Objective To evaluate the shortterm efficacy of osteoarticular allografts in the limb salvage of the proximal tibia. Methods From 1998 to 2003, 15 patients (7 males, 8 females; aged 14-56 yr, average 33) with bone tumor of the proximal tibia underwent osteoarticular allografts, among whom 7 had progressive giant cell tumor without any previous chemotherapy; 8 had malignant tumor with previous chemotherapy, including 6 patients with osteosarocoma, 1 with spindle cell sarcoma, and 1 with malignant fibrous histiocytoma. According to the Enneking system, the patients were classified into ⅠB (7 patients), ⅡA (2 patients), and ⅡB (6 patients). All the patientsunderwent the marginal resection with an allograft (average length 12 cm, range6-16 cm) implanted. Results The follow-up for an average of 21 months (range,3-58 months) revealed that among the 8 patients with malignant tumor of the proximal tibia undergoing chemotherapy, 5 had union of the bone, 3 had no union of the bone; among the 3 patients, 2 had a complication of infection and 1 had a local recurrence. All the 3 patients underwent amputation at the lower part of the femur. According to the Mankin score, 2 patients had a perfect result, 2 good, 1 fair, and 3 poor, with a 50% effectiveness rate. Among the 7 patients with progressive giant cell tumor at the upper part of the tibia, none had infection or local recurrence, but 2 hadnonunion of the bone and 2 had joint instability, aided by the kneeaidingsystem. According to the Mankin score, 3 patients had a perfect result, 2 good,and 2 fair, with a 71% effectiveness rate. Conclusion The osteoarticular allograft of the proximal tibia has many advantages in spite of a relatively highrate of complications, and it is the limb salvage of choicefor the progressivebenign or malignant bone tumors of the proximal tibia.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.
From 1972 to 1990,121 cases of bone tumor were treated by segmental resection of tumor and followed by artifical joint re- placement. All of the prostheses were designed and manufactured by our hospital. One hundred and two cases were followed up for an average of 7.4 years and the curative rate with the affected limbs preserved was 85.28%. The indication, the advantages and disadvantages, the material and the type of artifical joints, and the assessment of functional reconstruction following operation were discussed.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.
Objective To study the operative effect and complication of the prosthesis replacement of the proximal humerus with malignant tumor. Methods From October 1998 to August 2003, the prosthesis replacement was performed to treat the proximal femur with malignant tumor in 4 patients, including 2 patients with osteosarcoma (Enneking staging,ⅡA) and 2 patients with giancell tumor of the bone (ⅡA,ⅡB). By the International Society of Limb Salvage(ISOLS) criterion, the 2 cases of osteosarcoma were preoperatively scored as 4 and 5 points, and 2 cases of giant cell tumor of the bone were scored as 9 and 11 points. The patients’ psychological conditions as well as their limb pain, shape, locality, activity, and function werealso observed. Results The follow-up for 24-58 months (mean, 44 months) showed that there was no local recurrence or infection in all the patients except onepatient who had the loosening of the screws for the fixation 17 months after operation and had no treatment. After operation, all the patients had a better postoperative extention angle from 22° to 41°(mean, 25°), bending angle from 29° to 80°（mean, 35°）, abduction angle from 5° to 28°, and circumgyrate angle from 15° to 22° in their shoulder joints. However, the shoulder joint function was still unstable to some extent and the joints had a decreased strength. By the criterion formulated by the ISOLS, the postoperative score for assessing the 2 patientswith osteosarcoma was increased by 16 points when compared with the preoperative score; the score for the 2 patients with giant cell tumor of the bone was increased by 9.5 points.Conclusion The prosthesis replacement to treat the malignant tumor of the proximal humerus is the good method of choice and has a good therapeutic result; however, there are more complications and so the method should be cautiously employed in the clinical practice.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
Objective To evaluate the effectiveness of prosthetic revision using custom-made long stem prosthesis and allograft-prosthesis composite (APC) for aseptic loosening after bone tumor resection. Methods Between January 2002 and June 2008, 14 patients with aseptic loosening after bone tumor resection were treated. There were 8 males and 6 females,aged 21-70 years (mean, 43.9 years). The locations were distal femur (8 cases), proximal femur (2 cases), and proximal tibia (4 cases). Pain of the affected l imb occurred after 6-31 years of prosthesis replacement and worsened when bearing and walking; 6 patients had shortened l imb. The functional results were assessed quantitatively according to the functional rating system of the Musculoskeletal Tumor Society (MSTS). The MSTS score was 16.36 ± 1.50 before revision. The X-ray films showed obvious prosthetic loosening and subsidence. The average time of symptom was 4.5 years (range, 3-9 years). In 7 patients having severe bone loss (the decrease of the thickness of cortical bone was more than 50%) and the prosthetic subsidence was more than 2 cm, the revision operation with the APC was performed; in 7 patients having less bone loss (the decrease of the thickness of cortical bone was less than 50%), the custom-made long stem prosthesis was performed. Results All wound healed by first intention. Two patients had temporary peroneal nerve paralysis and recovered after 3 months. All the patients were followed up 3.6 years on average (range, 2 years and 2 months-7 years) after revision. After revision, pain was rel ieved and the range of joint was improved. The MSTS score was 23.43 ± 2.56 at 12 months after revision showing significant difference when compared with the preoperative score (t=8.910, P=0.024). The X-ray films showed that lucency space l ine around stem cement in 2 patients at 12 months, and no prosthesis loosening and infection occurred. Conclusion The prosthetic revision after l imb salvage surgery with prosthesis for bone tumors was acceptable. The good functional results can be achieved by the revision with the APC or the custom-made long stem prosthesis according to the bone loss.
Objective To analyze the causes and the reoperation therapies after salvage limb surgery with prosthesis for bone tumors. Methods The retrospective analysis was performed on 85 patients undergoing the limb salvage operation with prosthetic replacement for tumors from January 1994 to December 2004. Ofthe patients, 21 (13 males and 8 females, aged 18-58 years) underwent reoperations for various reasons. All the diagnoses were pathologically confirmed(10 patients with osteosarcoma, 4 with chondrosarcoma, 5 with giant cell tumor of the bone, 2 with osteofibrosarcoma). The distal femur was involved in 9 patients, proximal tibia in 8, proximal femur in 2, proximal humerus in 1, and acetabulum in 1. According to the Enneking surgical grading system, there were 5 patients in ⅠB and 16 in ⅡB. The time between the first operation and the reoperation was 2 weeks to 20 years. The common reasons for the reoperation were tumor recurrence in 8 patients, prosthetic loosening in 5, no healing of the incision in4,joint dislocation in 3, and implant fracture in 1. The amputation and the prosthesis revision were respectively performed on 6 patients, extensive resection ofthe tumor on 3, the myo-skin flap translocation on 4, internal hemipelvectomy without reconstruction on 1, and open reduction on 1.Results The follow-up in18 patients for 1-5 years (average, 3 years and 4 months) revealed that 4 patients died of osteosarcoma with pulmonary metastasis. The other 14 patients had no tumor recurrence or loosening of the prosthesis, and the incisions healed well. The assessment on the joint function was performed on 13 of the 18 patients and the results were as follows: excellent in 2 patients, good in 5, fair in 4, and poor in 2, with a satisfaction rate of the reoperation with limb salvage of 84.6%and an excellent-good rate of 53.8%. Conclusion Tumor recurrence is the most common reason for the reoperation after the limb salvage with prosthesis for tumors, and loosening of the prosthesis is an important reason, too. By therules of the bone tumor limb savage, the limb salvage operations can also beperformed, which can achieve a satisfactory result of the limb function.
ObjectiveTo investigate the clinical outcome of application of joint prosthesis in limb salvage treatment of mildmalignant tumor at the articular ends of femurs, with severe osteolysis. Methods The treatment of 15 cases of mildmalignant tumor at the articular ends of femurs with severe bone destruction, from 1978 to 1999, was reviewed. There were 10 cases of giant-cell bone tumor and 5 cases of chondrosarcoma, among which there were 5 cases at the stage ofⅠA, 9 cases at ⅠB, and 1 case at ⅡA, with 4 cases at the proximal end and 11cases at the distal end. The tumor was totally removed, with a massive bone defect left at the foci, and then the prosthesis replacement was performed to reconstruct the articular joint. All of the 15 patients were followed up for 9 monthsto 20 years, 4 years and 3 months on average, before clinical evaluation. Results All of the wound healed well, with primary healing. Local relapse occurred in one case and the patient died of lung metastasis; the amputation of the replaced knee joint was performed in one case due to severe infection after trauma; radiograph showed there was slight sunk of the prosthesis in 2 cases after replacement. The other 11 cases recovered well with satisfactory function. Conclusion The limb salvage treatment of mildmalignant tumor at the articular ends of femurswould be available, especially for those with massive bone destruction, when the tumor is removed by whole and rationally marginal resection, followed by properlyutilization of prosthesis and general post-operative exercise.
Objective To summarize and analyze the clinical experience and theclinical outcome of treating tumorous diseases in the proximal femur by the customized hip arthroplasty. Methods Eleven patients (7 males and4 females, aged 40-69 years) with a tumorous disease in the proximal femur received a removal ofthe proximal femur and the customized hip arthroplasty from February 1994 to November 2002. Of the 11 patients, 7 had giant cell tumor in the proximal femur, 2 had chondroblastoma, 1 had osteitis deformans, and 1 had fibrous dysplasia. Six patients received the artificial total hip replacement and 5 underwent the dipolar-cup artificial femoral head prosthesis replacement. Results The follow-upfor 1-5 years in 9 patients (2 patients lost the follow-up) revealed that afteroperation one patient with hemorrhage from the incision had been given a local compression for 5 days, and finally lost the function of the quadriceps muscle and had sensory deprivation in the anterior part of the thigh. Five years later, the patient had a quadriceps muscle power of the “0” degree, a decreased sensation, the “3” degree of the hamstring and the extension and flexion muscles of the lower limb, with lameness and crutch walking. The quadriceps muscle powertest showed that 5 patients had the “3” degree of the muscle power and 2 of them had paroxysms of pain in the upper part of the thigh, especially after a long time of standing and walking, so both of them received the dipolar-cup artificial femoral head prosthesis replacement. Three patients had the “4” degree of the quadriceps muscle power, with an extension range of the hip joint of 10°27° and an average flexion degree of 74°. According to the Harris scale, 3 patientswere assessed to be good (8089), 5 moderate (70-79), but 1 bad (lt;70). No infection, recurrence or the loosening of the prosthesis was found in all the patients during the follow-up. Conclusion The customized hip arthroplasty has a goodclinical outcome in treatment of a tumorous disease in the proximal femur. However, there is a high incidence of deficiency of the quadriceps muscle power after operation, which may be relevant to the removal of the upper attachment of the quadriceps muscle. If the attachment of the quadriceps muscle, especially the internal, external and posterior septum attachment, can be fixed in the body of the prosthesis during operation, the power of the quadriceps muscle can be enhanced and the patient can have a better therapeutic effect.