Chitosan is a kind of biological material with good histocompatibility and gradual biodegradability in vivo. It has no toxicity or side-effect. For its gradual degradation, chitosan and adriamycin were mixed and formed drug delivery system (DDS). The release test of DDS and exudant of DDS in inhibiting OS-116 were examined in vitro. The results were as following: the DDS could release adriamycin in slow and stable way. The SO-116 inhidition rate of the exudant of the DDS on the 1st, 20th, 40th and 60th day was 58.11%, 36.48%, 24.32% and 21.62% respectively. It was concluded that the drug delivery system was a slow release system. It could maintain the concentration of adriamycin in a certain level. It was also suggested that the chitosan was a good carrier for slow release of chemotherapeutic drug in local therapy for postoperative treatment of bone tumor.
Objective To evaluate the shortterm efficacy of osteoarticular allografts in the limb salvage of the proximal tibia. Methods From 1998 to 2003, 15 patients (7 males, 8 females; aged 14-56 yr, average 33) with bone tumor of the proximal tibia underwent osteoarticular allografts, among whom 7 had progressive giant cell tumor without any previous chemotherapy; 8 had malignant tumor with previous chemotherapy, including 6 patients with osteosarocoma, 1 with spindle cell sarcoma, and 1 with malignant fibrous histiocytoma. According to the Enneking system, the patients were classified into ⅠB (7 patients), ⅡA (2 patients), and ⅡB (6 patients). All the patientsunderwent the marginal resection with an allograft (average length 12 cm, range6-16 cm) implanted. Results The follow-up for an average of 21 months (range,3-58 months) revealed that among the 8 patients with malignant tumor of the proximal tibia undergoing chemotherapy, 5 had union of the bone, 3 had no union of the bone; among the 3 patients, 2 had a complication of infection and 1 had a local recurrence. All the 3 patients underwent amputation at the lower part of the femur. According to the Mankin score, 2 patients had a perfect result, 2 good, 1 fair, and 3 poor, with a 50% effectiveness rate. Among the 7 patients with progressive giant cell tumor at the upper part of the tibia, none had infection or local recurrence, but 2 hadnonunion of the bone and 2 had joint instability, aided by the kneeaidingsystem. According to the Mankin score, 3 patients had a perfect result, 2 good,and 2 fair, with a 71% effectiveness rate. Conclusion The osteoarticular allograft of the proximal tibia has many advantages in spite of a relatively highrate of complications, and it is the limb salvage of choicefor the progressivebenign or malignant bone tumors of the proximal tibia.
From 1972 to 1990,121 cases of bone tumor were treated by segmental resection of tumor and followed by artifical joint re- placement. All of the prostheses were designed and manufactured by our hospital. One hundred and two cases were followed up for an average of 7.4 years and the curative rate with the affected limbs preserved was 85.28%. The indication, the advantages and disadvantages, the material and the type of artifical joints, and the assessment of functional reconstruction following operation were discussed.
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.
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.
The treatmen t of the bone defect of the distal part of the radiu s included repair of the bone defect and resto rat ion of the funct ion of the w rist jo in t. Since 1979, th ree operat ive methods w ere u sed to t reat 13 cases, and they w ere graf t ing of the vascu larized f ibu la by anastom rsis f ibu lar vessels, graf t ing of upper part of f ibu lar w ith lateral inferio rgen icu lar artery and graf t ing vascu larized scapu la f lap. Follow up had been carried ou t from1 to 10 years. The resu lt w as sat isfacto ry. The discu ssion included the repair of the defect of the m iddle o r distal part of the radiu s, the operat ive methods, main at ten t ion s and indications. It was considered that it shou ld be based on the length of bone defect wh ile the operative method was considered.
【Abstract】 Objective To di scus s the resect ion of tumors of pelvic ring and i t s recons truct ion ofdefects. Meth ods From January 1999 to December 2006, 48 patients with tumors in pelvic ring were treated and defects were reconstructed. There were 32 males and 16 females, aged 14-72 years(mean 45.1 years), including 12 cases of benign tumor and 36 cases of mal ignant tumor. Fourteen cases had lesions in region Ⅰ , 11 cases in region Ⅱ , 12 cases in region Ⅲ , 3 cases in region Ⅳ and 8 cases had two or more regions. The selection of surgical method: benign tumor in wing of il ium or in sacro-il iac articulation was curettaged , mal ignant tumors were resected radically or boardly . Benign or mal ignant tumor in pubis, ischium or pubic symphysis was resected radically , defects were reconstructed with plastic plate or not. For tumor affecting aceta bulum , resection of tumor and replacement of the peri- pelvic prothetic or artificial hip joint replacement were performed to reconstructthe function of hip joint. Results Twelve patients with benign tumors were followed up 12-72 months and could walk well, only 1 case relapsed locally. Thirty-six patients with mal ignant tumor were followed up 6 - 72 months, the survival time was 6-12 months in 2 cases (5.6%), 12-24 months in 2 cases(5.6%), 24-36 mongths in 6 cases (16.7%), 36-72 months in 14 cases (38.8%), and more than 72 months in 12 cases (33.3%); 28 patients (77.8%) could walk normally, 6 (16.7%) could walk with the help of walking stick , 2(5.5%) needed wheel chair to move. Compl ications occurred in 6 cases( including 2 venous thrombus,1 anoxic encephalopathy, 2 wound delayed heal ing, and 1 dislocation after total hip joint replacement); the patients’ condition took a turn for the better. Conclusion Operation is a favorable way for the treatment of pelvic tumor. Selecting convenient operation methods to resect tumors or reconstruction defects according the position of the tumor will do good favor to good results,increase the survival time and improve qual ity of l ife.
ObjectiveTo investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery. MethodsBetween July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function. ResultsAll patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ2=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ2=0.106, P=0.744). ConclusionFibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.
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 compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.