Objective To investigate the effect of the semi-joint prosthesis replacement in treating malignant tumors around the children’s knees. Methods Five children (aged 8-12 years) with malignant tumors around the proximal end ofthe tibia underwent the semi-joint prostheses replacement from March 2000 to June 2005. All the children had been diagnosed with osteosarcoma, which was graded as ⅡB by the Enneking staging system. The pathologic changes involved the upper segment of the tibia 9-11 cm in length. Before operation all the patients underwent puncture biopsy and standard chemotherapy. The lesion extent was determined by X-ray, CT and MRI, and then the size of the prosthesis was determined. The length of the prosthesis was 1-2 cm longer than that of the excised bone. After operation the patients were given neoadjuvant chemotherapy for 2 courses and they could walk with the help of a special brace 4 weeks postoperatively. Results All the 5 patients had a successful semi-joint prosthesis replacement exceptone patient who had a skin flap necrosis, and the wound healed after a flap grafting. The remaining patients had their wounds healed by first intention. The12-36 months’ follow-up revealed that all the patients had no metastasis or recurrence of the tumor and they were living and well except one patient who died oflung metastasis 8 months after operation. Conclusion The semi-joint prosthesis replacement in the limb salvage surgery for maligant tumors around the children’s knees has advantages of avoiding a damage to the normal osteoepiphysis, stabilizing the knee joint, and facilitating elongation of the limb in future. Italso creates the condition for total knee replacement in adults.
Objective To probe a satisfactory surgical management of the limbsalvage for osteogenic malignant tumors around the knees. Methods From January1989 to December 2001, 42 patients (19 males and 18 females, aged 12-46) with osteogenic malignant tumors around the knees underwent surgical management of the limb salvage, including prosthesis replacement, allogenous bone grafting, and bone cement with adriamycin filled. Based on the pathological examination, osteosarcoma was found in 11 patients, synoviosarcoma in 4 patients, malignant fibrous histiocytoma in 3 patients, and giant cell tumor of the bone in 19 patients. All the patients underwent neoadjuvant chemotherapy for 1-2 courses before operatioexcept the patients with giant cell tumor of the bone. The patients underwent prosthesis replacement, allogenous bone grafting, bone cement with adriamycin filled, and postoperative chemotherapy. By the Enneking evaluating system, the patients were assessed on their reconstructed limb functions after the reconstructive operation for the musculoskeleta malignant tumors. Of the patients, 37 were followed up after operation. Results According to the follow-up for 3-11 years (mean, 5.6 years) in the 37 patients, 2 patients had recurrence and metastasis of the tumor, and died 3 and 4 years after operation, respectively. One patient underwent amputation of the limb for local recurrence of the tumor. One patient had amputation of the limb for the preoperative radiotherapy and the infection and necrosis of the operative wound after the limb-salvage surgery. Two patients had amputation of the limb for the rejection of the allogenous bone graft and theformation of the fistula.Thirty-one patients had good wound healing andgood functions of the limb. The results were evaluated by the Enneking evaluating system as follows: excellent in 7 patients, good in 14, fair in 10, and poor in 6. Conclusion Making an early diagnosis, recognizing the operative indication, choosing the operative method, and performing the preoperative and postoperative chemotherapy and/or radiotherapy are the keys to achieving an ideal limb-salvage surgery for osteogenic malignant tumors around the knees.
Objective To evaluate the methods of the pedicle screw-rod fixationsystem combined with allograft bone or polymethylmethacrylate (PMMA) for the reconstruction of pelvic girdle after the complete resections of primary malignantbone tumor and the metastatic lesion of ilium. Methods From July 1999 to July2004, 16 patients with iliac malignant bone tumor were treated with the techniques of the complete resection and reconstruction. There were 9 males and 7 females at the age of 16 to 80 years. The 10 patients with primary malignant bone tumor included 4 cases of chondrosarcomas, 3 cases of osteosarcomas, 2 cases of Ewing sarcomas, and 1 case of malignant giant cell tumor of bone. The 6 patients with the metastatic lesion consisted of 2 cases of breast carcinoma, 1 case of lung carcinoma, 1 case of kidney carcinoma, 1 case of thyroid carcinoma and 1 case of prostate carcinoma. A solitary skeletal metastatic lesion was demonstrated in all metastases. There were 2 cases of stage ⅠA and 8 cases of stage ⅡB in primary malignant bone tumor according to the Enneking classification. The pedicle screwrod fixationsystem combined with allograft bone was used to reconstruct the pelvic girdle in primary malignant tumor. The patients with metastases underwent the pedicle screwrod system fixation with PMMA or without PMMA. The postoperative complication of reconstruction, local recurrence and bone healing were investigated. The postoperative function was analyzed according to the method reported by Enneking. Results The average followup was 35.6 months (5 to 65 months). Of all patients, 2had suspected deep infection, 2 had internal fixation loosening and 1 had nonunion of allograft bone. The mean healing time of the osteotomy site was 5.8 months (4.2 to 8.4 months). No immune rejection was seen. There were 2 patients with local recurrences, 3 patients with pulmonary metastases and 2 deaths due to metastases. The average functional score was 24.8(82.7%) in 8 survival. The functional results also were classified as excellent in 4, good in 3 and fair in 1. The median survival was 11.8 months (4.6 to 48.5 months) in metastases. Four patientshad lived for 1 year or longer after surgical intervention. The internal fixation loosening occurred in 2 patients, new destruction in 3 patients and no infectionoccurred. All patients immediately alleviated the pain and could walk with or without support after operation. At follow-up after 1 year, the average functional score was 21.7(72.3%). The functional results also were classified as excellent in 2 and good in 2. Conclusion Because of less complication and good function, the pedicle screwrod fixation system combined with allograft bone orPMMA are advisable for the reconstructions of pelvic stability after the complete iliac resections of primary malignant bone tumor and the metastatic lesion.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis to treat maliganant bone tumors around the knee. MethodsBetween March 2007 and September 2014, 43 patients with malignant tumor around the knee were divided into 2 groups: 3D printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis were used in 21 cases (trial group), and conventional tumor resection and reconstruction with hinged total knee prosthesis were used in 22 cases (control group). There was no significant difference in age, gender, tumor location, pathological diagnosis, tumor stage, diameter of tumor, disease duration, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05), which were comparable. Intraoperative length of tumor resection and blood loss were recorded and compared, and the postoperative complications and tumor recurrence were observed. The Musculoskeletal Tumor Society (MSTS) score was used to evaluate knee joint function. ResultsThe operations were completed successfully in the patients of 2 groups and postoperative pathological results were negative in tumor resection margin. All the patients were followed up 12-77 months (mean, 36.7 months). There was no significant difference in the length of tumor resection and blood loss between trial group and control group (t=1.01, P=0.32; t=-0.76, P=0.45). In trial group, the resection range and reconstruction results were consistent with preoperative computer simulation; postoperative complications happened in 2 cases (9.52%); 1 case of immunological rejection and 1 case of infection); 2 cases (9.52%) had recurrence of osteosarcoma and pulmonary metastasis at 1 year after operation. In the control group, complication occurred in 6 cases (27.27%; 2 cases of periprosthetic fractures, 2 cases of infection, 1 case of incision nonunion, and 1 case of common peroneal nerve injury); 4 cases (18.18%) had recurrence of osteosarcoma and metastasis at 1 year after operation. There was no significant difference in postoperative complication and recurrence rate between 2 groups (χ2=2.24, P=0.14;χ2=0.67, P=0.41). At last follow-up, distal femur score of tumor and proximal tibial score of tumor in trial group were significantly better than those in control group (t=4.89, P=0.00; t=3.94, P=0.00). The mean flexion and extension range of motion of the knee joint was (115.45±12.25)° in trial group and was (101.49±11.96)° in control group, showing significant difference (t=3.78, P=0.00). ConclusionThe effectiveness using 3D printing navigation templates assisting reconstruction with personalized unrestricted prosthesis for maliganant bone tumors around the knee is better than conventional tumor resection and reconstruction with hinged total knee prosthesis. It can improve the joint function better and the patients' quality of life.
Objective To evaluate the applied value of group psychotherapy intervention in patients with malignant bone tumor. Methods From May 2015 to February 2016, 66 patients with malignant bone tumor were divided into the intervention group (n=30) and the control group (n=36) according to their preference. Patients in the intervention group were treated with psychological intervention and the ones in the control group were only received regular telephone follow-up guidance. The quality of life, mood, social support and other changes were collected and compared between the two groups. Results The patients’ overall health and quality of life scores, emotional function scores and Social Support Revalued Scale scores in the intervention group (75.2±21.4, 59.2±10.5, 39.20±5.60) were higher than those in the control group (68.3±14.7, 51.4±11.4, 35.30±5.30), while the patients’ Self-rating Anxiety Scale scores, Self-rating Depression Scale scores, self-blame, and retreat scores in the intervention group (39.2±8.3, 35.1±6.7, 0.29±0.22, 0.41±0.22) were lower than those in the control group (44.2±7.5, 40.9±7.7, 0.34±0.24, 0.50±0.41), and the differences were all statistically significant (P<0.05). Conclusion The implementation of group psychotherapy intervention in patients with malignant bone tumor can effectively ameliorate the patients’ negative emotions, and improve social support and coping styles status of the patients.