ABSTRACT
Objective:To investigate the early and middle term clinical efficacies of 3D-printed metal prostheses in the reconstruction of bone defects after osteotomy in malignant bone tumors.Methods:A total of 34 patients with malignant bone tumors of lower extremity femur and tibia who underwent 3D printing individualized metal prosthesis replacement surgery in the Department of Bone and Soft Tissue of Affiliated Cancer Hospital of Zhengzhou University from March 2019 to March 2022 were retrospectively analyzed. There were 23 males and 11 females, with an average age of 19.1±15.2 years (range, 7-80 years). There were 22 children and adolescents younger than 18 years old. There were 3 cases in the proximal femur, 15 cases in the middle and distal femur, 10 cases in the proximal tibia and 6 cases in the distal tibia. According to the final pathological diagnosis, 24 cases of osteosarcoma, 6 cases of Ewing's sarcoma, 2 cases of undifferentiated sarcoma, 1 case of osteosarcoma, and 1 case of malignant giant cell tumor of bone were enrolled in this study. Postoperative complications, wound healing, periprosthetic fracture and aseptic loosening, tumor outcome (evaluated by tumor control evaluation criteria), and length difference of lower limbs were recorded. Response evaluation criteria in solid tumor (RECIST) was used to evaluate tumor outcomes. Prosthetic-bone interface healing was evaluated postoperatively, and the function was evaluated based on Musculoskeletal Oncology Society (MSTS) 93.Results:The length of lesions was 70-240 mm in 34 patients, with an average of 125.5±35.4 mm. The length of osteotomy was 80-275 mm, with an average of 160.2±33.9 mm. No tumor was found on the osteotomy surface. The customized prosthesis was firmly installed and closely matched with the side of the preserved articular surface. There were 2 patients with local incision fat liquefaction and 4 patients with superficial wound infection, which healed after debridement and antibiotic treatment. One distal tibia osteosarcoma case developed severe periprosthetic infection 2 months after surgery, resulting in prosthesis implantation failure, limb movement pain and poor ankle function. After removal of the prosthesis, infection control and osteogenesis with the Ilizarov technique, the infection was completely controlled and local osteogenesis was possible. The remaining 33 patients had a good prosthetic-bone interface union. One case was found to have localized bone resorption on the contact surface of the prosthesis 7 months after operation, but the metal prosthesis and screws were not loose. The incisions healed well in other patients, without infection, prosthesis loosening, fracture or other complications. All patients survived and were followed up for 13.8±5.6 months (range, 7-27 months). During the follow-up, there was no recurrence of tumor at the osteotomy end in all patients, but 5 patients developed lung metastasis. At the end of the last follow-up, all patients survived. Among them, 16 patients had unequal length of lower limbs, including 10 cases within 2 cm, 3 cases between 2-5 cm, and 3 cases over 5 cm. With the exception of one patient whose prosthesis was removed due to infection, the MSTS 93 of the other patients was 24.9±2.2 (range, 19-28), and were rated as excellent in 26 cases and good in 7 cases. According to the RECIST evaluation criteria, 26 of 34 patients had complete response, 5 had disease progression, and 3 had stable disease.Conclusion:3D printed metal prosthesis is one of the effective methods for the treatment of bone defects after resection of malignant bone tumors in lower limbs, which is safe, reliable and has satisfactory early curative effect.
ABSTRACT
OBJECTIVE：To systematically e valuate the efficacy and safety of duloxetine in the improvement of pain symptoms of knee osteoarthritis （KOA），and to provide evidence-based reference for clinical treatment of KOA. METHODS ：Retrieved from PubMed，Embase，Medline，Cochrane Library ，CNKI，VIP and Wanfang database ，during the establishment of the database to Sept. 2019，RCTs about duloxetine （trial group ）vs. placebo （control group ）in the improvement of pain symptoms of KOA were collected. After data extraction and quality evaluation using Cochrane system evaluator ’s manual 5.1.0，Meta-analysis was performed by using Stata 14.0 software for WOMAC total score ，WOMAC pain score ，WOMAC stiffness score ，WOMAC function score and BPI-S score ，as well as the incidence of adverse reaction such as dry mouth ，somnolence and nausea. RESULTS：A total of 6 RCTs were included ，involving 2 059 patients. Meta-analysis results showed that WOMAC total score [MD＝－0.34，95％CI（－0.48，－0.20），P＜0.05]，WOMAC pain score [MD ＝－0.41，95％CI（－0.54，－0.29），P＜0.05]， WOMAC stiffness score [MD ＝－0.24，95％ CI（－0.37，－0.12），P＜0.05]，WOMAC function score [MD ＝－0.43，95％CI （－0.55，－0.31），P＜0.05]，BPI-S score [MD ＝－0.38，95％CI（－0.48，－0.28），P＜0.05] of trial group were significantly lower than those of control group ；the incidence of dry mouth [RR ＝3.55，95％CI（2.00，6.29），P＜0.05]，somnolence [RR ＝3.23， 95％CI（1.88，5.54），P＜0.05] and nausea [RR ＝6.95，95％CI（2.99，16.15），P＜0.05] in trial group were significantly higher than control group ，with significant difference. CONCLUSIONS ：Duloxetine can relieve the pain and improve knee function in patients with KOA ，but it is necessary to pay attention to its adverse reactions.
ABSTRACT
Objective To compare the clinical outcome of shape memory alloy (SMA) embra-cing fixator and reconstruction plate fixation in treatment of displaced or comminuted midshaft clavicle fractures. Methods There were 65 patients with displaced or comminuted midshaft clavicle fractures surgically treated with either a SMA embracing fixator or a reconstruction plate. The patients were divided into two groups according to fixation methods, ie, SMA embracing fixator group (30 patients at average age of 28.1 years) and reconstruction plate group (35 patients at average age of 26.1 years). All pa-tients were followed up for mean 12 months and shoulder function was evaluated using shoulder score. Results Compared with reconstruction plate group, SMA embracing fixator had shorter operation time, smaller wound incision and less loss blood (all P < 0.05). However, there was no statistical difference in aspects of hospital stay, cost, JOA shoulder score and bone union rate between two groups (all P > 0.05). Conclusion The internal fixation with SMA embracing fixator is better than reconstruction plate fixation in treatment of midshaft clavicle fractures.
ABSTRACT
BACKGROUND:The non-steroidal antiinflammatory drugs (NSAIDs) were widely used to prevent heterotopic bone formation following total hip arthroplasty (THA),however,its efficacy and safety is poorly understood.OBJECTIVE:To determine the efficacy and safety of postoperative NSAIDs therapy in patients undergoing THA using Meta analysis.METHODS:The databases of PubMed,Embase,Cochrane Library,Chinese biomedical literature,CNKI,VIP as well as bibliographies of retrieved articles were researched for randomized controlled trials comparing NSAID versus control after THA,and the data were analyzed using Review Manager 5.0.RESULTS AND CONCLUSION:A total of 13 randomized controlled trials totaling 4706 participants were included.The result of meta analysis showed that low dose aspirin did not significantly affect the incidence of heterotopic bone formation (HBF) [RR=0.99,95% CI (0.87,1.14) rather than medium to high dose NSAIDs [RR=0.44,95% CI(0.30,0.64),there was no significant difference between two group in hip pain and physical function,the incidence of HBF was 16.0% in NSAID-group and 11.1% in 7 Gy group.Apart from low dose aspirin,medium to high doses of postoperative NSAIDs produce a substantial reduction in the incidence of HBF at the cost of minor high gastrointestinal side effect.Limited evidence showed there were no significant differences between the groups for improvements in hip pain and physical function,7 Gy fraction is more effective than use of NSAID.