Object To investigate clinical features,surgical strategy and prognostic factors of bone metastasis from thyroid cancer.Methods A total of 46 patients with bone metastasis from thyroid cancer,who had undergone surgical treatment from January 1999 to July 2011 and had complete follow-up data,were enrolled in this retrospective study.There were 20 males and 26 females,aged from 40 to 87 years (average,56.87 years).Forty two (91.3％) cases of metastatic lesion located in axial skeleton,while 4 (8.7％) in limbs.The tumor histology type was well-differentiated in 35 patients and poorly differentiated in 11 cases.Nineteen patients (41.3％) had an isolated metastatic bone lesion,while other 27 patients (58.7％) had multiple lesions.Kaplan-Meier survival curve and Cox regression model were performed to identify prognostic factors among 19 factors including gender,age,tumor subtype,number of bone metastasis,site of bone metastasis,visceral metastasis,skeletal-related events,timing of metastasis,whether metastatic lesion was detected when thyroid cancer was diagnosed,whether thyroid surgery was performed,whether 131Ⅰ therapy was performed,whether chemotherapy or radiotherapy were performed,preoperative general condition (good or poor),surgical type (excisional surgery or palliative surgery),characteristics of metastatic lesion (osteolytic or mixed),intraoperative blood loss,whether measures were applied to prevent intraoperative bleeding,perioperative complications and long-term complications.Results Excisional surgery was performed in 36 patients (78.3％),while palliative surgery in other 10 patients (21.7％).The average amount of blood loss was 2603.26ml.The postoperative 5-year survival rate and 10-year survival rate were 37.3％ and 12.4％,respectively.Univariate analysis showed the significant prognostic factors include tumor subtype,number of bone metastasis,whether 131Ⅰ therapy was performed,and preoperative general condition (good or poor).Multivariate analysis showed the independent prognostic factors were number of bone metastasis (solitary or multiple) and whether 131Ⅰ therapy was performed.Conclusion For patients with bone metastasis from thyroid cancer,the prognostic factors are useful for determining indications for operation and improving treatment outcome.

[Objective]To evaluate the diagnostic strategy for bone metastasis from unknown primary. [Method]One hundred and twenty five patients with unknown primary bone metastasis were treated from June 2003 and December 2006.The distribution of bone metastasis while initial diagnosis mainly focused on spine,sacrum,pelvis,femur and humerus.The diagnostic strategy contained a series of physical examination,laboratory test,imaging study and pathological examination.[Result]The primary tumor was found in 70.4% cases,while 40% was in the lung,8% in kidney,5.6% in prostate,4.8% in liver,4% in breast,both 2.4% in thyroid and gastric,and 3.2% in other visceras.The physical examination revealed the occult primary site of the malignant tumor in only 9.6% cases.Although,43.2% patients had higher level of tumor antigen,but most of them were non-specific.Sixty percent of primary tumor was found by various imaging studies including plain radiograph,computed tomography and ultrasound.The pathological result after biopsy or operation identified or suggested the primary tumor in 66.4% cases.The one year survival rates after diagnosis were 58.57% and 22.93% in patients of bone metastasis with known and unknown origin,respectively.[Conclusion]The primary tumor can be diagnosed in most bone metastasis patients with no cancer history after careful examination,and patients will get benefit on survival time for targeted treatment.

[Objective] A retrospective study of patients with osteosarcoma in the proximal humerus was carried out to evaluate the effect of limb salvage surgery.[Methods]Thirty-eight patients received neoadjuvant chemotherapy and limb salvage were included in the study.Extraarticular or intraarticular resections of the proximal humerus were performed in 5 patients and 33 patients,respectively.The reconstructions included 31 custom-made prosthetic replacements,4 allograft prosthetic composites,1 bone cement spacer,and 2 autografts.The image files of patients receiving intraarticular resection were studied to identify tumor invasion of glenoid and deltoid muscule.[Results]Local recurrence encountered in 5 patients(13.2%)including 1 with extraarticular resection and 4 with intraarticular resection.In patients with intraarticular resection,image study revealed gleoid and deltoid muscule invasion occurred in 7 patients,of whom only 4 had local recurrence.The overall 5-year survival rate was 56.4%,and the disease-free survival rate was 40.5%.Complication rate of limb salvage surgery was 18.4%,which included two autograft bone fractures,one embolism of upper limb artery combined with radial nerve injury,and 4 shoulder joint instabilities.The functional outcomes of mean MSTS 93 score was 22.7 points(75.6%).The active external extension of shoulder joint was restricted in patients with extraarticular resection of no more than 30 degrees,and in patients with intraarticular resection of mean 45 degrees.[Conclusion]Acceptable oncological result and better function could be obtained after intraarticular resection of osteosarcoma in proximal humerus if glenoid or deltoid muscle invasion was not found on image study.Prosthetic replacement in these patients had lower complication rate,and better upper limb or hand function.

[Objective]To summary wound related complications and risk factors of sacral tumor surgery,and discuss the prevention and treatment strategy in order to decrease surgical risk and prevent the related complications.[Methods]From August 1997 to June 2008,302 patients with sacral tumors who underwent operations were retrospective studied to review complication types,risk factors and treatment strategies of complications.[Results]Wound nonunion,deep infection,cerebrospinal fluid leakage,viscera injuries and severe bleeding were the most common complications of peri-operation stage.Tumor diameters larger than 10cm,surgery and radiation history were the major risk factors of wound nonunion,deep infection and viscera injuries.Severe bleeding happened in 11 patients,and the major risk factors were tumor larger than 10cm,tumor locating at S2 or higher and en bloc surgery.Surgery and radiation history were the main reasons of cerebrospinal fluid leakage.[Conclusion]Understanding the risk factors of complications of sacral tumor surgery are helpful to judge and prevent complications after surgery.Some measures of prevention and treatment are effective to decrease the surgical risks.

[Objective] To discuss the surgical treatment strategy of spinal hemangioma.[Methods]Data on 33 patients with spinal hemangioma treated from October 1997 to October 2008 were reviewed.There were 19 females and 14 males.The average age was 54 years old.Chief complaints were pain(n=13),myelopathy(n=12),radiculopathy plus local pain(n=8).Nine patients without spinal cord and radial nerve compression underwent percutaneous vertebroplasty(PVP),and 24 patients with spinal cord and radial nerve compression,paravertebral soft tissue mass or spinal unstability were treated by operation.Anterior,anteroposterior and posterior approaches were used in 9,12,and 3 patients respectively.Transarterial embolization was done in 3 patients.[Results]No perioperative complication was observed in 9 patients after PVP,with a mean follow-up of 41 months.Pain was relieved.There was no perioperative death among the 24 patients who received operation.The blood loss during operation was 2739 ml and 1619 ml for anterior and posterior approaches,respectively(P=0.12).One case of paravertebral hematoma,one case of spinal canal hematoma,and one case of wound infection were observed in this group.Pain was relieved in 89%(17/19)of the patients.According to the Frankel Scale,the neurologic situation was improved in all the 12 patients with myelopathy.By a mean follow-up of 48 months,no internal fixation failure was seen.Tumor recurrence or growth was found in 4 patients,two had no symptoms and one underwent radiotherapy for pain.Repeated operation was performed in one patient with myelopathy.[Conclusion]Most patients with symptomatic spinal hemangioma could be treated successfully by surgery.Individual surgical plan should be made according to the reason causing symptoms and the general condition of the patient.

Objective To explore the complications of the total elbow arthroplasty after the resection of the peri-elbow tumor. Methods Between June 1998 and June 2002, eight patients underwent total elbow arthroplasty after resection of tumors, which involved 7 males and 1 female (mean age, 42.6 years; range, 22-63 years). The patients included 1 metastasis, 1 GCT, 2 MFH, 1 osteosarcoma, 1 lymphoma, 1 desmoid fibroma, and 1 synovial sarcoma. The tumors located 3 in distal humerus, and 5 in proximal ulna. For those of the distal humerus, after the resection of the tumors, the origins and the insertions of the musculi flexors, extensor, pronators and supinators were repaired as far as possible. The application of the prothesis was relatively simple, the prosthetic stem of the distal humerus was cemented, the intercondylar notch was sawn off, but both the lateral and medial epicondyles were kept, the prothesis impacted in the notch; While for those tumors located on the proximal ulna, the stem was spiraled in the intramedullary cavity, Patients were evaluated according to the Mayo Elbow Performance Score. Results All the patients were followed up at least one year or to death (mean duration, 2.5 years). Pain scores decreased from a mean of 3.6 to 2.0. Mean elbow motion from extention to flexision arc improved from 29? to 73? (range, 55?-105?). Seven cases were excellent or good (87.5%), and only one was poor (12.5%). There were none of the complications, such as infection, incision non-union and nerve injury. All patients without local recurrence as well. The X-ray didn't reveal any sign of loosening or breakage for the artificial elbow joint. Conclusion Total elbow arthroplasty after resection of tumors can decrease the pain and improve the function substantially. For metastatic tumors, this technique can be also used to alleviate symptom if there is no other good option.

Objective To study retrospectively the efficacy and complications of different surgery approaches used to treat primary spinal tumors and to discuss the surgical strategy in treating them. Methods 135 patients with primary spinal tumors had been treated between July 1998 and July 2005. The following diagnoses were made based on histopathological findings: multiple myeloma in 25 patients, giant cell tumor in 17, neurofibroma or neurilemmoma in 23, chondrosarcoma in 7, osteoblastoma in 6, aneurysmal bone cyst in 4, lymphoma in 9, eosinophilic granuloma in 6, hemangioma in 15, osteosarcoma in 3, Ewing sarcoma in 5, and other different tumors in 15. Anterior approach and posterior approach was used in 73 cases and 31 cases respectively. Posterolateral approach was used in 13 cases and combination of anterior and posterior approach was used in 18 cases. Results Pain relief was obtained in 126 of the 135 patients(93.3%). Improved neurological function was seen in 86 of 92 patients who had suffered from impaired neurological function. No severe complications were found in the follow-up period. Cerebrospinal fluid leakage was observed in 11 patients, and which was successfully treated using antibiotics therapy and raising the foot of the bed. 3 patients suffered from stress ulcer after operation, but they recovered soon after blood transfusion and anti-acid treatment. Other complications included subcutaneous emphysema (in 3 patients), superficial wound infection (in 3 patients),nerve root injury (in 2 patients), implant loosening (in 2 patients), and neurological morbidity due to surgery (in 1 patient). Conclusion When single or two adjacent vertebrae are involved by spinal tumors such as giant cell tumor and chondrosarcoma, tumor resection should be performed through combination of anterior and posterior approach. Aggressive resection based on the Tomita or WBB staging system is the treatment most likely to achieve long-term local control.

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.

Objective To culture human pituitary adenoma cells to provide some useful experimental foundations to practice pituitary adenoma cells as donor cells in the extracranial implantation. Methods Human pituitary adenoma cells obtained by operation were cultured in vitro, and their growth state was dynamically observed. Immunohistochemical staining and RIA were used to evaluate their functional status. Results The cultured pituitary adenoma cells still had secretory function in vitro. 6 cases of GH adenoma cells secreted a large amount of GH, 5 cases of PRL adenoma cells secreted a large amount of PRL, and 3 cases of pituitary adenoma cells without function could also secrete a small quantity of FSH, LH and PRL. Conclusion 14 cases of cultured human pituitary adenoma cells had secretory function in vitro, which provides the useful experimental data to perform extracranial implantation with pituitary adenoma cells as donor cells.