【Abstract】 Objective To review the progress in the treatment of bone defect by porous tantalum implant. Methods Recent l iterature was extensively reviewed and summarized, concerning the treatment method of bonedefect by porous tantalum implant. Results By right of their unique properties, porous tantalum implants have achievedvery good results in the treatment of certain types of bone defects. Conclusion Porous tantalum implants have their ownadvantages and disadvantages. If the case is meet to its indications, this method can obtain a good effect. Porous tantalum implants provide a new way for the cl inical treatment of bone defects.
Objective To evaluate the effectiveness of prosthetic revision using custom-made long stem prosthesis and allograft-prosthesis composite (APC) for aseptic loosening after bone tumor resection. Methods Between January 2002 and June 2008, 14 patients with aseptic loosening after bone tumor resection were treated. There were 8 males and 6 females,aged 21-70 years (mean, 43.9 years). The locations were distal femur (8 cases), proximal femur (2 cases), and proximal tibia (4 cases). Pain of the affected l imb occurred after 6-31 years of prosthesis replacement and worsened when bearing and walking; 6 patients had shortened l imb. The functional results were assessed quantitatively according to the functional rating system of the Musculoskeletal Tumor Society (MSTS). The MSTS score was 16.36 ± 1.50 before revision. The X-ray films showed obvious prosthetic loosening and subsidence. The average time of symptom was 4.5 years (range, 3-9 years). In 7 patients having severe bone loss (the decrease of the thickness of cortical bone was more than 50%) and the prosthetic subsidence was more than 2 cm, the revision operation with the APC was performed; in 7 patients having less bone loss (the decrease of the thickness of cortical bone was less than 50%), the custom-made long stem prosthesis was performed. Results All wound healed by first intention. Two patients had temporary peroneal nerve paralysis and recovered after 3 months. All the patients were followed up 3.6 years on average (range, 2 years and 2 months-7 years) after revision. After revision, pain was rel ieved and the range of joint was improved. The MSTS score was 23.43 ± 2.56 at 12 months after revision showing significant difference when compared with the preoperative score (t=8.910, P=0.024). The X-ray films showed that lucency space l ine around stem cement in 2 patients at 12 months, and no prosthesis loosening and infection occurred. Conclusion The prosthetic revision after l imb salvage surgery with prosthesis for bone tumors was acceptable. The good functional results can be achieved by the revision with the APC or the custom-made long stem prosthesis according to the bone loss.
Objective To identify the postoperative function and short-term outcome of Global Modular Replacement System (GMRS) for reconstruction of defect after removal of tumor so as to supply information for cl inical appl ication. Methods Between March 2007 and May 2009, 30 l imb-salvage cases reconstructed with GMRS were retrospectively reviewed, including 18 males and 12 females with a median age of 25 years (range, 11-57 years). The preoperative diagnoses were osteosarcoma in 15 cases, mal ignant fibro-histiocytoma in 4, giant cell tumor in 3, chondrosarcoma in 2, and Ewing’s sarcoma and angiosarcoma in 1 respectively. The duration of symptom ranged from 1 to 15 months with an average of 5.6 months. There were 4 revision cases at mean time of 3.4 years after index surgeries. The locations were the proximal femur in 3 cases, distal femur in 22 cases, and proximal tibia in 5 cases. According to Enneking stage, 2 cases were rated as stage IB, 1 as stage IIA, and 27 as stage IIB. Four cases were compl icated by pathologic fracture. Results The average operation time was 165 minutes (range, 120-240 minutes); the mean blood loss was 448.3 mL (range, 100-1 500 mL); and the mean resection length was 14.1 cm (range, 7.5-22.5 cm). All the wounds healed by first intention. All 30 patients were followed up 10-35 months (22.3 months on average). Local recurrence occurred in 2 cases (6.7%) at 5 and 14 months respectively and distal metastasis occurred in 5 cases (16.7%) at 4-12 months (7.3 months on average) postoperatively. One patient died of multiple lung metastases at 10 months postoperatively. Twenty-nine patients survived at last follow-up, including 25 cases of tumor-free survival and 4 cases of tumor bearing survival. Aseptic loosening occurred in 2 cases (6.7%) at 1.5 years and 2 years postoperatively respectively. Deep infection occurred in 1 case (3.3%) at 1 year postoperatively. At last follow-up, the Musculoskeletal Tumor Society (MSTS) 93 scores were 4.6% ± 0.7% for pain, 3.7% ± 0.9% for function, 3.2% ± 1.3% for satisfactory degree, 4.3% ± 0.9% for orthesis, 3.7% ± 0.7% for walking, 3.3% ± 1.0% for gait; total score was 75.9% ± 14.2%. The Toronto Extremity Salvage Score (TESS) score was 87.0 ± 7.0. Conclusion Reconstruction for defect after removal of tumor with GMRS has satisfactory short-term outcome with good function recovery and low compl ication rate.
【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.
Objective To investigate the clinical application and complicationof the lyophilized small-segment allogeneic bone used in repairing bone defectscaused by benign bone tumor and tumor-like lesions after resection and curettage. Methods From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56years, averaged 32.8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm×0.8 cm to 10.0 cm×2.0 cm, andthe bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. ResultsThere was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bonetransplantation. The wounds in 196 patients were healed by the first intension.The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30cases; the wound had delayed healing in 4, including 3 whose wounds were healedby changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang’s standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14.78%) patients were not satisfied. Conclusion The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.
Objective To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection. Methods Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissuesarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in ⅠB and 23 patients in ⅡB. The patients with osteosarcomaor Ewing sarcoma received the standard chemotherapy before and after operation.Eighteen and ten patients received the segmental allograft prosthetic compositereplacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score. Results According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allografthost junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23.4. ConclusionThe prosthetic composite replacement of the intercalary allograft and the segamental allograft can be used n the skeletal defect reconstruction after the limb tumor resection. The stablecontact in the allografthost junction and the b intramedullary internal fixation can help to reduce the complication rate of the allograft.
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.
Objective To assess the clinical outcome of thelimb salvage surgery and complications occurring in the lower extremities after a wide resection of sarcoma. 〖WTHZ〗Methods A total of 167 patients underwent a limb-sparing procedure by means of the implantation of a custom-made or modular tumor endoprosthesis from July 1997 to July 2004. Of the 167 patients, 100 were followed up, including 56 males and 44 females, with their ages ranging from 13 to 57 years at surgery.In 5 patients, a proximal femur prosthesis was implanted; in 57 patients, a distal femur prosthesis was implanted; and in 38 patients, a proximal tibia prosthesis was implanted. According to the Enneking staging, 3 patients were grouped in the stage of ⅡA, 85 in ⅡB, and 12 in Ⅲ. Seventy-one patients used a domestic prosthesis, and 29 patients used a prosthesis made in Link Company, Germany. For the reconstruction, 17 patients used an autograft prosthesis composite, 21 patients used the allograft prosthesis composite, and the remaining 62 patients used an artificial prosthesis. All the patients received chemotherapy for 1-2 courses and 3-5 courses before operation and after operation, respectively. After operation, The Musculoskeletal Tumor Society(MSTS) score was used to evaluate the recovery of their corresponding functions. Results According to the follow-up for 1-8 years, with a median of 3.5 years, and the assessment by the Kaplan-Meier estimate, the 3-year survival rate of the prostheses was 81.8%, and the 5year survival rate was 65%. As for the complications, prosthesis breakage occurred in 6 patients, periprosthesis infection in 13 patients, aseptic loosening in 2 patients, non-union between the host bone and graft bone in 5 patients, allograft absorption in 2 patients, prosthesis sinking in 2 patient, and periprosthesis fracture in 1 patient. Local recurrence developed in 7 patients within 6 months to 2 years after operation. Of the 7 patients, 4 had a recurrence of the softtissue tumor for which resection was performed; the other 3 patients underwent amputation of the diseased limb. The mean MSTS score was 23.30±5.17, with an excellent limb function in 62 patients, good in 27 patients, fair in 7 patients, and poor in 4 patients. The overall excellent and good function was obtained in 89% of the patients. Conclusion We conclude that tumor prostheses can give a satisfactory functional outcome after the tumor around the knee is removed; however, the tumor prostheses still need to be further improved because of a high complication rate.
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 summarize and analyze the clinical experience and theclinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. Methods Eleven patients (7 males and4 females, aged 40-69 years) with a tumorous disease in the proximal femur received a removal ofthe proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. Results The follow-upfor 1-5 years in 9 patients (2 patients lost the follow-up) revealed that afteroperation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the “0” degree, a decreased sensation, the “3” degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle powertest showed that 5 patients had the “3” degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the “4” degree of the quadriceps muscle power, with an extension range of the hip joint of 10°27° and an average flexion degree of 74°. According to the Harris scale, 3 patientswere assessed to be good (8089), 5 moderate (70-79), but 1 bad (lt;70). No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. Conclusion The customized hip arthroplasty has a goodclinical outcome in treatment of a tumorous disease in the proximal femur. However, there is a high incidence of deficiency of the quadriceps muscle power after operation, which may be relevant to the removal of the upper attachment of the quadriceps muscle. If the attachment of the quadriceps muscle, especially the internal, external and posterior septum attachment, can be fixed in the body of the prosthesis during operation, the power of the quadriceps muscle can be enhanced and the patient can have a better therapeutic effect.