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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1215-1220, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063482

RESUMO

Objective: To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children. Methods: A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph. Results: Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°). Conclusion: Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Neoplasias Ósseas/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Osteossarcoma/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1221-1225, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063483

RESUMO

Objective: To evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors. Methods: Between March 2012 and January 2018, 11 patients with distal tibial malignant and invasive tumors were treated with vascularized fibula reconstruction. There were 7 males and 4 females with an average age of 20 years (range, 16-39 years). There were 8 cases of osteosarcoma, 2 cases of invasive giant cell tumor of bone, and 1 case of hemangioendothelioma. The tumors were rated as benign stage 3 in 2 cases and malignant stageⅠA in 1 case, stageⅡA in 4 cases, and stage ⅡB in 4 cases according to the Enneking staging. The disease duration was 1-6 months (mean, 2.7 months). The limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score, and the distal and proximal union of the transplanted fibula and the diameter of the fibula were examined by imaging. Results: All incisions healed by first intention. All patients were followed up 16-85 months (mean, 41 months). No tumor recurrence or metastasis occurred during the follow-up. The proximal and distal grafts in the 10 cases showed osseous healing, and the healing time was 7-12 months (mean, 10.1 months) at proximal end and 7-12 months (mean, 9.3 months) at distal end. In 1 case, the proximal end did not heal at 19 months, while the distal end healed at 13 months; proximal bone grafting was performed, and the proximal end healed. Among the 4 patients with distal screw fixation, 2 had peri-internal fixation fractures after graft healing, but no skin necrosis or infection occurred. All the 7 patients with distal steel plate fixation had no peri-internal fixation fracture, but 1 patient developed anterior tibial skin necrosis. At 12 months after operation, the diameter of fibula increased 1-5 mm (mean, 2.4 mm) by compared with that before operation. The MSTS score was 17-27 (mean, 22.8). Conclusion: Reconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results, which is one of the feasible and worthy methods for the distal tibial malignant and invasive tumors.


Assuntos
Neoplasias Ósseas , Fíbula , Adolescente , Adulto , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia , Tíbia/cirurgia , Adulto Jovem
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1226-1232, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063484

RESUMO

Objective: To summarize the experience in the treatment of infection after limb salvage surgery for malignant tumor around knee joint, and explore the risk factor related to infection after limb salvage surgery. Methods: A clinical data of 212 patients with malignant tumor around the knee joint underwent limb salvage surgery between January 2008 and December 2017 were retrospectively analyzed. Among them, 14 cases had infection after limb salvage surgery. Two cases of acute infection were treated with sensitive antibiotics; 12 cases of chronic infection were treated with debridement and antibiotic bone cement occupying device implantation in the first stage, and prosthesis revision (8 cases), knee joint fusion (2 cases), or amputation (2 cases) in the second stage after infection control. The age, gender, preoperative chemotherapy cycle, bone marrow suppression, serum albumin, hemoglobin, operation time, postoperative drainage time, and blood transfusion volume were analyzed to screen the risk factors related to infection after limb salvage surgery. The infection and tumor recurrence were observed, and the limb function was evaluated by Enneking scoring system. Results: The univariate analysis showed that the preoperative chemotherapy cycle, bone marrow suppression, operation time, and postoperative drainage time were the influencing factors of postoperative infection ( P<0.05). Multivariate analysis showed that the operation time, preoperative chemotherapy cycle, and postoperative drainage time were risk factors of postoperative infection ( P<0.05). Among the 14 patients, 1 patient died of traffic accident at 6 months after the second stage operation, and 13 patients were followed up 12.2-48.0 months (mean, 19.9 months). Two cases of acute infection cured. Among the 11 patients with chronic infection, 2 cases of subluxation of the antibiotic bone cement occupying device after the first stage operation occurred; 9 cases of infection cured and 2 cases recurred. At 12 months after operation, except 1 case died by accident, the Enneking scores of the other 13 patients were 12-26, with an average of 20. At last follow-up, 1 case of lung metastasis was still alive, and no tumor metastasis or recurrence was found in the rest. Conclusion: The time of limb salvage surgery, preoperative chemotherapy cycle, and drainage time after limb salvage surgery are the risk factors of infection after limb salvage surgery. Early etiological examination and drug sensitivity test is the key to the treatment of infection. One-stage debridement combined with antibiotic bone cement occupying device can effectively cure infection and save patients' limbs.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Neoplasias Ósseas/cirurgia , Humanos , Articulação do Joelho , Salvamento de Membro , Recidiva Local de Neoplasia , Osteossarcoma/cirurgia , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(27): e20715, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629645

RESUMO

To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision.This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft.The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement.Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Neoplasias Femorais/cirurgia , Úmero/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Tíbia/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 146-150, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192418

RESUMO

Presentamos el caso de un osteoma osteoide recurrente en forma de un osteoblastoma agresivo en columna lumbar. Un varón de 15 años acudió a nuestro servicio con una escoliosis dolorosa. El TC y la RM mostraron una tumoración formadora de hueso esclerótico de 7 mm compatible con un osteoma osteoide. Se realizó una ablación percutánea guiada por radiofrecuencia con remisión completa de la sintomatología. Seis meses después, dicha sintomatología recurrió. Se realizaron TC y RM que mostraron un crecimiento del nidus en la lámina L4 derecha, con un diámetro de 15 mm. Se realizó una resección marginal. La histología mostró un osteoblastoma epiteloide. Un años después, se realizaron nuevos estudios de imagen que mostraron una nueva recurrencia del tumor con rasgos agresivos e invasión del canal espinal. Se le realizó una cirugía de resección en bloque con estabilización de la columna lumbar. La histología confirmó el diagnóstico de osteoblastoma epiteloide


We report an uncommon case of osteoid osteoma recurring as an aggressive osteoblastoma of the spine. A 15-years-old male consulted in our department with long-term painful scoliosis. The CT-scans and MRI revealed a sclerotic bone forming tumor of 7 mm diameter consistent with a osteoid osteoma. A percutaneous radiofrequency ablation was performed with complete resolution of the symptoms. After 6 months, the symptoms recurred. A new CT and a MRI showed a growth of the nidus on the right L4 lamina, with a size of 15 mm. Therefore, a marginal resection by laminectomy of L4 was performed. Pathology confirmed an epithelioid osteoblastoma. A year later, subsequent imaging studies showed a new recurrence with aggressive features and invasion of the spinal canal. The patient then underwent an "in block surgery" needing concurrent stabilization of the spine. Histopathology confirmed the diagnosis of epithelioid osteblastoma


Assuntos
Humanos , Masculino , Adolescente , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/terapia , Neoplasias Ósseas/diagnóstico por imagem , Osteoblastoma/diagnóstico por imagem , Recidiva Local de Neoplasia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Osteoblastoma/patologia , Ablação por Radiofrequência/métodos , Escoliose/cirurgia , Laminectomia
7.
Anticancer Res ; 40(6): 3551-3557, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487657

RESUMO

BACKGROUND/AIM: Previous studies have identified pelvic tumors as a risk factor for surgical site infections (SSI). However, risk factors for extremity tumors are still unclear. This study investigated risk factors for postoperative deep infection in malignant bone tumors of the extremities. PATIENTS AND METHODS: Data from 238 patients with 256 malignant bone tumor surgeries were reviewed. Univariate analysis and multiple logistic regression determined risk factors for deep infection. RESULTS: Deep infection was found in 23 of 256 cases (9.0%). Tibial tumor (OR=6.04; 95%CI=2.14-17.05; p<0.001) and operative time ≥5 hours (OR=3.25; 95%CI=1.15-9.23; p=0.027) were independent risk factors for deep infection. CONCLUSION: Tibial tumor and operative time ≥5 hours are independent risk factors for deep infection after surgery of malignant bone tumor of extremities. Strategies to minimize risk of infection in the tibia and decreasing operative time should be implemented, along with other measures to decrease SSI.


Assuntos
Neoplasias Ósseas/complicações , Extremidades/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Criança , Pré-Escolar , Extremidades/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Adulto Jovem
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 751-755, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538567

RESUMO

Objective: To investigate the short-term effectiveness of three-dimensional (3D) printing personalized prosthesis in the treatment of giant cell tumor of bone around knee joint. Methods: A clinical data of 9 patients with giant cell tumor of bone around knee joints and met the inclusive criteria between May 2014 and August 2017 was retrospectively analysed. There were 4 males and 5 females, with an average age of 35.8 years (range, 24-50 years). The lesion located at the distal femur in 4 cases and at the proximal tibia in 5 cases. The disease duration was 5-25 months (mean, 12.9 months). According to Campanacci grading, there were 2 patients of grade Ⅰ and 7 of grade Ⅱ. The 3D printing personalized prosthesis was designed based on the CT scanning and 3D reconstruction prepared before operation. All patients were treated with the tumor resection and 3D printing personalized prosthesis reconstruction. The radiological examination was taken to observe the tumor recurrence and the Musculoskeletal Tumor Society 1993 (MSTS93) score was used to evaluate the knee function. Results: All operations were successful and all incisions healed by first intention without early complications. All patients were followed up 24-40 months (mean, 31.2 months). At last follow-up, no complication such as pain, pathological fracture, prosthesis loosening, or tumor recurrence occurred. The MSTS93 score was 20-29 (mean, 24.7). The knee function was rated as excellent in 6 cases and good in 3 cases, with the excellent and good rate of 100%. Conclusion: For giant cell tumor of bone around knee joint, 3D printing personalized prosthesis has the advantages of bio-fusion with host bone, mechanical stability, good joint function, and ideal short-term effectiveness. But the middle- and long-term effectiveness still need to be further observed.


Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Prótese do Joelho , Impressão Tridimensional , Adulto , Neoplasias Ósseas/reabilitação , Neoplasias Ósseas/cirurgia , Feminino , Tumor de Células Gigantes do Osso/reabilitação , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho/normas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Tech Vasc Interv Radiol ; 23(2): 100678, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591190

RESUMO

Image-guided percutaneous thermal ablation plays an increasingly important role in the multidisciplinary management of musculoskeletal lesions. Established indications for ablation in this setting include the treatment of osteoid osteomas, palliation of painful skeletal metastases, local control of oligometastatic disease, and consolidation of bone tumors at risk for fracture. Emerging indications include the treatment of symptomatic soft tissue masses such as extra-abdominal desmoid tumors and abdominal wall endometriosis. This review will discuss considerations in patient selection and preprocedural workup, ablation technology and techniques, strategies to avoid complications, and expected outcomes of ablation in the musculoskeletal system.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia/tendências , Eletroporação/tendências , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência/tendências , Neoplasias de Tecidos Moles/cirurgia , Cirurgia Assistida por Computador/tendências , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Humanos , Micro-Ondas/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Fatores de Risco , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento
10.
Adv Exp Med Biol ; 1257: 13-29, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32483727

RESUMO

Advances in chemotherapy, sophisticated imaging, and surgical techniques over the last few decades have allowed limb-salvage surgery (LSS) to become the preferred surgical treatment for bone sarcomas of the extremities. The goal of LLS is to maximize limb functionality to allow for the maintenance of quality of life without compromising overall survival and tumor local recurrence rates. Today, limb-salvage procedures are performed on 80-95% of patients with extremity osteosarcoma, and the 5-year survival rate in extremity osteosarcoma patients is now 60-75%.This chapter will focus on LSS for extremity osteosarcoma. Common types of surgical reconstruction techniques including endoprostheses, intercalary or osteoarticular allografts, vascularized fibular autografts, and allograft prosthetic composites (APC), and their complications such as infection, local recurrence, graft fracture, implant failure, and nonunion will be discussed in detail. Anatomic locations of lesions discussed include the proximal femur, distal femur, proximal tibia, distal tibia, proximal humerus, distal humerus, and forearm bones.


Assuntos
Neoplasias Ósseas , Salvamento de Membro , Osteossarcoma , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Humanos , Recidiva Local de Neoplasia , Osteossarcoma/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
11.
Adv Exp Med Biol ; 1257: 85-94, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32483733

RESUMO

Osteosarcoma relapses not only herald a very poor prognosis but also opportunities to treat this genetically diverse complex cancer in new ways. This review will attempt to show that the field is a rapidly evolving one in which not only cytotoxic agents but also local control strategies and the immune system can be harnessed to improve the prognosis of relapsed patients. The molecular heterogeneity and the difficulty of effectively treating most common patterns of relapse with surgery and/or radiation (lung and/or bone metastases) have been responsible for a wide variety of approaches to learning whether agents are active against osteosarcoma. This chapter will highlight past, current, and potential future approaches to provide more effective systemic therapy for the problem of recurrent metastases of osteosarcoma. These include single-agent trials with a wide variety of agents, radiopharmaceuticals, and immune therapies. Finally, how such efforts are integrated into more effective local control strategies is also discussed.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Ensaios Clínicos como Assunto , Humanos , Recidiva Local de Neoplasia , Osteossarcoma/tratamento farmacológico , Osteossarcoma/radioterapia , Osteossarcoma/cirurgia
12.
Bone Joint J ; 102-B(6): 779-787, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475244

RESUMO

AIMS: Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction. METHODS: Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS). RESULTS: At a mean follow-up of 159 months (1 to 207), 23 patients were alive without disease, one was alive with lung metastases, one was alive following local recurrence, four were dead of disease, and three had died from other causes. The overall ten-year survival was 77%. There was only one (3%) local recurrence, which occurred at 26 months. There were 18 complications in 17 patients; 13 wound healing complications/infections, three fractures, one pulmonary embolism, and one dislocation of the hip. Most complications occurred early. The mean functional scores were 21.1 (SD 8.1) for MSTS-87, 67.3 (SD 23.9) for MSTS-93 and 76.2 (SD 20.6) for TESS. CONCLUSION: Patients requiring Type I or Type I/IV pelvic resections can expect a good oncological outcome and a high rate of local control. Complications are generally acute in nature and are easily manageable. These patients achieved a good functional outcome without the need for bony reconstruction. Cite this article: Bone Joint J 2020;102-B(6):779-787.


Assuntos
Neoplasias Ósseas/cirurgia , Ílio/cirurgia , Sacro/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Bone Joint J ; 102-B(6): 795-803, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475245

RESUMO

AIMS: To assess the correlation between the histological response to preoperative chemotherapy and event-free survival (EFS) or overall survival (OS) in patients with high-grade localized osteosarcoma. METHODS: Out of 625 patients aged ≤ 40 years treated for primary high-grade osteosarcoma between 1997 and 2016, 232 patients without clinically detectable metastases at the time of diagnosis and treated with preoperative high-dose methotrexate, adriamycin and cisplatin (MAP) chemotherapy and surgery were included. Associations of chemotherapy-induced necrosis in the resected specimen and EFS or OS were assessed using Cox model and the Pearson's correlation coefficients (r). Time-dependent receiver operating characteristic analysis was applied to determine the optimal cut-off value of chemotherapy-induced necrosis for EFS and OS. RESULTS: OS was 74% (95% confidence interval (CI) 67 to 79) at five years. Median chemotherapy-induced necrosis was 85% (interquartile range (IQR) 50% to 97%). In multivariate Cox model, chemotherapy-induced necrosis was significantly associated with EFS and OS (hazard ratio (HR) = 0.99 (95% CI 0.98 to 0.99); p < 0.001 and HR = 0.98 (95% CI 0.97 to 0.99); p < 0.001, respectively). Positive correlation was observed between chemotherapy-induced necrosis and five-year EFS and five-year OS (r = 0.91; p < 0.001, and r = 0.85; p < 0.001, respectively). The optimal cut-off value of chemotherapy-induced necrosis for five-year EFS and five-year OS was 85% and 72%, respectively. CONCLUSION: Chemotherapy-induced necrosis in the resected specimen showed positive correlation with EFS and OS in patients with high-grade localized osteosarcoma after MAP chemotherapy. In our analysis, optimal cut-off values of MAP chemotherapy-induced necrosis in EFS and OS were lower than the commonly used 90%, suggesting the need for re-evaluation of the optimal cut-off value through larger, international collaborative research. Cite this article: Bone Joint J 2020;102-B(6):795-803.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Metotrexato/administração & dosagem , Osteossarcoma/tratamento farmacológico , Osteossarcoma/cirurgia , Adolescente , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Criança , Correlação de Dados , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Necrose/induzido quimicamente , Terapia Neoadjuvante , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Período Pré-Operatório , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
14.
Bone Joint J ; 102-B(6): 772-778, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475249

RESUMO

AIMS: For paediatric and adolescent patients with growth potential, preservation of the physiological joint by transepiphyseal resection (TER) of the femur confers definite advantages over arthroplasty procedures. We hypothesized that the extent of the tumour and changes in its extent after neoadjuvant chemotherapy are essential factors in the selection of this procedure, and can be assessed with MRI. The oncological and functional outcomes of the procedure were reviewed to confirm its safety and efficacy. METHODS: We retrospectively reviewed 16 patients (seven male and nine female, mean age 12.2 years (7 to 16)) with osteosarcoma of the knee who had been treated by TER. We evaluated the MRI scans before and after neoadjuvant chemotherapy for all patients to assess the extent of the disease and the response to treatment. RESULTS: The mean follow-up period was 64.3 months (25 to 148) after surgery and no patients were lost to follow-up. On MRI evaluation, 13 tumours were near but not in contact with the physes and three tumours were partially in contact with the physes before neoadjuvant chemotherapy. Bone oedema in the epiphysis was observed in eight patients. After neoadjuvant chemotherapy, bone oedema in the epiphysis disappeared in all patients. In total, 11 tumours were not in contact and five tumours were in partial contact with the physes. The postoperative pathological margin was negative in all patients. At the last follow-up, 12 patients were continuously disease-free and three had no evidence of disease. One patient died due to the disease. Functionally, the patients with retained allograft or recycled autograft had a mean knee range of flexion of 126° (90° to 150°). The mean Musculoskeletal Tumor Society functional score was 27.6 (23 to 30). CONCLUSION: TER is an effective limb-salvage technique for treating malignant metaphyseal bone tumours in paediatric and young osteosarcoma patients with open physes when a good response to chemotherapy and no progression of the tumour to the epiphysis have been confirmed by MRI. Cite this article: Bone Joint J 2020;102-B(6):772-778.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Imagem por Ressonância Magnética , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/cirurgia , Adolescente , Criança , Epífises/cirurgia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Cirurgia Assistida por Computador
15.
Medicine (Baltimore) ; 99(24): e20442, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541466

RESUMO

Surgical treatment of malignant bone tumors comprises tumor resection and reconstruction. The most commonly used reconstruction method is prosthesis replacement, which achieves good early function, but has a high long-term incidence of complications. Another reconstruction option is autologous bone replantation, which has the advantages of anatomical matching and no need for large bone bank support. Few studies have evaluated reconstruction with liquid nitrogen-inactivated autogenous bone.The present study aimed to evaluate the oncological results, bone healing results, complications, and indications of reconstruction with liquid nitrogen-inactivated autogenous bone grafts.The study population comprised 21 consecutive patients. The tumor site was the tibia in 9 cases, femur in 8, and humerus in 4. There were 37 osteotomy ends in total. After freezing and rewarming, the medullary cavity of the autogenous bone was filled with antibiotic bone cement. Seventeen patients received bilateral plate fixation, 2 received intramedullary nail and distal plate fixation, and 2 received single plate fixation.The average follow-up was 31 ±â€Š6 months. Eighteen patients survived without tumors, and the 3-year survival rate was 80.4%. All cases had adequate surgical margins, but recurrence developed in 1 patient. Metastasis occurred in 3 patients, who all died of metastasis. Intraoperative inactivated bone fracture occurred in 1 patient, and screw breakage was found in 1 patient. Nonunion occurred at 1 humeral diaphysis osteotomy site, and 1 patient was lost to follow-up; the average healing time of the other 35 ends was 13 ±â€Š6 months, and the bone healing rate was 97.2%. The average bone healing times in the metaphysis and diaphysis were 9 ±â€Š3 months and 15 ±â€Š6 months (P = .003). The average bone healing times in the upper and lower limbs were 16.6 ±â€Š7.4 months and 12.3 ±â€Š5.8 months (P = .020). The average Muscle and Skeletal Tumor Society score was 28 ±â€Š3 (21-30) in the 18 survivors.Liquid nitrogen-inactivated autologous bone replantation for primary malignant limb tumor was safe and effective, as shown by the relatively low complication rate, high bone healing rate, and satisfactory postoperative function. This is a reliable biological reconstruction method for malignant bone tumors with specific site and bone destruction characteristics.


Assuntos
Neoplasias Ósseas/cirurgia , Osso e Ossos/cirurgia , Nitrogênio/uso terapêutico , Osteossarcoma/cirurgia , Reimplante/estatística & dados numéricos , Adolescente , Adulto , Neoplasias Ósseas/mortalidade , Criança , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Adulto Jovem
16.
Mymensingh Med J ; 29(2): 317-324, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32506085

RESUMO

Osteoarticular allografts have provided the chance of limb-sparing trial in tumor surgery. Several authors have reported 50-75% long term (>10 years) successful use of these types of grafts, and large well recognized series provide confirmation that limb reconstruction following extensive resection of bone and joints has been possible with their use. Infection has been a major problem, affecting up to 12 per cent of recipients and often resulting in re-operations and infrequently amputations. This prospective Interventional study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Biomedical Research division, Atomic Energy Centre, Savar, Dhaka, Bangladesh from January 2008 to December 2017. In this study patients' age were 20-50 years and male was 12(60%) & female was 8(40%). We assessed the results of 20 limb-salvage procedures (Resection-Arthrodesis Procedure) using 11-18cm of distal femur or proximal tibial osteoarticular allografts after wide resection of aggressive or malignant Giant Cell Tumour (GCT) around the knee joint, Campanacci Grade III or recurrent case of Campanacci Grade II. At the ten-year follow-up, two patients had died, one due to infection and tumor metastasis to the lungs and one due to medical causes. The allografts survived for more than five years was twelve patients (60%) all of whom had good function, ranging from 73% to 90% of normal. The allografts were removed because of fracture in two patients and infection in two patients. Remaining three patients allograft was survived with satisfactory function but follow up was 3 years. All postoperative problems related to the allograft reconstruction were documented. Functional outcome was evaluated using the Musculoskeletal Tumour Society Scoring System and at least more than 3 years follow up should be taken for categorization of the results. Among the 20 patients, satisfactory result was 15(75%) patients and unsatisfactory result was 5(25%) patients. P value was <0.001.


Assuntos
Neoplasias Ósseas/cirurgia , Tumores de Células Gigantes , Aloenxertos , Artrodese , Bangladesh , Transplante Ósseo , Feminino , Humanos , Articulação do Joelho , Salvamento de Membro , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
17.
Br J Radiol ; 93(1114): 20200266, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32520586

RESUMO

Osteoid osteoma is a painful benign bone tumour of children and young adults with characteristic clinico-radiological features depending upon the location of the lesion. Intraoperative visualisation of the nidus is difficult and therefore curative surgery is often associated with excessive bone removal, significant perioperative morbidity and potential need of bone grafting procedures. With advancement in cross-sectional imaging and radiofrequency ablation (RFA) technology, CT-guided RFA has emerged as the treatment of choice for the osteoid osteoma. This procedure involves accurate cannulation of the nidus and subsequent thermocoagulation-induced necrosis.Multidisciplinary management approach is the standard of care for patients with osteoid osteoma. Appropriate patient selection, identification of imaging pitfalls, pre-anaesthetic evaluation and a protocol-based interventional approach are the cornerstone for a favourable outcome. Comprehensive patient preparation with proper patient position and insulation is important to prevent complications. Use of spinal needle-guided placement of introducer needle, namely, "rail-road technique" is associated with fewer needle trajectory modifications, reduced radiation dose and patient morbidity and less intervention time. Certain other procedural modifications are employed in special situations, for example, intra-articular osteoid osteoma and osteoid osteoma of the subcutaneous bone in order to reduce complications. Treatment follow-up generally includes radiographic assessment and evaluation of pain score. Dynamic contrast-enhanced MRI has been recently found useful for demonstrating post-RFA healing.


Assuntos
Neoplasias Ósseas/cirurgia , Ablação por Cateter/métodos , Osteoma Osteoide/cirurgia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Humanos , Ondas de Rádio
18.
Anticancer Res ; 40(5): 2751-2755, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366420

RESUMO

BACKGROUND/AIM: Non-vascularized methods to reconstruct bone defects following tumor resection are associated with complications. As a result, the free vascularized fibular flap (FVF) has become a mainstay for reconstruction. The purpose of this study was to analyze FVF reconstruction in the upper extremity. PATIENTS AND METHODS: We reviewed 28 (14 female and 14 male, mean age of 29±20 years) patients reconstructed with an FVF in the upper extremity following tumor resection. Reconstruction most commonly involved the humerus (n=17, 61%) and a malignant (n=23, 82%) tumor. RESULTS: The limb salvage rate was 93% (n=26), with primary union occurring in 71% (n=20) of patients. Following bone grafting the overall union was 96% (n=27) at a mean 13±11 months. At most recent follow-up the mean MSTS93 rating was 82±22%. CONCLUSION: FVF effectively provided a functional reconstruction following tumor resection. Although, one in four patients will need additional bone grafting, the overall union rate is high.


Assuntos
Neoplasias Ósseas/cirurgia , Fíbula/irrigação sanguínea , Fíbula/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos/irrigação sanguínea , Extremidade Superior/patologia , Extremidade Superior/cirurgia , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Intervalo Livre de Doença , Feminino , Humanos , Salvamento de Membro , Masculino , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Extremidade Superior/diagnóstico por imagem
19.
Medicine (Baltimore) ; 99(20): e20159, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443331

RESUMO

Postoperative delirium (PD), characterized by acute onset of global impairment in consciousness and cognition, is a common complication following major surgeries and is often associated with adverse outcomes. Because of the multiple comorbidities of the patient along with extensive nature of the surgery, patients undergoing surgery for bone metastases may be prone to developing PD. However, no study exists regarding PD in patients who undergo surgery for bone metastases.Two hundred seventy six patients with mean age of 64 years (range, 16-94) who underwent surgery for bone metastases were reviewed. The diagnosis of PD was made by the psychiatrist, according to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Possible perioperative clinic-pathologic factors that may be associated with the development of PD were investigated.Among the 276 patients, 9% (n = 25) developed PD. On multivariate logistic regression analysis, history of psychiatric disorders (odds ratio [OR] = 9.63; 95% confidence interval [CI] 1.78-21.74, P = .004), high preoperative serum C-reactive protein (CRP) level (OR = 1.17; 95% CI 1.06-1.29, P = .001), low preoperative serum albumin level (OR = 0.13; 95% CI 0.03-0.48, P = 0.002), and high dose of opioid analgesics received in the immediate postoperative period (OR = 1.05; 95% CI 1.01-1.07, P = .001) were independently associated with the development of PD. Patients with PD had lower survival (log rank, P = .001) than patients without PD.Incidence of PD is considerable in patients undergoing surgery for bone metastases. History of psychiatric disorders, preoperative serum albumin and CRP levels, and the dose of postoperative opioid analgesics are associated with the development of PD.


Assuntos
Neoplasias Ósseas/cirurgia , Delírio/etiologia , Metástase Neoplásica/patologia , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Neoplasias Ósseas/secundário , Proteína C-Reativa/análise , Cognição/efeitos dos fármacos , Cognição/fisiologia , Comorbidade , Delírio/epidemiologia , Delírio/mortalidade , Delírio/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
20.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32398328

RESUMO

A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.


Assuntos
Comportamento do Adolescente/ética , Anestesia Epidural/ética , Dor Pós-Operatória/prevenção & controle , Relações Pais-Filho , Relações Médico-Paciente/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Comportamento do Adolescente/psicologia , Anestesia Epidural/métodos , Anestesia Epidural/psicologia , Neoplasias Ósseas/psicologia , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Dor Pós-Operatória/psicologia , Pais/psicologia , Sarcoma de Ewing/psicologia , Sarcoma de Ewing/cirurgia , Recusa do Paciente ao Tratamento/psicologia
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