Objective To investigate the clinical Results of microwave heliotherapy on the malignant bone tumors of scapula. Methods Form June 1998 to February 2008, 17 patients with malignant bone tu-mors of scapula were treated with microwave heliotherapy. There were 12 males and 5 females, 48 years old on the average (ranging from 13 to 59 years). The tumors included: the primary malignant tumor of the scapula (12 cases), the metastases of the scapula (5 cases). Locations of tumors included: the SI region (14 shape or curved nick on the surface of scapula. The lesions were heated at 50 ℃ fur 20 min at 2450 MHz microwave, with surrounding soft tissue protected by copper mesh. The necrotic tumor tissues were excised after the treatment of microwave heliotherapy. Results The axillary nerve of the patient with the metastases of the scapula was cut off, and the broken ends were sewed up after the tumor was excised. The duration of surgery was from 60 minutes to 180 minutes (120 minutes on average). The blood loss was from 300 ml to 1000 ml (460 ml on average). All patients were followed up for 3 months to 10 years (4.2 years on average). Three cases with Ewing sarcoma died due to brain metastases, pulmonary metastases or all body metastases 8 to 24 months postoperatively. Three cases with malignant fibrous histiocytoma died due to pulmonary metastases or all body metastases 10 to 22 months postoperatively. Five cases with the metastases died due to metastases 6 to 14 months postoperatively. Three patient's superduet function of shoulder joint was re-stricted. Conclusion The clinical Results demonstrated that the advantages of microwave heliotherapy in-cluded quick increase of temperature, sensitive responses, easy control of temperature, and effective inacti-vation of tumor cells in the malignant bone tumors of scapula.

Objective To explore the diagnostic value of MRI in tumor of soft tissue. Methods The MRI manifestations of 180 soft tissue tumors dating from October 2001 to August 2004 were retrospectively analyzed, they were all confirmed by pathology. All cases were examined with Picker 0.23 T MRI. Fast spin echo(FSE)T1 and T2-weighted sequences and short tau inversion recovery (STIR/TSHIRT) fat-suppressed sequences were commonly used. MR examinations were performed at least in two of coronal, sagittal, axial planes. Of 180 cases, there were 62 vascular tumors, 34 giant cell tumor of tendon sheath, 26 neural tumors, 23 lipomas, 18 fibrous tumors; 17 malignant tumors including 7 of malignant fibrous histiocytoma(MFH), 3 of malignant lymphomas, 2 of liposarcoma and one each of chondrosarcoma, myofibrosarcoma, melanoma, facial sarcoma and leiomyosarcaoma. 10 cases were of tumor-like lesions, including 2 of myositis ossificans, 8 of fat necrosis. GCT of tendon sheath (33/34 cases), hemangiomas (23/52 cases) were common in hands and feet. MFH often involved legs and upper arms(4/7 cases, 3/7 cases). The tumors in the groin were mainly malignant(4/5 cases). Results The ratio of benign to malignant tumors was 9∶1. Tumors showed isointensity or hypointensity in T1WI and hyperintensity or mainly hyperintensity but mixed signal in T2WI. The diameter of benign tumors was 1-18 cm, the malignant was 4-10 cm. The tumors were lobulated, oblong or irregular in shape. 12 invaded to bone, 28 involved to neurovascular system. Some body parts were easily involved because of different histologic component. Conclusion The MRI for soft tissue tumors is highly sensitive. The location and some characteristical signs are useful for diagnosis, whereas the size of the lesion, the degree of border smoothness and the signal intensity are not certain for the diagnosis.

Objective\ Treatment of spondylolisthesis using freeze dried femoral ring allografts plus morselled cancellous autografts (called as composite cortical ring) by anterior lumbar interbody fusion (ALIF). Methods\ Fourteen patients were treated by this procedure, there were six males and eight females. The age of the patients range from 40 to 56(average 46). Ten segments were of grade Ⅱspondylolisthesis, five segments were of gradeⅠ. Ten patients were treated with RF as internal fixation, four patients with short Harrington rod as internal fixation. Results\ The fusion rate and clinical results of ALIF were analyzed by comparing the findings on the X-ray films taken preoperatively and 6 months postoperatively as well as by JOA score. The fusion rate of 15 segments of 14 patients(two segments of 1 patient was fused) is 85.7%, the average improvement rate of JOA score is 73.3%at an average follow up of 26.6 months. Conclusion\ ALIF with composite cortical ring could successfully restore the spinal structure, maintain the interspace height distracted intraoperatively, obtain high fusion rate and excellent clinical results.\;

0.05).2)a.There was no severe side effects related to cement in 20dogs,and no pulmonary embolic necrosis was found in autopsy.Cement leakage was frequent which occupied the spinal canal no mo re than 1/4of the median sagittal dia meter without major neurological complication.The epidural leaks we re related to the vertebral morpholo gy.b.The average peak temperatures were 70.5℃at the core,53.5℃at the in terface,40.8℃at the anterior corte x,and 40.5℃in the spinal canal.The temperature above 50℃lasted for 2.9minutes at the core,and 1.3minutes at the interface.In pathological examination,necrosis of osteocytes was found focally at t he periphery of the cement,and resid ual bone in this area showed signs of acti ve remodeling.3)The procedure was technically successful in all pa-tients,with an average injection am ount of 6.3ml cement per vertebral body.No clinically significant com-plications were noted.The 3slight e pidural leaks,1slight neural foram ina leak,and 5paravertebral leaks detected with CT had no clinical importance.Partial or complete pain relief was achieved in all patients as-sociated with improved mobility,an d 1patient experienced transitory worsening of pain followed by significant pain relief.Patients with vertebra l haemangioma or compression fractu res were discharged in 1-4days(average,1.6days)after the procedure.Of the 26patien ts,22were followed up from 6to 24mon ths(average,13.5months),partial or complete pain relief were sustained in 21cases,the other one experienced relapse of pain following partial pain relief,which was related to the deterioration of the metastases.Con-clusion Minimal invasive PVP is a valuable alternative in the treatment of painfu l vertebral haemangioma,osteoporotic vertebral fractures,and osteolytic metastases or myelom a,providing acute pain relief and ea rly mobilization in appropriate patien ts.[

Objective Short-segment pedicle instrumentation for thoracolumbar burst fracture was known to have a relatively high incidence of failure and correction loss, intracorporeal gap secondary to reduction being probable causes. The purpose of this study was to evaluate the intracorporeal gap after reduction and the biomechanical effect of vertebroplasty on thoracolumbar burst fractures. Methods Six fresh adult thoracolumbar specimens were collected, and 10 segmental specimens (T11-L1, L2-L4, T12-L2) were processed. Burst fracture was created using free-drop test. Then the fractures were reduced and augmented with injectable self-setting calcium phosphate cement. The intracorporeal gap and bone mineral density(BMD) were measured using spiral CT and dual energy X-ray absorptiometry(DEXA) before fracture, after reduction and after vertebroplasty respectively. The stiffness in middle vertebrae and above discs were measured under flexion, extension, lateral flexion and torsion stress before fracture and after augmentation. The ultimate strength against compression was tested in the augmented vertebrae and the integral vertebrae below it. Results Burst fractures were created in eight of ten specimens. 1) There was no evident intracorporeal gap before fracture, which appeared after reduction with average volume of 5.25 cm3 (13.9% of total corporal volume), and it decreased to normal level after vertebroplasty. 2) The BMD was normal in all specimens before fracture, which decreased significantly after fracture reduction, and it was significantly higher after vertebroplasty than that before fracture or after reduction. 3) There was no significant difference of stiffness in vertebrae before fractures and after augmentation. The mean value of ultimate strength against compression in the augmented vertebrae decreased slightly but not significantly in contrast to the vertebrae below it. In contrast to the value before fracture, the stiffness of above discs decreased significantly under flexion and extension stress but not significantly under lateral flexion stress after augmentation, while the stiffness of the specimen decreased significantly under torsion stress. Conclusion 1) Posterior reduction in thoracolumbar burst fracture can not reestablish intact corporeal structure, which may be an important cause of postoperative implant failure and correction loss. 2) Vertebroplasty with injectable self-setting calcium phosphate cement is helpful to reestablish intact corporeal structure, and restore stiffness and strength of the injured corpora nearly to its initial value.

Objective To investigate the clinical results of percutaneous vertebroplasty(PVP) for symptomatic vertebral hemangioma. Methods Eleven patients(2 males and 9 females) suffered from symptomatic vertebral hemangioma(11 thoracic segment levels and 3 lumbar segment levels) were treated with PVP under DSA or CT guidance. The main goal of this procedure was to relieve hemangioma related pain. All patients were examined with CT scan after intervention and were followed up from 3 to 34 months (average, 15.2 months). Results The procedure was technically successful in all patients, with an average injection amount of 6.3 ml cement per vertebral body. No clinically significant complications were found. There was no epidural leakage, and the 2 paravertebral leakages detected with CT had no clinical importance. Partial or complete pain relief was achieved in all patients associated with improved mobility, and 1 patient experienced transitory worsening of pain followed by significant pain relief. Patients were discharged in 1-4 days (average, 1.5 days) after the procedure. Pain relief was sustained in all patients at the last following-up. Conclusion PVP is a valuable minimal invasive alternative procedure in treatment of symptomatic vertebral hemangioma and provides satisfactory pain relief with less complications.

Objective Lateral dislocation of the patella pulled laterally from the trochlea and across the lateral femoral condyle,was often a transient phenomenon with spontaneous reduction,diagnosis based on the results of physical examination and clinical history was difficult.The present was in an effort to explore the mechanism and definition of acute patellofemoral dislocation as well as assessment with MRI of the injury.Methods From May2001to July2002,34patients aging from11to25years with18males and16females,had a history of knee joint,28of which were experienced a twisting injury with the knee in flexion and internal rotation of femur on a fixed foot.Sagital,coronal and transverse MRI were performed with T 1 WI,T 2 WI,STIR and TSHIRT sequences.The manifestations of MRI were analyzed retrospectively,and clinical data,X-ray films,CT scan and the findings of arthroscopy were studied as well.Results All of34cases injured were found the signal intensity abnormalities of subchondral bone in the inferior medial part of patella and the anteri-or lateral part of lateral femoral condyle,which suggested that bone was injured.MRI findings of cartilage fis-sure at medial patella were found in20cases and injury of the patella retinaculum was seen at MRI in27cas-es.MRI findings revealed joint effusion in all patients,and lateral subluxation of the patella was seen at MRI in23cases.Conclusion The resultant jury on MRI findings of acute patellofemoral joint dislocation caused by a-cute impingent of patellar medial facet to lateral femoral chondyle at the various degree of flexion and rotation of the knee include the osteochondral fracture in the inferior medial part of patella,the anterior lateral part of lateral femoral condyle,the subluxation or dislocation of patella,the injury of medial patella retinaculum and the joint effusion.MRI could be helpful for the diagnosis of the disease,and demonstrate the location and ex-tent of injury on the different compartments of the involved knee.

Objective To analyze the clinical results of percutaneous vertebr oplasty (PVP) for osteolytic spinal tumor. Methods Forty patients with osteolyt ic vertebral metastases or myeloma were selected from Feb. 2000 to Jun. 2003 to undergo percutaneous vertebroplasty. All patients complained of back pain. Among them, 6 cases had radiculopathy, and 1 had paraplegia. Based on CT or MR scanni ng, the posterior vertebral wall was involved in 21 cases. 42 PVP was performed on 59 segment levels under fluoroscopic or CT guidance, including 1 at cervical spine, 29 at thoracic spine, 27 at lumbar spine and 2 at sacrum, and biopsy was performed in 28 cases simultaneously. CT scanning was conducted after interventi on to assess the lesion filling and cement leakage, and all patients were asked to remain lying on bed for 4 hours prior to axial loading. In combination with P VP, radiotherapy, chemotherapy, medicament were administered before or after the intervention. Results The procedure was technically successful in all patients with an average injection amount of 6.5 ml cement per vertebral body. Partial or complete pain relief was achieved in 39 cases, associated with improved mobilit y in 38 cases, the symptoms of patients with radiculopathy and paraplegia were u nchanged. Two cases with severe multiple vertebral destruction underwent PVP at one segment, neither of them experienced improved mobility. In one case, the sev erity of pain was unchanged, while the other experienced partial pain relief for 48 hours. Leakages were detected with CT at 21 levels of 17 cases. 2 of 7 epidu ral leakage produced transitory radicular pain, which were relieved in 6 h and 8 h respectively. 2 with intervertebral foraminal venous leakage, 8 with paravert ebral leakage, and 6 with intra-disc leakage had no clinical symptoms. 37 cases were followed up from 2 to 32 months (average, 8.5 months). Exclusive of poor re sults in 2 patients, pain relief was sustained in 29 cases, and 6 patients exper ienced relapse of pain following partial pain relief, which was related to the d eterioration of tumors. Conclusion PVP of osteolytic spinal tumors is a minimal invasive procedure that provides immediate and stable pain relief with improved mobility. It can be combined with radiotherapy or chemotherapy.

Giant cell tumour of bone is one of the most common primary musculoskeletal tumours,accounting for 10％-21％ of bengin bone tumours,which can behave like malignant tumors and have benign histologic characteristics.Giant cell tumour (GCT) of bone is classified by the World Health Organisation (WHO) as a benign but locally aggressive tumour.Intralesional excision and wide resection may be helpful in operative treatment for GCT.However,there are limitations with these options in spite of the use of adjuvant therapy.For instance,intralesional excision had more local recurrence rate and less complications,wide resection had less local recurrence and poor functional results.Therefore,there is no widely held consensus regarding the ideal treatment selection for all GCT patients.The purpose is to review literature reports on the morphological features of GCT of bone and existing surgical method,and discuss the relationship between morphology characteristics of GCT and the selection of surgical options and postoperative recurrence rate,in order to help oncological doctors to choose surgical method in the clinical practice.

ObjectiveTo explore the application and outcome of locking compression plate in the treatment of unstable distal radius fracture.Methods From January 2006 to December 2008,eighty-two patients with consecutive unstable distal radius fractures were preformed with open reduction and locking compression plate fixation by volar, dorsal or bilateral approaches. There were 31 males (bilateral fractures in two patients) and 49 females with an average age of 51 years (range, 17-74 years).According to AO/OTA criterion, there were seven patientswith type A3 fractures, four with type B 1, 12with type B2, 10 with type B3, 16 with type C1, 21 with type C2 and 12 with type C3. The locking plate fixations through simple volar approach was performed in 61 patients, fixations through dorsal approach in 12, volar 1/3 radius cylindrical steel plate fixation through volar and dorsal approach in five, bilateral fixations through volar and dorsal approaches in four. Furthermore, the external fixator was used in 19 patients, fixation of the ulna fractures in seven, and bone graft in 39. ResultsThe patients were followed up for average 20.7 months ( range, 1-4 years), which showed postoperative complications including bubble appearing around the incision in three patients, infection in one, median nerve injury in three, screws penetrating into extensor compartment in four, threads penetrating into radiocarpal joint because of reduction loss in two, rejection in one and traumatic arthritis in seven. According to the Cooney criterion, the result was excellent in 56 pateints, good in 19, fair in six and poor in one, with excellence rate of 91％. Conclusions The locking compression plate can provide firm fixation and allow early functional exercise and hence is suitable for unstable distal radius fracture especially the osteoporosis patients with comminuted compression fracture.