[Show abstract][Hide abstract] ABSTRACT: This study aimed to evaluate the oncologic and functional outcome of the cases treated with hemisacrectomy through a sagittal plane in the sacrum and simultaneous en bloc resection together with the ipsilateral sacroiliac joint without sacrificing the contralateral sacral nerves and summarize tumor resection techniques and reconstruction strategy.
En bloc resection of a sacral malignancy with ipsilateral sacroiliac joint and preservation of the contralateral sacral nerves by sagittal hemisacrectomy had been performed in 15 patients. An intra-abdominal aortic balloon was used in all these cases and a combined posterior-anterior approach was adopted. A modified Galveston technique was used to reestablish spinopelvic stability and a nonvascularized fibula autograft was used in selected cases.
Contralateral sacral nerves were preserved in all 15 patients. Adequate margins (wide and marginal margin) were accomplished in 10 patients. Local recurrence occurred in seven (47 %) patients, and four of these had an inadequate margin. There was no perioperative death. Four (27 %) patients had wound problems. No mechanical breakdown occurred until the last follow-up. All the patients were able to walk without the use of a walking aid. Sphincter function was partially preserved in all these patients. At the last follow-up, seven (47 %) patients survived without evidence of disease, two (13 %) patients lived with disease, and six (40 %) patients had died of disease.
This procedure has an oncologic outcome that is similar to that of other high sacrectomy and a much better function outcome. Although demanding, it is indicated in selected patients.
No preview · Article · Dec 2013 · European Spine Journal
[Show abstract][Hide abstract] ABSTRACT: To observe the healing process and the change of biomechanical properties of hypertonic saline-induced devitalized bone segment, so as to provide fundamental theory for clinical treatment.
A model of New Zealand rabbit ulnar segments devitalized by hypertonic saline was established and then reimplanted in situ. The ulnar specimens were taken for examination of X-rays, light microscope and three-point-bend test at the end of 3, 6, 12, and 24 weeks postoperatively.
The devitalized bone healed at the end of 12 weeks in the X-ray film. The histological examination showed that osteoblast multiplied and secreted osteoid gradually. The maximal breaking load of the devitalized bone continuously increased and reached the top at the end of 24 weeks [control group (206.25±16.64) N vs. devitalized group (196.88±8.24) N, P>0.05].
The devitalized bone healed through intramembranous and endochondral ossification, and the endochondral ossification predominated; the biomechanical strength of devitalized bone continually increased as time lasted.
No preview · Article · Dec 2012 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences
[Show abstract][Hide abstract] ABSTRACT: Background and objectives:
The purpose of this study was to estimate the risk factors having relationships with pathologic fracture of osteosarcoma of extremities and to evaluate the role of limb salvage surgery in this group of patients.
We retrospectively analyzed 28 consecutive cases of pathologic fracture of primary high-grade localized osteosarcoma of extremities between June 1, 2001 and June 30, 2009. All patients underwent limb salvage surgery and neo-adjuvant chemotherapy. They had a median age of 14 years (range, 6-30 years). The average follow-up time was 40.7 months (range, 9-108 months). Clinicopathological factors were analyzed in relation to pathologic fracture. Their recurrence and survival rates were compared to those in cohort of 171 osteosarcoma patients without pathologic fracture who underwent limb salvage surgery during the same period at the same institution.
Less than 15 years, telangiectatic histological subtype, tumor located at the proximal humerus, and radiographical manifested as osteolytic features were risk factors in relation to pathologic fracture. The overall 3- and 5-year survival rates were 50.5% and 45.4%, respectively, in the fracture group, and were not significantly different from those in the control group (71.0% and 61.9%, respectively). Of all 28 fracture patients, 4 experienced local recurrences (14.2%) and 14 developed distant metastasis (50%), which were not significantly different from the rates in the control group (8.8% and 37.4%, respectively).
Limb salvage surgery with adequate margins combined with neo-adjuvant chemotherapy for pathologic fracture of osteosarcoma did not seem to significantly increase the risk of local recurrence or distal metastasis.
No preview · Article · Dec 2012 · Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Surgical treatment of pelvic osteosarcoma is often challenging. The objective of this study was to assess the oncologic and functional outcome and the operation-related complications of patients with pelvic osteosarcoma who were treated in a single center in the past decade.
Nineteen patients underwent surgical procedures between June 2000 and June 2009. There were 11 males and 8 females with a mean age of 30 years. According to Enneking and Dunham pelvic classification system, there were: Type I-3, Type I + IV-3, Type I + II-2, Type II + III-4, Type I + II+ III-1, Type III-1, and type I + II+ IV-5. All patients received chemotherapy.
Local recurrence rate was 26.3% (5/19). The 5-year overall survival rate was 44.9%. Seventeen patients received reconstruction after tumor resection. The average MSTS 93 score was 18 (10-23) for the 11 patients with hemipelvic endoprosthetic reconstruction and 23 (20-25) for 6 patients with rod-screw reconstruction. Complication was found in 7 of 19 patients (36.8%).
The oncological results of pelvic osteosarcoma are poor at best. Even with a higher complication rate, we believe restoration of pelvic ring continuity and hip joint mobility is reasonable option to achieve favorable functional outcomes in selected patients.
No preview · Article · Sep 2012 · Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Because of the anatomic complexity of the pelvis, there is no standard surgical treatment for giant cell tumors (GCTs) of the pelvic bones, especially in the periacetabular region. Treatment options include intralesional curettage with or without adjunctive techniques and wide resection. The best surgical treatment of a pelvic GCT remains controversial.
We compared wide resection and intralesional excision in terms of (1) local control, (2) function, and (3) complications.
We retrospectively identified 27 patients with periacetabular benign GCTs who underwent surgery from July 1999 to July 2009. Intralesional surgery was performed in 13 patients and wide resection in 14 patients. We determined surgical complications, local disease control, and Musculoskeletal Tumor Society (MSTS) 93 functional score. The minimum followup was 18 months (mean, 50 months; range, 18-121 months).
Four of 13 patients who had intralesional surgery and none of 14 who had wide resection had local recurrence. The mean functional score was 24 for the 13 patients who underwent intralesional surgery and 22 for the 14 patients who had wide resection. One minor and one major complication occurred among patients who underwent intralesional surgery and one minor and six major complications occurred among patients who underwent wide resection.
Even with a higher complication rate with wide resection and prosthetic reconstruction, we believe the lower local recurrence rate makes wide resection a reasonable option for patients with extensive and/or aggressive GCTs involving the acetabulum.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Full-text · Article · Nov 2011 · Clinical Orthopaedics and Related Research
[Show abstract][Hide abstract] ABSTRACT: Scapular prosthetic replacement after total scapulectomy can result in oncologic salvage and good postoperative function with a low rate of complications.
Ten patients who underwent constrained scapular prosthetic replacement after total scapulectomy between 2003 and 2009 were reviewed retrospectively.
At a mean follow-up of 36 months, 2 patients died of their disease. One patient showed recurrence and metastasis. Complications, including dislocation and superficial wound infection, occurred in 2 patients. The mean Musculoskeletal Tumor Society 93 score was 23.2 of 30 points. High scores were achieved for most items except hand position; only 5 patients can raise their hands above their waist. The ranges of active shoulder abduction and forward flexion motion were 20° to 45° and 40° to 65°, respectively. All patients retained normal hand and elbow functions.
Although there are limitations in the shoulder's active motion, reconstruction with a scapular prosthesis can provide oncologic salvage and result in good postoperative function with a low rate of complications.
No preview · Article · Apr 2011 · Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]
[Show abstract][Hide abstract] ABSTRACT: To analyze the oncological and functional outcome of limb salvage in this location.
From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36.4 months.
Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P = 0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients.
The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.
No preview · Article · Oct 2010 · Zhonghua wai ke za zhi [Chinese journal of surgery]
[Show abstract][Hide abstract] ABSTRACT: To investigate the clinical outcome of consecutive pelvic osteosarcoma treated with surgery and chemotherapy in a single institution, and to discuss the surgical strategy, resection and reconstruction.
Twenty-one consecutive cases with pelvic osteosarcoma underwent surgical procedures between June 2000 and June 2009. There were 12 male and 9 female with a mean age of 32 years. According to Enneking and Dunham pelvic classification system, type Iwas 3 cases, type I+IV 3 cases, type I+II 4 cases, type II+III 4 cases, type I+II+III 1 case, type III 1 case, and type I+II+IV 5 cases. Among the 21 cases, 19 were diagnosed as classical osteosarcoma and 2 were diagnosed as low-grade pathologically. All the tumors were stage IIB. All the patients received en-bloc resection with 13 wide resection and 8 marginal resection. Thirteen patients underwent modular hemi-pelvic endoprosthesis reconstruction, and 5 patients underwent rod-screw system reconstruction combined with autograft. Two patients received hemipelvectomy and one type III patients had resection without reconstruction. The mean follow-up period was 30.3 months (range, 6.0-87.0).
Thirteen patients out of 21 survived after treatment. The overall survival rate was 61.9%, and 23.8% patients were alive without disease. The estimated 5-year survival rate was 44.2% based on Kaplan-Meier curve. The local recurrence rate was 28.6%, among which 4 cases were type II resection, 1 was type I resection, 1 was type I+IV resection.No local relapse was found on the hemipelvectomy and type III resection cases. The local recurrence rate after wide resection was 23.1%, and 37.5% for marginal resection.Nine patients had lung metastases and one patient was found bone and lymph node metastases. The MSTS 93 function score was 20.6 ± 5.4 for 13 patients, and 22.5 ± 2.1 for rod-screw reconstruction cases. The function score was 17.7 ± 5.5 for hemi-pelvic prosthetic reconstruction.
Limb salvage procedures could be performed on most pelvic osteosarcoma cases, and satisfying function outcome could be achieved with proper reconstruction, however, the overall survival is still lower compared with those in extremities.
No preview · Article · Jul 2010 · Zhonghua wai ke za zhi [Chinese journal of surgery]
[Show abstract][Hide abstract] ABSTRACT: To retrospectively review the experience with different surgical procedures for periacetabular metastasis.
The data of 43 patients with periacetabular metastasis between July 2000 and July 2007 was reviewed. There were 21 patients with primary malignant tumors at the beginning, and 10 patients diagnosed metastasis by preoperative biopsy. The other 12 patients presented skeletal involved as initial manifestations of metastasis prior to the pathological diagnosis of the primary tumor. Twelve patients had solitary metastasis, and the others had multiple bone metastasis. The surgical procedure included curettage (35 cases) and en-blot excision (8 cases). The techniques of reconstruction of acetabular defect included total hip replacement (THR) with cemented components or titanium acetabular reconstruction cup (12 cases), THR with partial pelvis replacement with Candal Hook (16 cases), THR with Steinmann pins and cement augmented or titanium cup reconstruction (7 cases), and modular hemipelvic prosthesis reconstruction (8 cases).
All the patients received successful operations. The average score for preoperative pain of 7.2 was assessed. Forty-one patients (95.4%) were evaluated for relief of pain and resumption of walking, and the pain score improved to 3.5 after surgery. The average functional score was 24.5 postoperatively. Six of 32 patients had local recurrence. Fourteen patients died of diseases. The average blood loss during the operation was 1600 ml in 43 patients and the bleeding exceeded 3000 ml was in 3 patients with renal carcinomas. Major complications included two superficial wound infections, one multiple organ failure and two dislocations.
Although surgery will not typically cure patients of their metastatic disease, surgery that is well planned and well executed can help many people by relieving their suffering and improving their quality of life.
No preview · Article · Nov 2009 · Zhonghua wai ke za zhi [Chinese journal of surgery]
[Show abstract][Hide abstract] ABSTRACT: To discuss the surgical management, local recurrence rate and complications of giant cell tumor (GCTs) of the pelvic and sacrum.
From December 1997 to December 2005 the data of 46 patients of GCTs of pelvic and sacrum treated were reviewed. There were 25 men and 21 women with the average age of 32 years old ranging from 17 to 64. Out of 46 patients,there were 24 tumors involved the sacrum and the others at the pelvis. According to the site of the tumors on the bone, they was classified into three regions: 8 patients involved region I (ilium), 10 region II (acetabulum) and 4 region III (ischiopubic). Two patients had lesions located at S(1-5), 4 at S(1-4), 12 at S(1-3), 5 at S(1-2) and 1 at S(3-5). Surgical management: 2 patients received 3 times of operations and 7 underwent 2 operations. There were 19 patients managed with intralesional marginal excision and 2 patients with intralesional marginal excision and adjuvant radiotherapy, another 3 patients with widely marginal excision as the treatment of sacral lesions. Nineteen patients underwent the enbloc excision except 2 involved ischium and 1 involved ilium for the managements of pelvic lesions.
One recurrent patient with the large, ragged tumor died of serious infection in 2 weeks after the second surgery. The remain 45 patients had followed-up durations ranging from 12 months to 8 years. One patient of malignant giant cell tumor of sacrum died at 15 months after surgery. One patient with postoperation sarcoma underwent reoperation and radiotherapy but died at the 13th month. One patient with sacral lesion occurred pulmonary metastases in two years after surgery, and received chemotherapy with ADM, DDP and IFO. One year later there was no much change in metastatic tumor. One patient with acetabular lesion underwent curettage before local recurrence and pulmonary metastases were found in 2 years. The patient was treated with pulmonary radiation, widely marginal excision and hemi-pelvic prostheses reconstruction. There was no progression in metastatic lesion during the following up. The local recurrence rate of GCT at sacrum was 9/24 (37.5%), and at pelvis was 2/22 (9.1%). However, 2 patients with ischium lesions both recurred after curettage. Nineteen lesions with enbloc excision showed no recurrence at all.
The treatment for GCT of the pelvic and sacrum should be more aggressive because of high incidence of local recurrence after intralesional excision. Although it might induce sacral nerve deficit, widely marginal excision is the best surgical procedure because of its low recurrence rate.
No preview · Article · May 2008 · Zhonghua wai ke za zhi [Chinese journal of surgery]