Objective To evaluate the feasibility and short-term effectiveness of three-dimensional (3D) printed titanium-alloy prosthesis reconstruction after the distal tibia tumor segment resection. Methods The clinical data of 6 patients with bone defect after distal tibia tumor segment resection treated with 3D printed titanium-alloy prosthesis reconstruction and tibiotalar joint fusion between January 2020 and December 2021 were retrospectively analyzed. There were 2 males and 4 females; the age ranged from 12 to 35 years, with an average of 18.5 years. Among them, 4 cases were osteosarcoma, 1 case was Ewing sarcoma, and 1 case was giant cell tumor of bone. The Enneking staging was stage ⅡA in 3 cases, stage ⅡB in 2 cases, and stage Ⅲ in 1 case. The disease duration was 2-5 months (mean, 3.2 months). All patients received preoperative neoadjuvant therapy, and patients with osteosarcoma and Ewing sarcoma started chemotherapy at3 weeks after operation. The systemic and local tumor conditions and prosthesis conditions were evaluated regularly after operation. The Musculoskeletal Tumor Society (MSTS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score were used to evaluate the lower extremity and ankle function. Results All patients were followed up 8-26 months, with an average of 15.6 months. There was no local recurrence and distant metastasis during the follow-up. The ankle joints of 5 cases were all in 90° functional position at last follow-up, and there was no complication such as prosthesis loosening and fracture; the ankle joint fusion was stable, the local bone ingrowth was good, and the daily activities could be completed, but the ankle range of motion was limited and the ankle joint was stiff. The MSTS score ranged from 22 to 26, with an average of 24, and 3 cases were evaluated as excellent and 2 cases were good; the AOFAS score ranged from 71 to 86, with an average of 80.6, and 4 cases were evaluated as good and 1 case was fair. One patient had severe periprosthetic infection at 2 months after operation, resulting in failure of prosthesis implantation, pain in limb movement, and poor ankle function; MSTS score was 12, AOFAS score was 50, and both were evaluated as poor; distraction osteogenesis was performed after removal of prosthesis and infection control, at present, it was still in the process of distraction osteogenesis, and local osteogenesis was acceptable. Conclusion Using 3D printed titanium-alloy prosthesis and tibiotalar joint fusion to reconstruct the bone defect after distal tibia tumor segment resection has satisfactory mechanical stability and function, and is one of the effective distal tibial limb salvage methods.
ObjectiveThe research progress of new multifunctional bone cement in bone tumor therapy in recent years was reviewed, in order to provide help for the future research of anti-tumor bone cement. Methods The related literature on the treatment of bone tumors with new multifunctional bone cement at home and abroad in recent years was extensively reviewed and summarized. Results The new multifunctional bone cements include those with the functions of photothermotherapy, magnetic thermotherapy, chemoradiotherapy, and antibacterial after operation, which are discussed from the aspects of anti-tumor, drug controlled release, and cytotoxicity. Controlled drug release has been achieved in multifunctional bone cements by adjusting heat and pH or incorporating particles such as chitosan oligosaccharides and γ-cyclodextrin. At present, multifunctional bone cement with hyperthermia, radiotherapy, and chemotherapy has effectively inhibited the local recurrence and distant metastasis of bone tumors. Broadening the application of bone cement for photothermal and magnetic thermal therapy to deeper bone tumors, investigating more precise controlled release of drug-loaded bone cement, and introducing nanoparticles with both thermal conversion and intrinsic enzymatic activities into bone cement for synergistic anti-tumor therapy are promising research directions. ConclusionThe new multifunctional bone cement inhibits bone tumor cells, promotes new bone formation in bone defects, and prevents incision infection after tumor resection. Certain progress has been made in anti-tumor, antibacterial, drug-controlled release, and reduction of cytotoxicity. Expanding the deeper application range of the new multifunctional bone cement, verifying the safety in clinical application, and focusing on the individualized treatment of the new multifunctional bone cement are the problems that need to be solved in the future.
ObjectiveTo explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur.MethodsBetween March 2012 and December 2016, 20 patients (21 lesions) with benign bone tumors or tumor like conditions of proximal femurs were treated with DHS and intralesional curettage via Watson-Jones approach. Their average age was 27.8 years (range, 11-51 years), including 13 males and 7 females. The pathological diagnosis were fibrous dysplasia in 11 cases, simple bone cyst in 2 cases, aneurysmal bone cyst in 2 cases, benign fibrous histocytoma in 2 cases, giant cell tumor in 2 cases, and chondroblastoma in 1 case, including 3 pathological fractures. According to the Enneking staging system, 18 patients were in stage S1, 3 patients with pathological fractures in stage S2. There was no varus deformity or valgus deformity. The operation time, intraoperative blood loss, and time of full weight-bearing were recorded. X-ray film and CT were used to observe the bone graft fusion and location of DHS. Complications were recorded. Visual analogue scale (VAS) and Musculoskeletal Tumor Society (MSTS) scoring were used to evaluate function of lower limbs.ResultsThe average operation time was 177.1 minutes (range, 110-265 minutes). The average intraoperative blood loss was 828.6 mL (range, 200-2 300 mL). There was superficial incision infection in 1 case, deep incision infection in 1 case, and hip discomfort in 1 case, respectively. All patients were followed up 6-63 months (mean, 27.4 months). The time of full weight-bearing was 2 days in 2 patients with giant cell tumor and 2 to 13 weeks with an average of 7.2 weeks in the other patients. At last follow-up, VAS and MSTS were 0.19±0.51 and 29.62±0.97 respectively, showing significant differences when compared with the values before operation (3.52±2.62 and 23.71±8.77) (t=5.565, P=0.000; t=–3.020, P=0.007 ). X-ray film showed the all bone grafts fusion with mean time of 8.2 months (range, 5-12 months). There was no pathological fracture of the femur, local tumor recurrence, chronic hip pain, dislocation, or femoral head necrosis during follow-up.ConclusionThe treatment of benign bone lesion of the proximal femur using DHS and intralesional curettage via Watson-Jones approach is a safe and effective method.
Objective To explore the role and effectiveness of three-dimensional (3D) printing technology based on 3D multimodality imaging in surgical treatment of malignant bone tumors of limbs. Methods The clinical data of 15 patients with malignant bone tumors of the limbs who met the selection criteria between January 2016 and January 2019 were retrospectively analyzed. There were 6 males and 9 females, with a median age of 34 years (range, 17-73 years). There were 5 cases of osteosarcoma, 3 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 1 case of hemangiosarcoma, 1 case of ameloblastoma, and 3 cases of metastatic carcinoma. The tumors were located in the humerus in 5 cases, ulna in 2 cases, femur in 3 cases, and tibia in 5 cases. The disease duration was 2-8 months (median, 4 months). Preoperative 3D multimodality imaging was administered first, based on which computer-assisted preoperative planning was performed, 3D printed personalized special instruments and prostheses were designed, and in vitro simulation of surgery was conducted, successively. Two cases underwent knee arthroplasty, 2 had semi-shoulder arthroplasty, 2 had proximal ulna arthroplasty, and 9 had joint-preserving surgery. Surgical margins, operation time, intraoperative blood loss, surgical complications, Musculoskeletal Tumor Society (MSTS) score, and oncological outcome were collected and analyzed. Results All 15 patients completed the operation according to the preoperative plan, and the surgical margins were all obtained wide resection margins. The operation time was 80-240 minutes, with a median of 150 minutes. The intraoperative blood loss was 100-400 mL, with a median of 200 mL. There was no significant limitation of limb function due to important blood vessels or nerves injury during operation. One case of superficial infection of the incision was cured after dressing change, and the incisions of the other patients healed by first intention. All patients were followed up 6-48 months, with a median of 24 months. Two of the patients died of lung metastasis at 6 and 24 months after operation, respectively. No local recurrence, prosthesis dislocation, or prosthesis loosening occurred during follow-up. At last follow-up, the MSTS score ranged from 23 to 30, with an average of 25. Conclusion3D printing tecnology, based on 3D multimodality imaging, facilitates precise resection and reconstruction for malignant bone tumors of limbs, resulting in improved oncological and functional outcome.
It is extremely necessary to find an ideal filling material for the treatment of benign bone defect, particularly those benign osteolytic defect in children with a comparatively large cavity. From July, 1995 to December, 1996, 10 cases of benign osteolytic bone defects were treated, in which 5 cases of benign osteolytic defects, 3 cases of bone cysts, 1 case of fibrous dysplasia of bone and 1 case of non-ossifying fibroma. After through curettage of the cavity, the natural non-organic bone in cube-shaped was used to fill the prepared cavity. The results showed that the activities of the patients resumed normal in 3 to 6 months after operation. The roentgenographic examination after operation showed that the lucent spaces between NNB cubes disappeared with obvious new bone formation and the bony cavity was obliterated with newly-formed bone. There was no recurrence of the lesion during a follow-up of 7 to 24 months. It was concluded that to treat the osteolytic defect of bone with NNB was a method of choice. The new bone formation appeared early in large amount and increased rapidly.
ObjectiveTo evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions.MethodsThe clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function.ResultsThe operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones (P<0.05).ConclusionThe treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis to treat maliganant bone tumors around the knee. MethodsBetween March 2007 and September 2014, 43 patients with malignant tumor around the knee were divided into 2 groups: 3D printing navigation templates assisting reconstruction with personalized unrestricted total knee prosthesis were used in 21 cases (trial group), and conventional tumor resection and reconstruction with hinged total knee prosthesis were used in 22 cases (control group). There was no significant difference in age, gender, tumor location, pathological diagnosis, tumor stage, diameter of tumor, disease duration, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05), which were comparable. Intraoperative length of tumor resection and blood loss were recorded and compared, and the postoperative complications and tumor recurrence were observed. The Musculoskeletal Tumor Society (MSTS) score was used to evaluate knee joint function. ResultsThe operations were completed successfully in the patients of 2 groups and postoperative pathological results were negative in tumor resection margin. All the patients were followed up 12-77 months (mean, 36.7 months). There was no significant difference in the length of tumor resection and blood loss between trial group and control group (t=1.01, P=0.32; t=-0.76, P=0.45). In trial group, the resection range and reconstruction results were consistent with preoperative computer simulation; postoperative complications happened in 2 cases (9.52%); 1 case of immunological rejection and 1 case of infection); 2 cases (9.52%) had recurrence of osteosarcoma and pulmonary metastasis at 1 year after operation. In the control group, complication occurred in 6 cases (27.27%; 2 cases of periprosthetic fractures, 2 cases of infection, 1 case of incision nonunion, and 1 case of common peroneal nerve injury); 4 cases (18.18%) had recurrence of osteosarcoma and metastasis at 1 year after operation. There was no significant difference in postoperative complication and recurrence rate between 2 groups (χ2=2.24, P=0.14;χ2=0.67, P=0.41). At last follow-up, distal femur score of tumor and proximal tibial score of tumor in trial group were significantly better than those in control group (t=4.89, P=0.00; t=3.94, P=0.00). The mean flexion and extension range of motion of the knee joint was (115.45±12.25)° in trial group and was (101.49±11.96)° in control group, showing significant difference (t=3.78, P=0.00). ConclusionThe effectiveness using 3D printing navigation templates assisting reconstruction with personalized unrestricted prosthesis for maliganant bone tumors around the knee is better than conventional tumor resection and reconstruction with hinged total knee prosthesis. It can improve the joint function better and the patients' quality of life.
Objective To compare the healing process and clinical results of bioactive glass and allogenic bone in the repair of bone defects after benign bone tumor curettage. Methods Between November 2011 and December 2012, 20 patients with benign bone tumor received bioactive glass and allogenic bone for repair of bone defects after benign bone tumor curettage. There were 17 males and 3 females, aged 9-68 years (median, 18.5 years). The mean course of disease was 3.3 months (range, 1-9 months). Pathological examination revealed that there were 7 cases of chondroblastoma, 5 cases of bone cyst, 2 cases of non-ossifying fibroma, 2 cases of enchondroma, 1 case of vascular tumor of bone, 1 case of lipoma of bone, 1 case of osteoid osteoma, and 1 case of chondromyxoid fibroma. The lesion located at the femur in 5 cases, at the tibia in 11 cases, at the humerus in 1 case, at the calcaneus in 2 cases, and at the talus in 1 case. The bioactive glass and allogenic cancellous bone were implanted in the cavity at the same time. The Musculoskeletal Tumor Society (MSTS) function evaluation score was used for evaluation of postoperative limb function. According to the imaging and clinical benefit, the healing processes of two kinds of implants were evaluated. The healing rate and healing time were compared. The distribution of the bioactive glass was divided into two layers: the layer close to host bone and the layer close to allogenic bone. The bone ingrowth time and bone resorption time in different layers were evaluated and compared. Results All cases were followed up 12-42 months (mean, 34.5 months). All incisions healed by first intention. There were no complications of wound infection or deep infection, rejection, nonunion of bone, fracture at bone graft site, and collapsing of articular surface. There was no tumor recurrence during follow-up. The mean MSTS functional score was 29.5 (range, 28-30) at last follow-up. Complete healing was observed in 11 cases and healing in 9 cases. The healing rates of two kinds of implants were both 100%. The healing time of bioactive glass and allogenic bone was (4.7±1.3) months and (5.2±1.6) months, respectively, showing no significant difference (t=-1.240, P=0.244). The bone ingrowth time and the bone absorption time were (3.6±0.9) months and (3.7±1.0) months in the layer close to host bone and were (4.2±1.3) months and (4.2±1.3) months in the layer close to allogenic bone, all showing no significant difference (t=1.785, P=0.097; t=1.476, P=0.172). Conclusion For the repair of bone defects after benign bone tumor curettage, bioactive glass can achieve satisfactory healing result and has good safety.
Objective To evaluate the applied value of group psychotherapy intervention in patients with malignant bone tumor. Methods From May 2015 to February 2016, 66 patients with malignant bone tumor were divided into the intervention group (n=30) and the control group (n=36) according to their preference. Patients in the intervention group were treated with psychological intervention and the ones in the control group were only received regular telephone follow-up guidance. The quality of life, mood, social support and other changes were collected and compared between the two groups. Results The patients’ overall health and quality of life scores, emotional function scores and Social Support Revalued Scale scores in the intervention group (75.2±21.4, 59.2±10.5, 39.20±5.60) were higher than those in the control group (68.3±14.7, 51.4±11.4, 35.30±5.30), while the patients’ Self-rating Anxiety Scale scores, Self-rating Depression Scale scores, self-blame, and retreat scores in the intervention group (39.2±8.3, 35.1±6.7, 0.29±0.22, 0.41±0.22) were lower than those in the control group (44.2±7.5, 40.9±7.7, 0.34±0.24, 0.50±0.41), and the differences were all statistically significant (P<0.05). Conclusion The implementation of group psychotherapy intervention in patients with malignant bone tumor can effectively ameliorate the patients’ negative emotions, and improve social support and coping styles status of the patients.
Objective To summarize the effect of self-setting CPC on the repair of bone defect after tumor resection in children. Methods From December 1998 to December 2006, 32 patients with benign bone tumor were treated, and the bonedefect was repaired by CPC. Among them, there were 21 males and 11 females, aged 4-14 years old (9.8 on average). The course of disease was 3-18 months. There were 12 cases of non-ossifying fibroma, 8 of bone cyst, 7 of osteoid osteoma and 5 of fibrous dysplasia. The bone defect was located in femur in 15 cases, in tibia in 8 cases, in humerus in 6 cases and in other positions in 3 cases. The range of bone defect was 2.0 cm × 1.5 cm × 1.0 cm - 10.0 cm × 5.0 cm × 4.0 cm. CPC spongiosa granules of 3-23 g were filled in 26 cases, including 3 children with pathologic fracture and internal fixation with plate, and injectable CPC of 5-20 mL was filled in 6 bone cyst cases. Results Thirty-two patients obtained heal ing by first intertion. All the patients were followed up for 12-48 months (23.5 months on average). No allergic reaction, toxicity, rash or high fever was found after operation. There was no pain or pruritus at the incisions. The X-ray films showed that the implanted CPC began to fuse with the host bone 4-9 months (7 month on average) after operation. The internal fixation was removed within 6-12 months of operation. And CPC spongiosa granules were absolutely absorbed within 8-36 months of operation. However, injectable CPC could be found 4 years after operation. The children’s l imbs could do normal exercises. Finally, bone matrix grew well and no recurrence was found. Conclusion CPC in repairing bone defect after benign bone tumor in children is a safe, economical, convenient and non-toxic method.