The role of mesh technology with tumor prosthesis reconstruction to reconstruct the extensor mechanism of knee joint after resection of proximal tibial tumors.

PURPOSE: The aim of this study was to evaluate the role of mesh technique in the reconstruction of the extensor mechanism after resection of proximal tibial tumors. METHODS: We retrospectively analyzed the cases of 14 patients who were diagnosed with proximal tibial tumors at our center and reconstructed with tumor prosthesis, gastrocnemius muscle, and mesh between 2012 and 2017. The treatment strategies for patellar tendon reconstruction primarily involve gastrocnemius reconstruction to cover the tumor prosthesis and mesh reconstruction for the patellar ligament. RESULTS: Among the 14 patients, the mean was 1.57° (range 0-12°) for active extension versus 105.00° (range 80-120°) for active flexion. The mean for passive extension was 0°. The passive flexion mean was 115.00° (range 90-120°). The extensor lag averaged 1.57° (range 0-12°), and the mean Musculoskeletal Tumor Society score (MSTS) was 23.57 (range 19-27). The average follow-up for all patients was 23.50 months (range 14-37). During the recent follow-up, all patients were able to walk without crutches. Two patients underwent above-the-knee amputation for local recurrence of the tumor, and lung metastasis occurred in three patients after operation. There were no postoperative complications. CONCLUSIONS: Extensor lag was remarkably reduced in the surgery group in comparison to previous study reports. Surgical resection is a simple, reliable, and effective method to remove and control the tumor. Mesh reconstruction of patellar ligament is effective to reconstruct the extensor mechanism of the knee after excision of tumor.

Significance of circulating tumor cells in osteosarcoma patients treated by neoadjuvant chemotherapy and surgery.

PURPOSE: By examining and identifying circulating tumor cell (CTC) counts and subtypes of peripheral blood in osteosarcoma patients, we evaluated the relationship between CTCs and characteristics of osteosarcoma patients, as well as CTC changes after neoadjuvant chemotherapy and surgery. METHODS: CanPatrol™ CTC technology was used to detect CTCs in peripheral blood before and after treatment in 32 osteosarcoma patients. Peripheral blood samples from 10 healthy volunteers were included as controls and examined for the presence of CTCs. RESULTS: Of the 32 osteosarcoma patients, CTCs were detected in 30 patients before treatment, and the average CTC count was 14.06±9.08. No CTCs were detected in the 10 healthy volunteers. The detected CTCs were divided into epithelial CTCs, mesenchymal CTCs (M-CTCs), and biophenotypic epithelial/mesenchymal CTCs. The average number of pretreatment CTCs was higher in stage III patients than in stage IIB patients (P=0.012). Twenty-eight patients were screened for changes in CTC count at 1 week after neoadjuvant chemotherapy and at 4 weeks after surgery. We divided these 28 patients into two groups according to the changes in the percentage of M-CTCs before and after treatment, and the results showed that the disease-free survival (DFS) was significantly shorter in the M-CTC percentage-increased group than in the M-CTC percentage-decreased or no-change group (P=0.032). Five patients with stage II osteosarcoma were examined for CTCs at the appearance of lung metastases, and the total number of CTCs was found to be higher at the appearance of lung metastases than before treatment in these patients. CONCLUSION: The rate of presence of CTCs in the peripheral blood of osteosarcoma patients is high, and patients with an increased percentage of M-CTCs after treatment have a shorter DFS. The dynamic monitoring of changes in CTC counts after treatment has clinical significance for the timely detection of recurrence or metastasis.

[Treatment of children with femoral subtrochanteric fracture with advanced elastic intramedullary nail technology].

OBJECTIVE: To explore curative effects of advanced elastic intramedullary nail technology in treating children with femoral subtrochanteric fracture. METHODS: Form March 2009 to December 2010, 16 children with femoral subtrochanteric fracture were treated with advanced elastic intramedullary nail technology. There were 12 males and 4 females ranging in age from 7 to 15 years old with a mean of 9.8 years old. According to fracture classification, 9 cases were stable fractures (traverse or short oblique type) and 7 cases were unstable fractures (comminuted or long oblique type). Radiographs and complications were retrospectively reviewed. Fracture healing were evaluated according to Flynn criteria. RESULTS: All children were followed up from 11 to 32 months with an average of 21 months. No incision infecton,bone nonunion and breakage of screw occurred. The fracture healing time was from 8 to 16 weeks with an average of 10.1 weeks. According to Flynn criteria, 14 cases got excellent results, 1 moderate and 1 poor. CONCLUSION: Advanced elastic intramedullary nail technology for the treatment of children with femoral subtrochanteric fracture is a safe and effective fixation, which is good for early mobilization, shorter the duration of hospital stays and reduce complications.