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.
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.
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.
The bone tumors are common in the lower part of the femur and upper tibia. Fifty-seven cases of repairment and reconstruction of the long bone defect after tumor resection in this area have reported in this paper. The main principle for the lesion and reservation of the joint function. The most suitable surgical procedure for each cases was selected according to the area, the character, the dimension and the length of the bone tumor.
OBJECTIVE To evaluate the clinical results of repair of bone defect by embryonic bone transplantation. METHODS From January 1994 to June 1999, 148 cases of bone defect were repaired by embryonic bone transplantation following alcohol treatment, there were 63 cases with bone cyst, 42 cases with fibrous dysplasia of bone, 26 cases with giant cell tumor of bone, and 17 cases with enchondroma among them. The maximal bone defect was 3.5 cm x 10.0 cm, while the minimal defect was 0.5 cm x 1.0 cm. RESULTS All of those bone defect with benign tumor were bone union used by embryonic bone transplantation after 3 months to 1 year of operation, the average healing course was 6.2 months, followed up 1 to 6 years, averaged 14 months, no tumor recurrence and no obvious local or system response were observed. CONCLUSION Embryonic bone can be used as a good repairing material of postoperative bone defect of benign tumors, the clinical results are satisfactory.
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.
OBJECTIVE To evaluate the efficacy of transposition of the gastracnemius muscle in the limb-salvage operation of the proximal tibial tumor. METHODS From 1995, transposition of the gastrocnemius muscle was applied to cover the devitalized bone, bone cement or autologous bone graft in 15 cases with tumors of the proximal tibia (transposition of medial heads of gastrocnemius muscle in 12 cases, and lateral heads of gastrocnemius muscle in 3 cases respectively). Among them, there were 7 osteosarcomas, 5 giant cell tumors, 1 malignant fibrous histocytoma, 1 chondrosarcoma and 1 osteoblastoma. The operations included segmental devitalization with 95% alcohol in 7 cases, knee reconstruction of the unilateral tibial plateau with iliac graft in 5 cases, segmental devitalization with microwave in 2 cases, local resection and bone graft in 1 cases. RESULTS Apart from 2 cases whose wounds needed suturing again due to the liquefaction of the subcutaneous fat around the incision, no wound complications were occured in other 13 patients. No significant loss in the function of the leg and ankle was observed after transposition of the gastrocnemius muscle. There was no local recurrence, but 3 patients died due to lung metastases. CONCLUSION Transposition of the gastrocnemius muscle after resection of promixal tibial tumors can improve the local blood supply, cover the deep structures and prevent from the failure of limb-salvage operation due to wound complications.
Objective To investigate the cl inical appl ication of grafting with bioactive glass (BG) and autologousbone marrow for defect after resection and curettage of benign bone neoplasm. Methods From January 2004 to May2007, 34 patients with bone defects were repaired. There were 21 males and 13 females with a mean age of 25.6 years (8 to 56 years). There were 14 cases of simple bone cysts, 6 cases of fibrous dysplasia, 3 cases of osteoid osteoma, 4 cases of non-ossifying fibroma, 2 cases of enchondroma and 3 cases of giant cell tumor of bone. Tumor sizes varied from 2.0 cm × 1.5 cm × 1.0 cm to 9.0 cm × 3.0 cm × 2.5 cm. Benign bone neuplasm was removed thoroughly with a curet or osteotome, bone defects ranged from 3.0 cm × 2.0 cm × 1.5 cm to 11.0 cm × 3.5 cm × 3.0 cm, which was closed-up with the mixtures of BG and autogenous red bone marrow. Six cases of pathologic fracture were fixed with steel plate or intramedullary nail. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone heal ing. Results All the patients had good wound heal ing after operation. There was no yellow effusion nor white crystal and skin rash appeared around wound, indicating no allergic reaction occurred. A follow-up of 1 to 4 years (mean 24.6 months) showed satisfactory heal ing without compl ications. At averaged 16 weeks after operation, patients with bone tumor in lower l imbs resumed walking independently and those with bone tumor in upper l imbs resumed holding object. There was no tumor recurrence during follow-up. Radiographically, the interface between the implanted bone and host bone became fuzzy 1 month after implantation. Two months after operation, the BG was absorbed gradually, new bone formation could be seen in the defects. Four months after operation, implanted bone and host bone merged together, bone density increased. Six to ten months after operation, the majority of the implanted BG was absorbed and substituted for new bone, bone remodel ing was establ ished. Conclusion BG may boast both bone conductive and bone inductive activities. The combined grafting with BG and autologous bone marrow appears to be minimally invasive treatment to repair bone defects of benign bone neuplasm, with rare compl ications and no significant reverse reaction, and could repair bone defects completely.
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 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.