion of tranexamic acid combined with intraoperative local infiltration of tranexamic acid in 26 patients, 90 cases in control group; 39 of the replacement required preoperative chemotherapy, There were 8 cases in the tranexamic acid group. In the tranexamic acid group, there were 23 cases (88.46%) in the distal femur and 3 cases (11.54%) in the proximal tibia, and 59 cases (65.56%) in the proximal femur in control group, and 31 cases (34.44%) of the proximal tibia. The length of the osteotomy is similar, the control group is 14.01±3.26 cm, and the tranexamic acid group is 15.21±4.69 cm. The operation time in control group was 2.57 h, and the tranexamic acid group was 2.34 h. Bleeding volume: the bleeding in control group was 613.33±212.76 ml, and the tranexamic acid group was 440.39±208.48 ml ( t=3.636, P=0.002). There were 54 patients (60%) had blood transfusion in control group, and 15 patients (57.69%) in the tranexamic acid group. There was a significant difference between two groups ( χ2=4.771, P=0.029). The total drainage volume was 623.92±316.87 ml in control group, 468.08±220.74 ml in tranexamic acid group ( t=2.328, P=0.022); estimated total blood loss index: 440.47±194.23 ml in control group, tranexamic acid group: 236.75±116.56 ml ( t=5.046, P=0.000); hemoglobin level in 3 d after surgery, control group: 84.29±11.21 g/L, tranexamic acid group: 92.12±13.66 g/L ( t=-2.951, P=0.004), perioperative blood loss: 866.14±418.68 ml in control group, 586.75±409.93 ml in the tranexamic acid group ( t=2.985, P=0.003). There were significant differences between two groups. All patients were rechecked for coagulation function within 3 days after surgery. The PT time of the patients in the tranexamic acid group was 15.01±1.01 s at 3 d, which is 14.88±0.85 s in control group, and the APTT was 41.18±4.61 s in tranexamic acid group, but approximately 40.77±4.63 s in control group, fibrinogen was 3.26±0.66 g/L and 3.31±1.20 g/L in control group, there is no significant difference between two groups. Conclusion:Local infiltration of tranexamic acid intravenous infusion of tranexamic acid during surgery can significantly reduce the perioperative bleeding volume of limb salvage surgery aroundknee joint and reduce allogeneic blood transfusion.

Muscle group excision is an effective and safe surgical treatment for soft tissue sarcoma of thigh / 中华骨科杂志

Objective To evaluate the local recurrence rate,limb function and complications of soft tissue sarcoma of thigh after muscle group resection.Methods Between January 2009 and August 2016,twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital,receiving thigh quadriceps muscle group resection,adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study.Patients who had received surgery of this lesion before,suffered from recurrent soft tissue tumor,had tumor involved multiple muscle groups which could not be resected completely,had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded.This retrospective study consisted of 12 male and 11 female.The age ranged from 20-80 with the average of 52.All the patients received CT and MRI of thigh to figure out the size of tumor,the invaded extension of the lesion and the specific muscle group involved.Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases.After all these examinations were done,needle biopsy with the guidance of CT scan was performed for the pathological diagnosis.The pathology included undifferentiated pleomorphic sarcoma (7 cases),rhabdomyosarcoma (2 cases),primitive neurotodermal tumor (1 case),synovial sarcoma (1 case),leiomyosarcoma (3 cases),fibrosarcoma (5 cases) and liposarcoma (4 cases).Sixpatients received quadriceps muscle group resection,eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection.Patients with undifferentiated pleomorphic sarcoma,leiomyosarcoma,primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy.None of patients received radiotherapy.After surgery,drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h.The affected thigh was bound up tightly.Intravenous antibiotics were used for 3 days to prevent from postoperative infections.Patients received quadriceps muscle group resection stayed in the bed for 4 weeks.After that they could walk with the protection of orthosis with unbending position.Other patients got out of bed after 2 weeks.All the complications after surgery were recorded.Reexaminations were arranged in 3,6,12 and 24 months after surgery separately.After that,reexamination was arranged every half a year.Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence.Lower limb function after surgery was evaluated by MSTS scores.Results All the surgeries of muscle group excision were successfully completed.The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h.The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL.The follow-up was a mean of 41 months (range,17-108 months).None was lost to follow-up.The local recurrence rate was 4.3％ (1/23).One patient with undifferentiated pleomorphic sarcoma had positive surgical margin,who received posterior compartment of the thigh resection.Local recurrence occurred 6 months after surgery.Then he received expanded resection.Six patients had distant metastases,five patients for lung metastases,one patient for lung and inguinal lymph node metastases.Of these,five patients had died and one lived with the metastasis.The median MSTS score was 26.3 points (range,14-30 points).Specifically,the median musculoskeletal tumor society (MSTS) score was 28 points (range,21-30 points) for 9 patients with posterior compartment of the thigh resection,twenty-nine points (range,27-30 points) for 8 patients with adductor muscle group resection,and 20.3 points (range,14-24 points) for 6 patients with quadriceps muscle group resection.Five patients had complications,including local recurrence (1 case),hematoma (2 cases) and cutaneous necrosis (2 cases),all of which were settled by reoperation.The rate of complication was 21.7％.Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh,which could reduce the risk of local recurrence,apart from quadriceps muscle group resection,the other two muscle group resections have limited impact on lower limb function,additionally,thigh muscle group resection is a safe procedure with few complications.

Personalized treatment options and clinical results of giant cell tumor of the long bone——A retrospective analysis of 281 patients from one institution / 中华骨科杂志

Objective To explore the personalized treatment options and clinical results obtained by our hospital for different parts of bone destruction of different degrees of bone giant cell tumor.Methods Retrospective analysis from January 2005 to December 2014,according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide resection or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases.There were 150 males and 131 females,with overall age from 14 to 71 years and an average of 35.10 yearsold.The distal ulna was 9 cases.The distal radiuswas 26 cases.The proximal humerus was 19 cases.The distal humerus was 2 cases.The proximal femur was 38 cases.The distal femur was 95 cases.The proximal tibiawas 59 cases.The distal tibiawas 10 cases.There were 19 proximal fibula cases,3 distal fibula cases and 1 case of multiple giant cell tumor of bone.We chose curettage and/or adjuvant therapy or wide resection,then with bone cement,allograft or autograft,prostheses to reconstructionaccording to tumor site,the degree of destruction,pathological fractures.The x2 test and Cox regression analysis were used to detect the statistic differences.The KaplanMeier survival analysis was used to count the disease-free survival.The relationship between tumor location,destruction degree,Campanacci grading,pathological fractures,treatment methods at different stages and recurrence were analyzed.Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study,including 37 pathological fracture and 244 non-fracture.According to the author's giant cell tumor diagnosis and treatment process,122 patients received a wide resection,159 cases were treated with curettage ± adjuvant therapy.23 patients had postoperative recurrence,the recurrence rate was 8.19％.The recurrence time after operation ranged from 9 to 75 months (average 30.95 months).There was no significant difference between the recurrence rate of lesions around the knee and other parts (x2=0.370,P=0.240).In the non-pathologic fracture group,the recurrence rate was significantly lower in the large section compared with curettage surgery (x2=9.393,P=0.002).Of the patients with intralesional surgery,126 patients reconstructed with cement and 28 patients reconstructed with autograft/allograft bone to rebuild mechanical stability.There were 14 recurrence cases (14/126,11.11％) in the bone cement group and 8 recurrence cases (8/28,28.57％) in the bone graft group.The recurrence rate in the bone cement group was significantly lower than that in the simple bone graft group (x2=5.846,P=0.017).The patients with lesion less than 50％,4 had recurrences (4/55,7.27％),12 recurrences occurred (12/76,15.79％) in more than 50％ and less than 75％ of the cross-sections,and if the lesion was more than 75％ cross-sectional area,4 cases of recurrence (4/113,3.54％).There was no significant difference in the proportion of bone destruction between different cross-sections in affecting tumor recurrence.The recurrence rate of Campanacci Grade Ⅲ patients was significantly higher than that of Campanacci Grade Ⅱ patients with curettage surgery (x2=9.909,P=0.002).Only 1 of the patients with pathological fracture had recurrence (1/37,2.70％),the recurrence rate was significantly lower than that the curettage group (x2=11.972,P=0.001).Among the early patients,79 cases (63.71％) were cured by surgery and 17 cases were relapsed,while in the last 5 years 80 cases (50.96％) were cured by surgery and 6 cases were relapsed,In two different periods,the curettage recurrence rate was significantly decreased (x2=9.246,P=0.003).Conclusion By selecting personalized treatment options for different patients,it is possible to increase the proportion of patients who maintain their knee joints while reducing the local recurrence rate,providing doctors and patients with a choice of treatment options.

Diagnosis and surgical treatment of spinal osteoblastoma / 中华骨科杂志

Objective To investigate the clinical charactistics,diagnosis,treatment options and surgical efficacy of spinal osteoblastoma.Methods From May 2007 to May 2016,the clinical manifestations,imaging data,diagnosis,treatment and prognosis of 11 patients with spinal osteoblastoma were retrospectively reviewed.There were 7 males and 4 females.The age ranged from 15 to 44 years old with the average of 27.5 years.Two lesions were involved in cervical spine and 6 lesions were located in thoracic spine.The other 3 cases was in lumbar spine.All patients suffered from local pain.Four patients had neurological deficiency,with 3 suffering radicular pain and 1 suffering incomplete paraplegia (Frankel C).Four patients were staged as Enneking 2 and treated by intralesional curettage.Seven patients were staged as Enneking 3.Accordingly,4 patients were treated by expanded excision with single posterior approach and 1 patient was treated by expanded excision with combined anterior and posterior approach.The other 2 patients were treated by piecemeal total vertebrectomy with single posterior approach.The pain release,neurological recovery and tumor recurrence were evaluated by postoperative follow-up.Results The mean operation time was 3.5 h (range,1.5-7 h) and the average intraoperative blood loss was 800 ml (range,100-3 000 ml).1 patient had cerebrospinal fluid leakage and 2 patients had pleural effusion.No surgical infection was detected in any patient.After surgery,the pain was dramatically relieved in all patients.The radicular pain in 3 patients were relieved and the incomplete paraplegia in 1 patient was recovered to Frankel E.The mean follow-up period was 45.8 months (range,12-117 months).Recurrence occurred in 1 case of cervical 7 and thoracic 1 spine leison 4 years after the surgery.Another expanded excision of the tumor was conducted for this patient and no recurrence was detected till now.No other cases of recurrence were observed.No loosing or breakage of implantation was detected during the follow-up.Conclusion For Enneking 2 leisons,intralesional curettage was effective.For Enneking 3 leisons,the expanded excision or piecemeal total vertebrectomy were recommended.No matter the excision was intralesional or not,the satisfactory results could be achieved if complete tumor excision could be conducted.

Efficacy of cervical giant cell tumor surgical treatment via lesion / 中华骨科杂志

Objective To investigate the safety and efficacy of curettage and excision for giant cell tumor of the cervical spine.Methods Retrospectively analyzed 6 cases of giant cell tumors patients who underwent surgical resection of cervical spine between April 2006 and July 2015.There were 2 males and 4 females with an average age of 31.3 years old (ranged from 18 to 42 years).Among them,4 cases were located in C2 vertebral body,1 case located in C3 vertebral body,1 case in C4 spinous pro cess and vertebral lamina.In this study,all the 6 patients underwent intralesional surgery,3 patients were Enneking grade ⅡA,which 1 case underwent curettage,2 cases underwent extended curettage;three cases were Enneking grade ⅢB,which 1 case underwent extended curettage,and 2 cases underwent subtotal spondylectomy.Three patients received local inactivation of the lesion.One patient received local radiotherapy after first posterior occipital-cervical fixation,and underwent posterior and anterior tumor resection,bone grafting and internal fixation 3 months later.One patient was treated with denosumab preoperatively,3 patients were treated with bisphosphonates postoperatively.The neurological status was evaluated by Frankel classification pre-and postoperatively,the pain scale was evaluated by Visual Analogue Scale (VAS) pre-and postoperatively.Imaging examination was used to assess the location and the extent of the tumor preoperatively,as well as the tumor recurrence postoperatively.Results The mean follow-up period was 61.1 months (ranged from 25 to 134 months).One case underwent posterior surgery,while other 5 cases underwent anterior and posterior surgery;3 patients underwent one-stage surgery,3 patients underwent multi-staged surgery.The mean intraoperative bleeding was 2 142 ml (ranged from 300 to 9100 ml).The mean preoperative VAS score was 3 (ranged from 2 to 5),the neck pain of the patients were all relieved postoperatively,and the mean VAS score was 0.The Frankel grade were E in all 6 patients of pre-and postoperation.One intracranial epidural hematoma occurred on the second day after operation,emergency evacuation of hematoma was then performed and the postoperative recovery was good.At the latest follow-up,no internal fixation loosening or failure occurred,and no tumor recurrence was observed in all patients.Conclusion Intralesional curettage and excision of the cervical spinal giant cell tumor is a safe and effective surgical method which can achieve satisfactory local control and prognosis.

Focal encephalitis, meningitis, and acute respiratory distress syndrome associated with influenza a infection

Objective: To present a case of influenza A infection complicated with focal encephalitis, meningitis, and acute respiratory distress syndrome

Clinical Presentation and Intervention: A 35-year-old woman presented with fever, headache, cough, and body aches. Seizures, altered consciousness, and dyspnea occurred later. A nasopharyngeal swab revealed a positive reaction for the influenza A antigen. Magnetic resonance imaging scans showed a T2 prolongation in the left frontoparietal subcortical white matter, which was consistent with focal encephalitis. She recovered after treatment with oseltamivir and antibiotics

Conclusion: This case report highlights focal encephalitis with concomitant pulmonary complications after influenza A infection

Giant cell tumor of bone in proximal tibia: a multicenter big-sample retrospective study / 中华骨科杂志

Objective To retrospectively analyze clinical features,treatment methods and efficacy of giant cell tumor of bone in proximal tibia,and to investigate risk factors affecting tumor recurrence and functional outcomes.Methods A total of 250 patients with giant cell tumor of bone in proximal tibia confirmed by pathology,who had undergone surgical treatment from March 2000 to July 2014,were enrolled in this study.There were 132 males and 118 females,with an average age of (34.59±12.86) years.A total of 140 patients who were followed up for more than 3 years were included in this study,and there were 72 males and 68 females,with an average age of (34.46± 11.96) years.There were 11 cases of Campanacci grade Ⅰ,58 cases of grade Ⅱ,71 cases of grade Ⅲ and pathological fracture of 47 cases.According to surgical methods,they were divided into bone grafting group (49 cases),bone cement filling group (34 cases),prosthesis group (46 cases) and others group (11 cases).The epidemiology,clinical and radiographic features and risk factors affecting tumor recurrence and functional outcomes were analyzed.Results A total of 140 patients were followed up,the follow-up period was 36-324 months,with an average of 95.4 months,and the median follow-up time was 88 months.Recurrence was found in 26 cases,and recurrence rate was 18.57％,with an average recurrence interval of 25.85 months.Recurrence was found in 17 cases in the first 2 years.The 5-year free survival rate was 77.60％.The recurrence rates were 18.37％ in bone grafting group,20.59％ in bone cement filling group,15.22％ in prosthesis group and 27.27％ in the others group,no statistically difference was found on recurrence rate and free survival rate (P=0.805,P=0.558).Recurrence was not related to all kinds of factors.A variety of related factors affecting postoperative recurrence were analyzed,sex,the first diagnosis of the original recurrence,left and right side,whether the eccentricity,fracture,cortical bone destruction,soft tissue mass,surgical methods,high-speed grinding,auxiliary application,and there was no significant correlation between recurrence and these factors.The MSTS 93 score was 25.26±4.31.Function of the primary patients was better than that of recurrence (P=0.044).Function of the patients treated with curettage with or without internal fixation was better than that with segmental resection (P=0.011).Function of the patients treated with grafting or bone cement filling was better than that with prosthesis or allograft-prosthesis reconstruction (P=0.004).There were no significant correlation between MSTS function score and gender,left and right side,whether the eccentricity,whether fractures,cortical bone destruction (Campanacci grade),whether there is soft tissue mass,whether the use of assisted inactivation,whether the use of grinding or internal fixation.Conclusion Various surgical methods had no significant effect on the recurrence of proximal tibial GCT,as for GCT in proximal tibia,there is no relation between recucrrence and related factors.Whether primary tumor and surgical methods are two important factors affecting limb function.

The short-term function of reverse shoulder arthroplasty after resection of the proximal humerus bone tumour / 中华骨科杂志

Objective To explore the short?term functional outcomes of the reconstruction of the proximal humerus by re?verse shoulder arthroplasty after tumor rescetion. Methods 8 patients who underwent reverse shoulder arthroplasty after tumor resection between January 2013 and December 2014. 5 were female and 3 were male, mean aged was 38 years old (25-61). 2 chon?drosarcomas and 6 giant cell tumors. Enneking stageing of 2 cases with chondrosarcoma were stageⅠB and stageⅡB. 6 giant cell tumors were Campanacci stage 3, meanwhile 3 cases had pathological fractures. The deltoid and axillary nerve were intact in all patients by image analysis before the operation. The proximal humerus was resected according to Malawer typeⅠresection. Then reverse shoulder arthroplasty reconstruction and bone graft was performed. The follow?up was scheduled, and the patient received X?ray examination of the shoulder. The range of motion of the shoulder was measured, the Constant?Murley score and musculoskel?etal tumor society(MSTS) score was recorded. Results The mean duration of the operation was 2.7 h (2-3.5 h). The bleeding in the operation was 510 ml (300-850 ml). The mean length of humerus resection was 8 cm (6-10 cm). The allografts were used in 7 cases and reimplantation after tumor bone deactivation was used in one. The latissimus dorsi transfer were performed in 2 cases. The rotator cuff were resected 1-1.5 cm from the great and lesser tubercles. The follow?up was 13 months (3-26 months). No infec?tion, dislocation, or loosening of prosthesis was found by the last follow?up. The X?ray showed the case who received reimplanta?tion after tumor bone deactivation had achieved bone union 1 year postoperation,7 cases received allograft had still nonunion at the host?graft junction. Bone resorption were found in all cases in different extent but the prosthesis were stable. No local recur?rence of the tumor was found. At last follow?up, active abduction was 155° (100°-175° ) and active forward elevation was 150° (115°-170°) and Constant?Murley score was 76%(68%-87%). The MSTS score was 92%(87%-97%). Conclusion The func?tional outcomes of the reconstruction of the proximal humerus by reverse shoulder arthroplasty after tumor rescetion was satisfied in early period. The reverse shoulder arthroplasty can be used in younger patient, but long?term results need further study.

Surgical treatment of giant cell tumor of bone around the knee: a multicenter retrospective study / 中华骨科杂志

Objective To retrospectively analyze treatment status quo of giant cell tumor of bone around the knee in several institutes,and to investigate risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes.Methods A total of 222 patients with giant cell tumor of bone around the knee confirmed by pathology,who had undergone surgical treatment in 5 institutes from March 2000 to May 2012,were enrolled in this study.There were 120 males and 102 females,with an average age of 35.5 years.The epidemiology,clinical and radiographic features and risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes were analyzed.Results Intralesional curettage was performed in 128 patients(57.6％),intralesional curettage combined with partial resection in 13 patients (5.8％),and marginal excision in 79 patients (35.5％).A total of 159 patients were followed up.The local recurrence rate was 19.0％ for patients treated with intralesional curettage,8.9％ for marginal excision and 0％ for intralesional curettage combined with partial resection,and the total local recurrence rate was 14.5％(23/159).The mean duration from primary operation to recurrence was 23.9 months.Univariate analysis indicated that surgical manner was the only factor affecting local recurrence.Pathological fracture,Campanacci grades,Enneking system as well as soft tissue mass had a significant influence on the selection of surgical manners.The mean MSTS score after intralesional curettage was obviously higher than that after marginal excision.Conclusion The surgical manner is the only factor affecting local recurrence and limb function.

Multivariate analysis of chondrosarcoma prognosis / 中华骨科杂志

Objective To screen possible factors affecting prognosis of chondrosarcoma.Methods A total of 37 patients with chondrosarcoma,who had undergone surgical treatment from December 2005 to March 2008 in our hospital and had complete follow-up data and definitive pathological diagnosis,were enrolled in this retrospective study.There were 16 males and 21 females,ageing from eleven to eighty-four years (average,42.8 years).The univariate analysis of survival rate was performed with Kaplan-Meier method and tested with the Log-rank test.Chi-squared test or Fisher's exact test were used to analyze numeration data,and then the significant indexes after univariate analysis were performed multivariate analysis with COX regression model to screen the independent factors affecting prognosis.On the basis of literatures,8factors including gender,age,duration of disease,tumor site,Enneking stage,surgical approach,distant metastasis and local recurrence were analyzed.Results Statistical significance was found in Enneking stage,surgical approach and distant metastasis,which indicated that they were related to survival rate 3years after surgery.However,gender,age,duration of disease,tumor site,and local recurrence had no significant correlation with prognosis.After multivariate analysis of Enneking stage,surgical approach,distant metastasis,the results showed that Enneking stage and surgical procedure were the independent prognostic factors,while distant metastasis was not an independent prognostic factor.Conclusion Enneking stage and surgical approach are the independent prognostic factors for chondrosarcoma,which can be used to evaluate prognosis of chondrosarcoma.

Proximal femoral autograft for pelvic reconstruction after tumor resection / 中华骨科杂志

Objective To investigate technique and indications of proximal femoral autograft for pelvic reconstruction after tumor resection.Methods Between October 2006 and May 2011,5 patients with primary malignant pelvic tumor underwent tumor resection,pelvic reconstruction by proximal femoral autograft,and hip reconstruction by tumor prosthesis.There were 3 males and 2 females,aged from 19 to 55years (average,30.6 years).There were 3 cases of chondrosarcoma and 2 cases of primitive neuroectodermal tumor (PNET).The tumor involved zone Ⅰ and zone Ⅱ in 3 cases,and zone Ⅱ and zone Ⅲ in other 2cases.All 5 patients were followed up,and complications,MSTS (Musculoskeletal Tumour Society) score and prognosis were recorded.Results At final follow-up,one patient died of pulmonary metastasis,one patient survived with local recurrence,and other 3 patients survived without recurrence.The complications consisted of local recurrence,prosthesis loosening,nonunion,infection,and sciatic nerve palsy.One patient underwent revision surgery for prosthesis loosening 26 months after the initial operation.One patient underwent amputation for local recurrence 6 months after the initial operation.The average MSTS score was 19.2.Conclusion Proximal femoral autograft is an effective method for pelvic reconstruction after tumor resection,which can be used for defect in zone Ⅱ and zone Ⅲ,as well as in zone Ⅰ and zone Ⅱ.However,the method has a high rate of complications.The short-term result is similar to that of pelvic prosthesis,while the long-term result needs further observation.

Total en bloc spondylectomy for thoracic and lumbar chondrosarcoma / 中华骨科杂志

Objective To investigate technique and clinical effect of total en bloc spondylectomy for thoracic and lumbar chondrosarcoma.Methods From January 2010 to March 2012,6 patients with thoracic or lumbar chondrosarcoma underwent total en bloc spondylectomy.There were 4 males and 2 females,aged from 25 to 54 years (average,38 years).The tumor ranged from T3 to L3; 1 located in T3 and T4,1 in T7,1in T11,1 in L1,1 in L2 and 1 in L3.According to Tomita surgical classification system,there was 1 case of type 2,1 case of type 4,3 cases of type 5 and 1 case of type 6.One patient underwent tumor resection through single posterior approach,while the other 5 patients underwent anterior dissection and posterior resection of tumor.All spines were reconstructed by posterior fixation with pedicle screws and anterior interbody fusion with titanium mesh cages or artificial vertebrae.Results The average amount of blood loss was 3200 ml (range,2100 to 6300 ml).The duration of operation ranged from 3.5 to 12 hours (average,5.5hours).Two patients obtained wide resection,3 obtained marginal resection,and 1 had intralesional margin.The complications included 2 cases of cerebrospinal leak,1 case of pleural effusion and 1 case of pulmonary infection.There was no wound infection and death during peroperative period.All patients were followed up for 6 to 32 months (average,19 months).The neurological function improved from preoperative Frankel C to postoperative Frankel E in 2 cases.All patients obtained bone union 6 to 12 months (average,8 months) after operation.At final follow-up,all patients could walk without aid,and there was no recurrence.Conclusion The total en bloc spondylectomy is an effective method for thoracolumbar chondrosarcoma,which could provide a satisfied tumor control and neurological function improvement.

The treatment of the fibrous dysplasia of the proximal femur with coxa vara by osteotomy plus plate fixation / 中华骨科杂志

Objective To investigate the clinical effect of subtrochanteric osteotomy plus dynamic hip/condyle screw (DHS/DCS)fixation to treat the fibrous dysplasia of the proximal femur with coxa vara.Methods Twenty-six clinical cases of femoral fibrous dysplasia with coxa vara were retrospectively analysed from April 2001 to May 2010.There were 9 males and 17 females,with a median age of 19(10 to 53).Forteen patients presented with monostotic disease,and 12 with polyostotic disease.The length of the lesion for polyostotic disease was from 9 cm to 36 cm,while for monostotic disease was from 7 cm to 15 cm.Seventeen cases were merged with pathologic fracture.The neck shaft angles were from 65 to 110 degree preoperation.The shortage of limbs was from 1.5 cm to 4.5 cm.Twenty-one patients involved in femoral neck were fixed with DHS and the other 5 cases with DCS.Results The duration of operation was from 80 to 170 min.The amout of bleeding was from 280 to 1650 ml with the average of 960 ml.The average postoperative neck shaft angles were 127 degree(119 to 140).The shortened limbs were extended 2.3 cm for average (1.5 to 3.6 cm).The follow-up time was from 9 to 118 months with the average of 39 months.All patients with osteotomy were healed.The neck shaft angle of 1 case decreased from post-operative 126°to 115°56months post-operatively,no coxa adducta recurrented and all internal fixations were in position.Hip screw backed out through the barrel in one case with the shortage of femoral neck.One case had femoral fracture after an injury.According to Guille function standard,24 cases were regarded as satisfied and 2 cases as unsatisfied.Conclusion Subtroehanteric osteotomy plus DHS/DCS fixation can effectively correct the fibrous dysplasia of the proximal femur with coxa vara,and significantly improve the function.

The diagnosis and therapeutics of the juxta-articular bone cyst in the acetabulum / 中华骨科杂志

Objective To discuss the diagnosis, differential diagnosis and therapeutics of the juxtaarticular bone cyst in the acetabulum. Methods Between August 1990 to April 2009, nineteen cases of clinical data of the juxta-articular bone cyst in the acetabulum data were collected from hospital records and analyzed retrospectively. There were 11 males and 8 females, with an average age of 42.3 years (range, 18-59). Seventeen patients felt an aching pain in the hip. The duration of symptoms was from 2 months to 20years with the median 15 months. All the radiographs showed a well-demarcated oval or circular radiolucent defect, close to subchondral bone, and outlined by a thin rim of sclerotic bone. Five cases accompanied with developmental dysplasia of the hip. After curettage of the bone cyst, 14 patients received iliac crest autogenous bone grafts, 3 patients received xenoma spongy bone-graft particles, and 2 patients received artificial bone grafts. Results Fourteen patients were precisely diagnosed as bone cyst by radiograph, and 4 patients were diagnosed by CT and MRI. The major axes of the focus were 2-4 cm in 16 patients, and 4-8 cm in 3patients. The sizes of the focus had no relationship with the symptoms and the course of the disease. Seventeen cases of the focus were located at the anterior superior of the bearing surface of the acetabulum. All patients were successfully followed up from 11 months to 13 years, averaged 6.2 years, and no relapses occurred during the follow-up period in every case. Fourteen patients felt asymptomatic, 3 patients felt uncomfortable in hip occasionally, and 2 patients with developmental dysplasia of the hip felt ameliorated in the initial stage of the therapy, followed by aggravation accompanying the hip joint space narrow. Conclusion Bone graft after thorough curettage of the capsular space was an effective therapy for the juxta-articular bone cyst in the acetabulum, and the anatomic distribution of radiological lesions indicated that the stress concentration maybe the etiological factor of the bone cyst.

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>

Salmonella infection after surgery of small intestine foreign bodies

To report the first case of Salmonella enterica serotype choleraesuis infection after surgery for small intestine foreign bodies. A 52-year-old woman presented to our hospital with the chief complaint of left abdominal pain for 1 day. The plain kidney-ureter-bladder film and abdominal computed tomography scan showed foreign bodies in the peritoneum. Metallic foreign bodies in the jejunum were found during surgery. Following surgery, the patient developed fever, and blood culture yielded Salmonella enterica serotype choleraesuis. The patient recovered smoothly after antibiotic therapy. Salmonella enterica serotype choleraesuis is a highly invasive serotype of nontyphodial Salmonella. In addition to gastroenteritis, bacteremia, or extraintestinal localized infections, physicians should know that it could complicate intestinal surgery