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Publications (9)0.9 Total impact

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    ABSTRACT: To demonstrate the common characteristics of giant cell tumor of bone in immature skeletons. From 1989 to 2009, the 8 skeletal immature patients were pathologically diagnosed with giant cell tumor (GCT) in our department, which accounted for 1.3% (8/621) of all GCT patients in an extremity. All patients were identified with an open epiphyseal plate by retrospective review of the radiograph, CT or MRI by senior consultants. Oncological and functional outcome were followed for a mean 44.1 months. There were 5 boys and 3 girls. The mean age was 13.8 years. All cases had a primary lesion. The distal femur is the most common site involved (3 cases), followed by the proximal tibia (2 cases). The proximal humerus, the distal tibia and the distal radius accounted for 1 case respectively. Oncological and functional outcome are followed for a mean 44.1 months. All lesions were lytic. Six lesions involved both the epiphysis and metaphysis. Two lesions located in the metaphysis area. Six lesions were treated with extended curettage and were reconstructed with allograft and (or) bone cement. Internal fixations were used in 2 cases. Two cases were treated with segmental resection. And one was reconstructed with cement spacer and the other one with segmental allograft and internal fixation. One patient (1/6) developed a bone recurrence after extended curettage. No extremity deformity and discrepancy were found during the follow up after the curettage. No metastasis was found during the follow up. Histologically GCT occurs in skeletal immature bone has the same pathological appearance but radiologically has its unique features. These lesions share same behavior as that in adults. A low local recurrence rate and good function can be achieved after a proper surgery.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2013; 51(9):827-830.
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    ABSTRACT: Giant cell tumors (GCTs) most commonly occur around the knee. The most beneficial procedure for this disease has been extensive curettage with reconstruction. However, since many GCTs may compromise the subchondral bone, surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis. In this study, we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis. We retrospectively analyzed 76 patients with GCT around the knee. The mean age at first diagnosis was 31.1 years. Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone. Patient follow-up was a median duration of 35 months, ranging from 18 to 113 months. The local recurrence rate was 5.3% (4/76). Secondary degenerative changes occurred in 30.3% (23/76) of the patients. Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients (P < 0.001). Of these 57 patients, 56.5% (13/23) treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting, the rate decreased to 29.4% (10/34), with a statistically significant difference (P = 0.041). GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage. Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.
    Chinese medical journal 08/2013; 126(16):3053-6. · 0.90 Impact Factor
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    ABSTRACT: To evaluate the surgical treatment and outcome of autogenous bone grafting and internal fixation in management of bone nonunion after massive allograft transplantation. From January 1994 to December 2006, 41 of 176 patients underwent bone nonunion after massive allograft transplantation. Twenty-two of 41 patients received autogenous bone grafting. Complete clinical and follow-up data was available for 15 cases. The average age at secondary autogenous bone grafting was 24 years old (ranging from 15 to 34). The primary diseases included osteosarcoma (5 cases), giant cell tumor (4 cases), parosteal osteosarcoma (2 cases), hemangioendothelioma (2 cases) and primitive neuroectodermal tumor (2 cases). Tumor was located at distal femur in 7 patients, middle of humerus in 3, middle of femur in 2, proximal tibia in 2 and proximal humerus in 1. Eight of 15 patients with simple bone nonunion received autogenous bone grafting. Another 7 patients with bone nonunion and fracture of primary internal fixation underwent autogenous bone grafting and re-internal fixation. At a mean follow-up of 46.8 months (ranging from 18 to 148 months), bone union was observed in 13 of 15 patients (86.7%) with the mean healing time 13.3 months (ranging from 5 to 20). Bone union could be observed in all 8 patients with simple bone nonunion and 5 of 7 patients with bone nonunion and internal fixation fracture, similar healing time 14 and 12 months respectively. There was no infection or any other complications. Two patients underwent re-nonunion received prosthesis replacement at last. The mean MSTS score of 13 patients was 25.1, with 8 simple bone nonunion patients and 5 combined with internal fixation fracture patients 25.4 and 24.6 respectively, also basically no difference. Autogenous bone grafting and internal fixation in management of nonunion after massive allograft transplantation have the advantage of easy operation, less complications, high rate of bone healing and good function result with obvious superiority to prosthesis replacement. For management of nonunion after massive allograft transplantation, autogenous bone grafting and internal fixation is mostly recommended.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2009; 47(11):837-41.
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    ABSTRACT: To evaluate the prognostic factors for the local recurrence of osteosarcoma in extremities treated with combined therapy. Between 1992 and 2001, 189 patients with non-metastatic osteosarcoma were treated. The average age at diagnosis was 18 years old. Tumors were located in the distal femur in 86 patients, proximal tibia in 52, and other locations in 51. Pathologic fracture occurred in 22 cases. One hundred and sixteen patients received combined therapy, 73 patients underwent non-combined therapy (tumor resection only or unfinished chemotherapy). In the combined therapy group, 90 patients underwent limb salvage surgery and 26 patients received amputations. In the non-combined therapy group, 42 patients underwent limb salvage surgery and 31 patients received amputations. With Chi-Square test, local recurrence rates were retrospectively evaluated in relation to gender, age, tumor site, pathologic fracture, serum level of alkaline phosphatase, protocol of chemotherapy, type of surgery, surgical margin, size of tumor, and postoperative chemotherapy. Multiple factors were analyzed by Logistic regression analysis. The 5-year-survival rate was 78.5% in the combined therapy group and 35.1% in the non-combined therapy group. Local recurrence rate was 16.6% (15 cases) in limb salvage surgery with combined therapy group (90 cases) and 38.1% (16 cases) in limb salvage surgery with non-combined therapy group (42 cases) (P<0.001). Metastasis rate was 28.4% (33 cases) in the combined therapy group (116 cases) and 65.7% (48 cases) in the non-combined therapy group (73 cases) (P<0.000). The local recurrence rate was significantly related to serum level of alkaline phosphatase after preoperative chemotherapy, type of surgery, surgical margin and chemotherapy protocol. Moreover, Logistic regression revealed that surgical margin and serum level of alkaline phosphatase after preoperative chemotherapy were the key factors affecting the local recurrence. The local recurrence is related to the surgical margin. The adequate surgical margin is very important for the limb salvage. The local recurrence is highly related to metastasis. The inadequate surgical treatment would damage the survival of patients with osteosarcoma.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 08/2007; 45(16):1114-7.
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    ABSTRACT: To evaluate the functional outcome and the complications of allograft replacement in management of bone tumors. Between March 1992 and September 2002 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5 - 35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts (n = 95), hemi-condylar (n = 15), massive (n = 23), allograft-prosthesis composite (n = 12), intercalary grafts (n = 15) or hemi-pelvic grafts (n = 4). Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. At a median follow-up of 47 months (range, 12 to 168 months) after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one (12.8%) patients had local recurrence and 38 (23.2%) nonunion. Late complications included 11 (6.7%) fractures of the allograft and 18 (11.0%) infections of the graft. Instability of the joint in the form of subluxation was noted in 13 (7.9%) patients. Ten extremities were amputated due to local recurrence or severe infection. Allografts can be used for reconstruction of bony defects after tumor resection. Allograft has nearly similar shape, strength, osteo-conduction and osteo-induction with host bone. Allograft implantation is a high complication reconstruction method, and the risk of recurrence increases when less surgical margin achieves.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2007; 45(10):677-80.
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    ABSTRACT: To discuss the indications of reconstruction with total femoral prosthesis for the patients with a majority of femur infiltrated by malignant bone tumor, and to evaluate the functional outcome and complication. Between October 1996 and October 2002, 17 patients with malignant bone tumor were treated with total femoral prosthesis replacement. The patients included 8 males and 9 females, whose age was from 12 to 34 years, with the average of 16 years. The lesions were located in the proximal femur metaphysis in 1, the distal femur metaphysis in 6, the femur shaft in 10, pathologic fracture in 2, skip lesions in 3. The extent of lesions was 23-28 cm (a majority of femur infiltrated by malignant bone tumor). Preoperative pathologic diagnosis were established by open biopsy (2 cases) or needle biopsy (15 cases). All patients were osteosarcoma. According to Enneking surgical staging system, the cases were 12 IIB and 5 IIIB. Seventeen cases received preoperative chemotherapy and 15 cases received postoperative chemotherapy. Seventeen cases were followed up with a mean time of 45 months (range 9-120 months). Local recurrence was observed in 3 (17.6%) after operation 6-14 months. In 12 IIB cases, 4 cases (33%) developed pulmonary metastasis and died. Eight cases remained continuously disease-free for average 75 months (range 50-120 months). In 5 IIIB cases, all with a mean survived term of 13 months (range 9-20 months) died. Fifteen patients (88%) could walk. The patients had maintained average 74% (range 40% - 93%) limb function scores evaluated by ISOLS criteria. Four cases had complications of paralysis of common peroneal nerve (3 cases) and dislocation of hip joint (2 case). No infection took place. Total femoral prosthesis replacement could be used in the treatment of the patients with a majority of femur infiltrated by malignant bone tumor and could effectively recover their limb function to a great extent. The procedure can effectively improve the quality of life for the patients with malignant bone tumor staging IIIB.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2007; 45(10):661-4.
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    ABSTRACT: To evaluate the survival rates and complications of combined therapy for primary osteosarcoma of the extremities between 1992 and 2001. From 1992 to 2002, 189 patients with non-metastatic osteosarcoma were treated. Their average age at diagnosis was 18 years old (ranging from 4 to 39). Tumors were located at distal femurs in 86 patients, proximal femurs in 4, proximal tibia in 52, proximal humors in 19 and other locations in 28. Combined therapy (resection of tumor with chemotherapy) was given 116 patients and non-combined therapy (tumor resection only and unfinished chemotherapy) to 73. In combined therapy group, 90 patients underwent limb salvage surgery, and 26 patients received amputations. In non-combined therapy group, 42 patients underwent limb salvage surgery and 31 patients received amputations. The 5-year-survival rates were 78.5% in the combined therapy group and 35.1% in the non-combined therapy group. Local recurrence rate was 16.6% (15 cases) in limb salvage surgery with combined therapy group (90 cases) and 38.1% (16 cases) in limb salvage surgery with non-combined therapy group (42 cases) (P < 0.007). Metastasis rate was 28.4% (33 cases) in the combined therapy group (116 cases) and 65.7% (48 cases) in the non-combined therapy group (73 cases) (P < 0.000). Functional evaluation showed that the patients who underwent salvage surgery had higher functional scores than those who had an amputation. According to MSTS scoring system (1993), 56 patients (excision alcohol replacement 36 cases, allograft 10 cases and prosthesis 10 cases) were evaluated functional scores. The average scores reached same level (P > 0.5). (1) In this study, the 5-year-survival rate in the combined therapy is improved. The treatment for the patients with metastasis in lung is very difficult for improvement of the 5-year-survival rate. (2) The local recurrence is related the surgical margin. The adequate surgical margin is very important for the limb salvage. (3) The combined therapy is very essential for improving survival rate.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2006; 43(24):1576-9.
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    ABSTRACT: To evaluate the functional outcome and the complications of allograft replacement in management of giant cell tumors of bone. Seventy-seven patients who underwent bone tumor resection and massive allograft reconstruction of bone defects between 1992 and 2002 were evaluated. The length of the resected part ranged from 5 to 11 centimeters. Fresh-frozen allografts were employed as osteoarticular grafts (n = 47), hemi-condylar (n = 12), massive (n = 14) or allograft-prosthesis composite (n = 4). Most of the lesions located in proximal and distal femur, proximal tibia and humerus. The oncological parameters that were evaluated including survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft. Mankin evaluation system was used to assess functional outcome. At a median of 35 months (range from 12 to 135 months) after the operation, 76 of the patients in the study group were free of disease, and one had died of disease. Eleven (14.1%) patients had local recurrence and 12 (15.4%) nonunion. Late complications included 5 (6.4%) fractures of the allograft and 5 (6.4%) infections of the graft. Instability of the joint in the form of subluxation was noted in 5 (6.4%) patients. One extremity were amputated due to local recurrence. On the basis of Mankin functional evaluation, the total satisfied rate was 83.2 percent. Osteoarticular graft got the highest score (91.5%) and hemi-condylar got the lowest (66.6%). Massive grafts and composite were at the middle (ranges from 71.4% to 75%). Allografts offer many types of reconstruction for bony defects after tumor resection. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity. It is also a method with high complication, and decreasing the complications could improve the functional score. Less resection could get better reconstruction and better function, less margin resulted at the same time. The risk of recurrence increases when less surgical margin achieves. The main end-result-influencing factor is local recurrence.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2005; 43(16):1058-62.
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    ABSTRACT: To improve the life quality of cancer patients with metastasis to long bone and to select suitable surgical treatment. Fifty two patients with metastasis 27 men and 25 women, were treated from 1990 to 1999. Their average age was 56.8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients), intramedullary nailing reconstruction (29), endoprosthesis (18), and temporary spacer (1). 21 patients accepted postoperative chemotherapy or radiotherapy. Follow-up of 52 patients for a mean of 28.2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability (36) 69%. Local tumor recurrence occurred in 11 patients. Surgical treatment can effectively improve the life quality of patients with metastasis to long bone. The metastatic lesions should be resected with wide or radical margin for the patients with kidney, breast, prostate and thyroid cancer.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2003; 41(2):134-8.