Objective To analyze the causes and the reoperation therapies after salvage limb surgery with prosthesis for bone tumors. Methods The retrospective analysis was performed on 85 patients undergoing the limb salvage operation with prosthetic replacement for tumors from January 1994 to December 2004. Ofthe patients, 21 (13 males and 8 females, aged 18-58 years) underwent reoperations for various reasons. All the diagnoses were pathologically confirmed(10 patients with osteosarcoma, 4 with chondrosarcoma, 5 with giant cell tumor of the bone, 2 with osteofibrosarcoma). The distal femur was involved in 9 patients, proximal tibia in 8, proximal femur in 2, proximal humerus in 1, and acetabulum in 1. According to the Enneking surgical grading system, there were 5 patients in ⅠB and 16 in ⅡB. The time between the first operation and the reoperation was 2 weeks to 20 years. The common reasons for the reoperation were tumor recurrence in 8 patients, prosthetic loosening in 5, no healing of the incision in4,joint dislocation in 3, and implant fracture in 1. The amputation and the prosthesis revision were respectively performed on 6 patients, extensive resection ofthe tumor on 3, the myo-skin flap translocation on 4, internal hemipelvectomy without reconstruction on 1, and open reduction on 1.Results The follow-up in18 patients for 1-5 years (average, 3 years and 4 months) revealed that 4 patients died of osteosarcoma with pulmonary metastasis. The other 14 patients had no tumor recurrence or loosening of the prosthesis, and the incisions healed well. The assessment on the joint function was performed on 13 of the 18 patients and the results were as follows: excellent in 2 patients, good in 5, fair in 4, and poor in 2, with a satisfaction rate of the reoperation with limb salvage of 84.6%and an excellent-good rate of 53.8%. Conclusion Tumor recurrence is the most common reason for the reoperation after the limb salvage with prosthesis for tumors, and loosening of the prosthesis is an important reason, too. By therules of the bone tumor limb savage, the limb salvage operations can also beperformed, which can achieve a satisfactory result of the limb function.
OBJECTIVE: To study the reparative and reconstructive methods for the large bone defect due to the excision of bone tumor. METHODS: According to the size and shape of the bone defect, we selected the proper bone and joint or manipulated bone segment of the profound hypothermia freezing allograft and gave locked intramedullary nails or steel plate and screws for stable internal fixation. RESULTS: In the 22 cases, 20 survived without tumor and 2 died. One patient treated with the allograft of semi-knee joint was found rejection. Then the wound did not heal. After the skin flap grafting was performed, the wound still did not heal, so the patient accepted amputation(4.5%). In the other 21 cases, the X-ray and 99mTc SPECT showed some callus or concentration of nuclein which implied bone union. According to Markin bone graft criterion, the excellent rate of function recovery was 81.8%. CONCLUSION: Allografting of bone and joint is a good and workable method in repairing and reconstructing the bone defect due to the excision of bone tumor. It should be further studied and be applied.
It is extremely necessary to find an ideal filling material for the treatment of benign bone defect, particularly those benign osteolytic defect in children with a comparatively large cavity. From July, 1995 to December, 1996, 10 cases of benign osteolytic bone defects were treated, in which 5 cases of benign osteolytic defects, 3 cases of bone cysts, 1 case of fibrous dysplasia of bone and 1 case of non-ossifying fibroma. After through curettage of the cavity, the natural non-organic bone in cube-shaped was used to fill the prepared cavity. The results showed that the activities of the patients resumed normal in 3 to 6 months after operation. The roentgenographic examination after operation showed that the lucent spaces between NNB cubes disappeared with obvious new bone formation and the bony cavity was obliterated with newly-formed bone. There was no recurrence of the lesion during a follow-up of 7 to 24 months. It was concluded that to treat the osteolytic defect of bone with NNB was a method of choice. The new bone formation appeared early in large amount and increased rapidly.
Seven cases with bone tumor in upper limb were reported. Five cases were treated by using free vascularized fibular graft, 2 cases by using fusion between humorus and clavicle. A follow-up study of six patients showed that the graft bone was united within 3 months in 5 cases, in 6 months in one case. Partial function of upper limb in 6 patients have been restored.
With the developing of three-dimensional (3D) printing technology, it is widely used in the treatment of bone tumors in the clinical orthopedics. Because of the great individual differences in the location of bone tumor, resection and reconstruction are difficult. Based on 3D printing technology, the 3D models can be prepared to show the anatomical part of the disease, so that the surgeons can create a patient-specific operational plans based on better understand the local conditions. At the same time, preoperative simulation can also be carried out for complex operations and patient-specific prostheses can be further designed and prepared according to the location and size of tumor, which may have more advantages in adaptability. In this paper, the domestic and international research progress of 3D printing technology in the treatment of limb bone tumors in recent years were reviewed and summarized.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.
OBJECTIVE To manufacture adriamycin-porous tricalcium phosphate (A-PTCP) ceramic drug delivery system (DDS) as a possible method for bone defect treatment after bone tumor operation. METHODS A-PTCP DDS was made from putting adriamycin into PTCP. Thirty rabbits were divided randomly into group A(24 rabbits) and group B(6 rabbits). A-PTCP was implanted in the greater trochanter of the right femur in group A. Adriamycin were injected into veins in group B. Muscle around A-PTCP and plasma were taken out at different period. Adriamycin concentrations in muscle and plasma were measured by high performance liquid chromatography (HPLC). RESULTS A-PTCP could gradually release adriamycin over 10 weeks. Adriamycin concentrations in the muscle were higher than that in plasma. CONCLUSION A-PTCP may be a new method for repairing bone defects after bone tumor operation.
Objective To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor. Methods From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging,ⅡA) and 2 patients with giancell tumor of the bone (ⅡA,ⅡB). By the International Society of Limb Salvage(ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients’ psychological conditions as well as their limb pain, shape, locality, activity, and function werealso observed. Results The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except onepatient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22° to 41°(mean, 25°), bending angle from 29° to 80°（mean, 35°）, abduction angle from 5° to 28°, and circumgyrate angle from 15° to 22° in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patientswith osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points.Conclusion The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
Objective To study the reconstruction method and effectiveness of titanium plate and Teflon patch for the chest wall after resection of sternal tumors. Methods Between October 2006 and November 2009, 4 patients with sternal tumors were treated and the thoracic cages were reconstructed. There were 2 males and 2 females, aged 30-55 years. The patientswere admitted because of chest lump or pain. The sizes of palpable lump ranged from 4 cm × 3 cm to 10 cm × 8 cm. CT examination showed bone destruction. After sternal tumor resection, defect size ranged from 10 cm × 8 cm to 18 cm × 14 cm, and titanium plate and Teflon patch were used to repair and reconstruct the chest wall defect. Results The operations of the tumor resection and reconstruction of chest wall defect were successfully performed in 4 cases. Incisions healed by first intention with no abnormal breath, subcutaneous emphysema, pneumothorax, and infection. One case failed to be followed up after 6 months; 1 case died of intracranial hemorrhage; and 2 cases were followed up 1 and 4 years respectively without tumor recurrence. The chest wall had good remodel ing. No loosening and exposure of titanium plate, difficulty in breathing, chest distress, and chest pain were observed during followup. Conclusion Surgical resection of sternal tumors will cause large chest wall defect which can be repaired by titanium plate and Teflon patch because it had the advantages of easy operation, satisfactory remodel ing, and less compl ication.