Pulmonary lymphangioleiomyomatosis (PLAM) is a rare chronic multi-system neoplastic disease that occurs in women of childbearing age. It lacks specific clinical manifestations and requires reliable biomarkers to achieve precise management. In recent years, with the emergence of emerging biomarkers, the detection rate of PLAM has been significantly improved, which can better monitor disease progression and provide timely feedback on the efficacy. These emerging biomarkers mainly include vascular endothelial growth factor-D, vitamin D-binding protein, CT score and prostaglandins. This article will focus on the current research results, and summarize the research progress of emerging biomarkers in PLAM diagnosis, prognosis evaluation, and disease monitoring, aiming to provide new ideas for the research and treatment of PLAM.
Objective To evaluate the clinical and radiographic outcomes of headless compression screws for Lisfranc joint injuries. Methods A retrospective analysis was made on clinical data of 34 patients (36 feet) with Lisfranc joint injuries who underwent open reduction and internal fixation with headless compression screws between January 2006 and January 2012. There were 22 males (24 feet) and 12 females (12 feet), aged 21-73 years (mean, 38.9 years). The causes of injury included traffic accident in 16 cases (17 feet), falling from height in 11 cases (12 feet), crushing in 5 cases (5 feet), and sports in 2 cases (2 feet). Of them, there were 19 cases (20 feet) of closed injury and 15 cases (16 feet) of open injury; there were 7 cases (8 feet) of pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries (LD), 22 cases (23 feet) of Lisfranc joint fracture dislocations (LFD), 5 cases (5 feet) of combined Chopart-LFD (CLFD). According to Myerson classification, 5 cases (5 feet) were rated as type A, 7 cases (8 feet) as type B1, 14 cases (15 feet) as type B2, 5 cases (5 feet) as type C1, and 3 cases (3 feet) as type C2. Associated fractures included 12 cases (13 feet) of metatarsal shaft fracture, 4 cases (4 feet) of cuboid fracture, 4 cases (4 feet) of navicular bone fracture, 6 cases (7 feet) of coneiform bone fracture/dislocation, 8 cases (10 feet) of ipsilateral lower limb multiple fracture, and 4 cases (4 feet) of contralateral lower limb multiple fracture. The clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Postoperative X-ray films were taken to assess the reduction, internal fixation, and the foot arch height. Results All patients were followed up 1 year to 5 years and 2 months (mean, 3.5 years). X-ray films showed anatomical reduction in 31 cases (33 feet, 91.7%). At last follow-up, AOFAS score and VAS score averaged 80.6 (range, 60-100) and 2.3 (range, 0-6), respectively; the AOFAS score was significantly higher in patients having anatomical reduction than the patients having no anatomical reduction, in patients with LD and LFD than in patients with CLFD, and in patients without cuneiform bone fracture/dislocation than in patients with cuneiform bone fracture/dislocation (P lt; 0.05). There was no significant difference in the talus-first metatarsal angle, the distance between the lateral edge of the base of the first metatarsal bone and the medial edge of the base of the second metatarsal bone, and the arch height between the injured foot and normal foot (P gt; 0.05). Reduction loss was observed in 1 case (1 foot) because of early weight bearing; post-traumatic arthritis developed in 9 patients (10 feet). The incidence of post-traumatic osteoarthritis was higher in the patients with non-anatomic reduction, coneiform bone fracture/dislocation, comminuted intra-articular fractures of Lisfranc joints, the injury types (P lt; 0.05). Conclusion Headless compression screws for fixation of Lisfranc joint injuries can provide satisfactory short- and mid-term clinical and radiographic outcomes. During surgery, the precise anatomic reduction and stable fixation should be paid attention to, especially in patients with CLFD, coneiform bone fracture/dislocation, and comminuted intra-articular fractures of Lisfranc joints so as to control the incidence of the post-traumatic osteoarthritis.
ObjectiveTo evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.MethodsThe clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.ResultsAll the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).ConclusionTaking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.
目的 通过对保留不同平面骶骨的新鲜人骨盆模型进行生物力学测试，分析骶骨切除平面与骨盆稳定性的关系，明确骶骨切除保留至何种程度时需行腰骶髂稳定性重建。 方法 选用6具正常成年男性新鲜尸体腰5-骨盆标本，采用200 N增量分级加载，以1.4 mm/min速率平稳加载直至1 000 N，依次测试保留完整骶骨及不同平面骶骨切除骨盆模型的最大主应力、剪切应力、位移及刚度变化，比较各组间的差异。最后测量1/2S1组骨盆环的极限载荷，记录骨折发生部位和骨折类型。 结果 随骶骨切除平面增高，最大主应力、剪切力及骶骨下沉位移在各测试点均有不同程度增大，骨盆的轴向刚度不断减小。当切除平面达骶1时，变化明显，尤其以经过骶1下1/4～下1/2时变化显著，与完整骶骨组比较，差异有统计学意义（P＜0.05）。骶1椎体下1/2平面切除后，骨盆的极限载荷是（2 375.97 ± 162.41）N，骨盆的破坏形态为经骶髂关节或骶椎的骨折。 结论 骶骨切除范围与骨盆环的稳定性密切相关，随着骶骨切除平面升高，残留骶髂关节各种应力急剧增高，骨盆的稳定性明显下降。当骶骨切除涉及骶1椎体时，极易发生骨折，需要进行腰骶髂局部重建以增强骶髂关节的稳定性。
Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia was reviewed and analyzed in terms of the reserved ankle joint and the non-reserved ankle joint. Results For large segmental bone tumor defect in distal tibia, the conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques can be selected, and the membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are gradually to be applied to repair the bone defect. Moreover, due to its long survival time, the function of reconstructed bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods has not yet been developed, great progress has been achieved in repair and reconstruction of the large segmental bone tumor defect in the distal tibia. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.
ObjectivesTo compare the role of problem-based learning (PBL) combined with team-based learning (TBL) methods with traditional lecture-based learning in the clinical probation teaching of bone tumor and explore which teaching method is more suitable for clinical probation teaching of bone tumor.MethodsThe 60 students of the 2013 grade five-year program medical students in West China Clinical College of Sichuan University who were undergoing clinical probation teaching in the orthopedic bone tumor subspecialty of West China Hospital of Sichuan University in April 2017 were randomly divided into 2 groups. The trial group adopted PBL combined with TBL teaching method, the control group adopted traditional teaching method. The general situation of the two groups of students were compared. After the end of the probation, the two groups of students’ knowledge mastery, comprehensive ability and satisfaction were compared.ResultsThere was no significant difference in the gender composition and the assessment scores of the last semester diagnostics course of the two groups of students (P>0.05). After the probation, in terms of knowledge mastery, the trial group’s theoretical test scores (89.13±3.47 vs. 87.03±2.99; t=2.511, P=0.015), teacher evaluation (88.33±4.48 vs. 85.90±3.96; t=2.231, P=0.030) and student evaluation (89.83±2.97 vs. 87.47±2.91; t=3.117, P=0.003) were better than those of the control group. In terms of comprehensive ability, the trial group’s ability in reasoning and induction, information management, goal completion, and communication (17.90±1.09, 18.00±0.91, 18.00±1.02, 17.90±1.13) were better than those of the control group (17.20±1.13, 17.13±1.20, 17.10±1.24, 16.83±1.29), the differences were statistically significant (P<0.05). There was no statistically significant difference in satisfaction between the two groups of students (P>0.05).ConclusionsPBL combined with TBL methods can improve the effect of clinical probation of bone tumors, deepen mastery of professional knowledge, improve comprehensive ability, and improve teaching quality.
Objective To explore the role and effectiveness of three-dimensional (3D) printing technology based on 3D multimodality imaging in surgical treatment of malignant bone tumors of limbs. Methods The clinical data of 15 patients with malignant bone tumors of the limbs who met the selection criteria between January 2016 and January 2019 were retrospectively analyzed. There were 6 males and 9 females, with a median age of 34 years (range, 17-73 years). There were 5 cases of osteosarcoma, 3 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 1 case of hemangiosarcoma, 1 case of ameloblastoma, and 3 cases of metastatic carcinoma. The tumors were located in the humerus in 5 cases, ulna in 2 cases, femur in 3 cases, and tibia in 5 cases. The disease duration was 2-8 months (median, 4 months). Preoperative 3D multimodality imaging was administered first, based on which computer-assisted preoperative planning was performed, 3D printed personalized special instruments and prostheses were designed, and in vitro simulation of surgery was conducted, successively. Two cases underwent knee arthroplasty, 2 had semi-shoulder arthroplasty, 2 had proximal ulna arthroplasty, and 9 had joint-preserving surgery. Surgical margins, operation time, intraoperative blood loss, surgical complications, Musculoskeletal Tumor Society (MSTS) score, and oncological outcome were collected and analyzed. Results All 15 patients completed the operation according to the preoperative plan, and the surgical margins were all obtained wide resection margins. The operation time was 80-240 minutes, with a median of 150 minutes. The intraoperative blood loss was 100-400 mL, with a median of 200 mL. There was no significant limitation of limb function due to important blood vessels or nerves injury during operation. One case of superficial infection of the incision was cured after dressing change, and the incisions of the other patients healed by first intention. All patients were followed up 6-48 months, with a median of 24 months. Two of the patients died of lung metastasis at 6 and 24 months after operation, respectively. No local recurrence, prosthesis dislocation, or prosthesis loosening occurred during follow-up. At last follow-up, the MSTS score ranged from 23 to 30, with an average of 25. Conclusion3D printing tecnology, based on 3D multimodality imaging, facilitates precise resection and reconstruction for malignant bone tumors of limbs, resulting in improved oncological and functional outcome.
The orthopedic bone tumor section is a difficult and key point in clinical teaching. 3D disease models have become a new tool for teaching clinical difficulties due to their intuitive and visual advantages. At present, in the standardized residents training clinical teaching of bone tumors, diversified teaching modes have accumulated a lot of experience, and the combination of 3D disease models can provide new strategies for clinical teaching of bone tumors. Therefore, this article introduces the current situation of clinical teaching in orthopedics, the current situation and challenges of bone tumor teaching, and the exploration and practice of using diversified teaching modes combined with 3D disease models at West China Hospital of Sichuan University, aiming to improve the quality of standardized residents training bone tumor teaching.
ObjectiveTo review the repair and reconstruction methods for large segmental femoral proximal bone defects caused by tumors, and to explore their clinical application effects, advantages, and disadvantages, and future research directions. MethodsA comprehensive search of Chinese and foreign databases was conducted to select basic and clinical research literature related to the repair and reconstruction of femoral proximal bone defects caused by tumors. The studies were classified and analyzed based on two main strategies: hip-preserving reconstruction and non-hip-preserving reconstruction. ResultsIn hip-preserving reconstruction, traditional methods such as allograft transplantation and vascularized autograft transplantation are common but have risks of poor bone integration and bone resorption. The clinical application of inactivated tumor segment reimplantation and distraction osteogenesis techniques is limited. In recent years, three-dimensional printing technology has become increasingly mature, with personalized prostheses and precise surgeries becoming development trends. Non-hip-preserving reconstruction primarily includes allograft prosthesis composite and total femoral replacement. The former focuses on improving the survival rate and bone integration efficiency of the allograft, while the latter requires the simultaneous reconstruction of hip and knee joint stability.ConclusionSignificant progress has been made in repairing and reconstructing proximal femoral bone defects caused by tumors, but many challenges remain. The integration of three-dimensional printing technology and digital design offers potential for precise bone defect repair. Future efforts should focus on new concepts, technologies, and materials through multidisciplinary approaches to provide personalized and precise solutions, thereby improving patient quality of life.
Objective To provide evidence for establishing medical specialist training system in China by evidence-based evaluation on the comparison of medical specialists training programs in different countries in Europe, America and Asia. Methods The principle and method of evidence-based science were adopted. Pubmed, official website (such as Ministry of Health, and medical board), homepages of famous medical universities or teaching hospitals and most frequently used search engines were systematically searched till Mar. 31, 2004. Included literatures were evaluated according to pre-defined standards. Results A total of 878 studies (827 in English, 51 in other languages) were included. The main contents covered clinical courses (43.3%), training quality assessment (13.5%) and existing problems (12.7%). Based on these and information from official website, the process of doctor training could be divided into three stages: residency training, specialist training and continuing medical education, with the characteristics of critical standards and strict examination in each stage. Training programs for neurosurgeon and family practitioner were analyzed. Conclusions Medical specialists training is a systematic project, which needs comprechensive planning and taking all factors (such as requirement of medical care market, diseaseburden) into account . To establishing a connterpart in China, priority should be given to training quality, feasibility and improvability. At the same time, we should change our mind, face the reality, and deal with problems during the interim.