Recurrence of Giant Cell Tumor of the Spine after Resection: A Report of 10 Cases.

OBJECTIVE: To review the clinical details and further treatments for recurrent spinal giant cell tumors (SGCT), and to analyze the risk factors of recurrence and shed new light on the treatment options and prognosis of recurrent SGCT. METHODS: A retrospective analysis of recurrent SGCT between April 2003 and January 2014 was performed. A total of 10 patients comprising 3 men and 7 women with a mean age of 28.9 years (range, 21-40 years) were included in the study. All complete clinical data, radiographs, CT, MRI, scans and pathological data were reviewed. The tumor locations and the regions involved were evaluated by CT and MRI. The blood supply of the tumors was evaluated by enhanced CT and MRI. The mean follow-up was 81.3 months (range, 35.7-172.1 months). RESULTS: All patients had Enneking stage 3 tumors; 9 (90%) of them had different extents of spinal canal involvement in the primary time period. All patients underwent intralesional resection during their first surgery. Only 1 patient received local adjuvant treatments; no patient underwent selective arterial embolization or used denosumab at that time. Only 1 patient underwent adjuvant radiotherapy postoperatively, and another patient used bisphosphonates. After recurrence, 1 patient was cured using denosumab, and 2 patients' disease was controlled through use of other medical treatments or adjuvant treatments. There were 3 repeated recurrences and 7 repeated surgical procedures were performed in 5 patients. There were 6 intralesional excisions and 1 decompression surgery. The mean relapse-free time after the first surgery was 32.3 months (range, 10.5-62.6 months). The overall mean relapse-free time was 40.2 months (range, 10.5-157 months). No distant metastasis was found in our series. At the final follow-up, 4 patients were disease free, 3 patients' disease was under control, 2 has progressive disease aggravation, while 1 patient died as a result of progression of disease 133.9 months after first surgery. CONCLUSION: Intralesional excision for recurrent spinal giant cell tumors is an effective option that may have satisfactory prognosis. However, the excision and the inactivation of the lesion should be carried out carefully and thoroughly without missing any corners. Early diagnosis of recurrence may be associated with better prognosis. Adjuvant treatments perioperatively and systemic medical treatments can decrease recurrence rates and can have therapeutic effects in the recurrent SGCT.

Open Surgery for Osteoid Osteoma with Three Dimensional C-arm Scan under the Guidance of Computer Navigation.

OBJECTIVE: To evaluate the clinical outcomes of open surgery for osteoid osteoma with three-dimensional (3-D) C-arm scan under the guidance of computer navigation. METHODS: The clinical data of 14 patients who had undergone 3-D C-arm scan under the guidance of computer navigation during open surgery for osteoid osteoma from March 2012 to June 2015 were analyzed retrospectively. There were nine male and five female subjects aged from 9 to 55 years (mean, 26 years). Eight of the tumors were located in the femur, four in the tibia, one in the humerus and one in the scapula. Preoperative pain visual analogue scale (VAS) scores ranged from 2 to 6 (mean ± SD, 4.7 ± 1.1). Conventional surgical approaches were used to expose the tumor surfaces depending on their locations. Involved regions were scanned by 3-D C-arm fluoroscopy during the procedure and then the tumors were accurately located and their niduses removed under the guidance of computer navigation. Afterwards, repeat 3-D C-arm scans of the surgical region were performed to confirm tumor eradication. None of the patients received postoperative intravenous analgesia. Eight patients received oral non-steroidal anti-inflammatory drugs on the day of surgery, these drugs being discontinued on the second postoperative day. Postoperative pathological diagnoses were recorded. At the follow-up visits, imaging and VAS scores were obtained to evaluate the therapeutic effect and any evidence of recurrence. RESULTS: All the patients successfully underwent computer navigation-guided surgery. The duration of surgery ranged from 60 to 135 min (mean, 94 min) and the amount of bleeding from 50 to 150 mL (mean, 80 mL). None of the patients needed bone grafting or internal fixation. No complications were seen. All patients were followed up for 4 to 36 months (mean, 16 months). Postoperative pathological diagnoses of osteoid osteoma were made in 12 patients; thus, the rate of pathologically confirmed diagnosis was 86%. VAS scores decrease to an average of 1.4 ± 0.6 3 days after surgery and were zero for all patients 4 months after surgery. No tumor recurrence was found by X-ray or CT scan examination during follow-up. CONCLUSIONS: The niduses of osteoid osteomas can be eradicated by open surgery with 3-D C-arm scan under the guidance of computer navigation with minimal damage to bone structure and a high rate of pathologically confirmed diagnoses.

A reduction clamp for an aiming component in associated acetabular fractures.

BACKGROUND: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. MATERIALS AND METHODS: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. RESULTS: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp's aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. CONCLUSION: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

The invention of an iliosacral screw fixation guide and its preliminary clinical application.

OBJECTIVE: To introduce an iliosacral screw fixation guide and evaluate its efficacy in fixation of sacroiliac joint fracture-dislocations. METHODS: Between January 2011 and May 2011, eight patients (five men, three women) with sacroiliac joint fracture-dislocation underwent percutaneous iliosacral screw fixation with the assistance of this minimally invasive guide and under CT guidance. The patients, aged from 26 to 56 years (mean 32 years), had vertically unstable pelvic fractures. Before surgery, six patients who had displacement of >2 cm in their sacroiliac joints underwent skeletal traction on the femoral condyle. The inserted sites were marked out on the affected side of their buttocks after the best screw trajectory had been determined under CT control. The gear that controls the direction of the minimally invasive guide was adjusted according to the inserting angle determined by CT scans. A K-wire was inserted into the sacroiliac joint along the pilot sleeve of the guide, and a hollow screw (diameter 7.3 mm) was implanted into the sacroiliac joint along the K-wire. RESULTS: All eight operations were successful on the first attempt. The operations lasted from 10 to 20 minutes (mean 14 minutes). Immediate CT scans confirmed that all the screws had been placed in the desired positions, none had penetrated the bones and the configuration of the sacroiliac joints had been satisfactorily restored and firmly fixed. No patient experienced numbness or radiating pain in the lower limbs during surgery. There were no postoperative vascular or neurological complications. CONCLUSION: The minimally invasive guide can eliminate discrepancies resulting from the surgeon's own sensory input when inserting screws under the guidance of CT, making percutaneous iliosacral screw fixation more accurate, safe and simple.

Poly[diaqua-bis[µ(2)-2,4-(dichloro-phenoxy)-acetato-κO:O']iron(II)].

In the title compound, [Fe(C(8)H(5)Cl(2)O(3))(2)(H(2)O)(2)](n), the Fe(II) atom is located on an inversion center. It is coordinated by four O atoms from four 2,4-dichloro-phenoxy-acetate ligands and two water mol-ecules, displaying a distorted octa-hedral geometry. The carboxyl-ate groups of the 2,4-dichloro-phenoxy-acetate ligands link the Fe atoms, forming a polymeric layered network in the bc plane. Intra-layer O-H⋯O hydrogen bonds enhance the stability of the two-dimensional network.

Poly[aqua-[µ-N'-(carboxymethyl)ethylene-diamine--N,N,N'-triacetato]neodymium(III)].

In the title complex, [Nd(C(10)H(13)N(2)O(8))(H(2)O)](n), each Nd(III) ion is coordinated by six O atoms and two N atoms from one N'-(carboxymethyl)ethylene-diamine--N,N,N'-triacetate (edta) ligand and one water mol-ecule, displaying a bicapped trigonal-prismatic geometry. The edta ligands link the neodymium metal centres, forming polymeric chains running along the a axis of the unit cell. These chains are further assembled via inter-molecular O-H⋯O hydrogen-bonding inter-actions into a three-dimensional supra-molecular network.

catena-Poly[[[diaqua-terbium(III)]-tri-µ(2)-isonicotinato-κO:O'] tris(perchlorate) monohydrate].

In the title complex, {[Tb(C(6)H(5)NO(2))(3)(H(2)O)(2)](ClO(4))(3)·H(2)O}(n), the Tb(III) ion is coordinated by six O atoms from six isonicotinate (inic) ligands and two water mol-ecules, displaying a bicapped trigonal-prismatic geometry. The inic ligands, which are protonated at the pyridine N atom, link the metal centres, forming a polymeric chain running parallel to the a axis. The chains are further assembled via intra- and inter-molecular O-H⋯O and N-H⋯O hydrogen-bonding inter-actions into a three-dimensional supra-molecular network involving the inic ligands, the water mol-ecules and the perchlorate anions. One of the perchlorate ions is disordered over two sites with occupancies of 0.561 (17) and 0.439 (17).