Child ; Female ; Humans ; Polyendocrinopathies, Autoimmune ; classification ; diagnosis ; therapy ; Treatment Outcome

Objective To analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods From December 1995 to January 2003, we operated on 33 patients aging from 8 to 16 years (average 12.2 years) with diagnosis of primary malignant bone tumor of the extremities with preserving the epiphysis in the limb salvage surgery. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing sarcomas, 2 chondrosarcomas, and 2 invasive osteoblastomas. The tumors were staged clinically, 2 cases inⅠA, 2 cases inⅠB, 17 cases in ⅡA, and 12 cases inⅡB. According to the relationship between the tumor and epiphyseal plate, the metaphyseal tumors in children were classified into 3 types: 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. Serious bone defects after tumor resections were repaired with massive allograft bone transplantation, followed by internal fixation by intramedullary nails and cancellous screws. Results Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clinical data. Postoperative follow-up was 12-72 months (average 37.6 months). Recurrences were seen in 3 cases, with one local recurrence in type Ⅲ case one year after tumor resection, other 2 recurrences around the femoral vessels in typeⅡcases 15 and 30 months after the tumor resection respectively. The recurrence rate accounted for 10.3%. Amputation was performed for the cases with recurrences. But pulmonary metastasis developed and the patients died. In this cohort, 9 cases died. Five-year survival rate was 57.9%. 4 cases reported 5 complications (17.2%). No patient reported skin necrosis, hematoma, infection, rejection to the allograft, and nonunion at the end of the follow-up. According to the functional evaluation criteria of Enneking, excellent were 11 cases, good 13 cases, fair 3 cases, and poor 2 cases. The excellent or good rate was 82.8%. Conclusion The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children and adolescents guarantees the patient's satisfactory postoperative limb functional results. Preoperative effective adjuvant chemotherapy and prevention of postoperative complications deserve great attention.

[Objective]On May 12,2008,an over 8.0-magnitude earthquake occurred in Wenchuan county,Sichuan province,China.The anthor's field hospital was deployed to An county,which arrived on the 3rd day after the disaster.During the first week of the deployment,284 victims with musculoskeletal injuries received orthopedic management.The objective of this article is to highlight the experience gained by this author's medical assistance team,focusing on the orthopedic care in the early part of the post-disaster relief activities.[Method]Records of 284 patients who underwent orthopedic management were reviewed retrospectively.[Result]There were a large number of musculoskeletal injuries amongst the survivors in the acute phase of the disaster,including spinal trauma,fractures and dislocations,peripheral nerve injuries and soft tissue injuries.The average age was 49.3 years(range,11 to 92 years) with 133 men and 151 women.The patients with upper extremity fracture were 85,with lower extremity fracture 73,with spinal fracture 23,with shoulder or hip dislocation 7.The patients with hand or foot injuries,peripheral nerve injuries and soft tissue injuries were 96.Open injuries were 67,the remaining were closed injuries.Totally 131 patients recovered,and the rest were transferred to the rear hospital for further management.The X-ray postoperatively showed that 21 open fractures were reduced functionally by means of external fixator,and the shoulder or hip dislocations were reduced anatomically.The wounds with primary suture had no infection.There were no other complications.[Conclusion]Correct diagnsis of the injuries,providing scientific and resonable therapeutic measures,and correct operative indication should be emphasized for early orllopedic care.Definitive surgeries such as open reduction and internal fixation are not recommended strongly.External fixation for post-earthquake open fractures is simple and effective,allowing simple approach to wound care and transferring to rear hospital during the whole period of fixation.

Objective To evaluate the effects of various resection and reconstruction method on pain relief and function restoration for periacetabular metastatic destruction in different grade. Methods This study involved 20 patients, 11 males and 9 females, with the average age of 52 years(range, 43-82 years). The original tumor consisted of 5 renal cell carcinoma, 4 breast carcinoma, 3 lung carcinoma, 2 thyroid carcinoma, 1 prostate carcinoma, 1 rectum carcinoma and 4 unknown primary cancers. A solitary periacetabular metastatic lesion was demonstrated in 14 patients and multi-metastases were seen in 6 patients, and accompanying periacetabular pathologic fractures in 4 patients. As to the Harrington grading system for the periacetabular metastatic destruction, there were 8 grade Ⅰ, 5 grade Ⅱ, and 7 grade Ⅲ. And according to grade Ⅰ, curettage and cement packing (5 cases) as well as stability reconstruction in iliac and acetabulum (3 cases) were performed; grade Ⅱ, curettage, cement packing and total hip arthroplasty with reinforcement ring was performed; grade Ⅲ, en bolc resection of acetabular lesion and modular prosthesis reconstruction was performed. The average score was 5.4(ranged from 3 to 9) according to Tomita scoring system. The pain relief and functional recovery were investigated from the regular follow up postoperatively. Results All patients showed the improvement in pain relief and mobility postoperatively. No prosthetic dislocation, deep infection and leg length discrepancy occurred. The prosthesis or internal fixation loosening happened in 5 of 15 patients at different stage. The median survival time of all patients was 16.5 months (range from 4.2 to 63 months). 2 patients survived over 5 years, 3 over 2 years, 6 over 1 year, 6 over 6 months, and 3 less than 6 months. According to the Enneking functional scoring system, the patients were rated as excellent in 10 cases, good in 8, fair 1 and poor 1 at the 3rd month postoperatively, and for the 7 cases with grade Ⅲ, excellent 2, good 2, and poor 2. The functions of 11 patients survived one year after surgery were excellent in 3, good 4, fair 2 and poor 2. Conclusion The favorable resections and reconstructions for periacetabular metastatic destruction could lead to remarked improvement in pain relief, functional recovery and quality of life.

Objective To investigate the early effect of extracorporeal shockwave(ESW) treatment on distraction osteogenesis of rabbit tibias and its mechanism. Methods 30 adult New Zealand white rabbits were used. After osteotomy of left tibias, improved Orthofix M- 100 bone fixator was applied. After 5 days, bone lengthening of 1 cm was obtained over 10 days. Randomly the animals were divided into ESW and control groups. No ESW treatment was given to the control group. The shock wave was set at 0.54 mJ/mm2 and 1000 shots each time were applied to the central areas in the ESW group. Then the animals were divided into 3 sub- groups, and were killed respectively at 45, 60 and 75 days after osteotomy. During the process, X- ray, bone mineral density (BMD) and histological examinations were conducted for every animal. Results By X- ray and BMD measurements, we found significantly more bone mass increased in the ESW group than in the control group at 45, 60 days after operation (P

Animals ; Drug Tolerance ; Glycogen Synthase Kinase 3 ; metabolism ; Glycogen Synthase Kinase 3 beta ; Morphine ; Phosphorylation ; Rats ; Signal Transduction

Purpose To investigate epidemiology and clinical features of tumors and tumor-like lesions of the foot and ankle,as well as prognosis of malignant tumors.Methods A total of 170 patients,surgically treated for bone and soft tissue tumors of the feet and ankle between 1984 and 2009 in a tertiary referral center specializing in orthopedic oncology,were enrolled in this retrospective study.The age,gender,clinical feature,tumor types,anatomical sites,the correlation between tumor size and tumor types,and the prognosis of malignant tumor were analyzed.Results There were 91 males and 79 females,aged from 7months to 76 years (average,33.1 years).There were 51 cases of bone tumor and 119 cases of soft tissue tumor.Benign tumors commonly occurred in the second and third decades of life,with an average age of 29.54years,while most malignant tumors occurred in patients aged between 40 and 59 years,with an average age of 43.73 years.Skin lesion was a symptom implying malignance.Soft tissue tumor and benign tumor were the most common types in the foot and ankle.Giant cell tumor of the tendon sheath was the most common type among benign soft tissue tumors; subungual exostosis and enchondroma were the most common types among benign osseous tumors; while melanoma and synovial sarcoma were the most common types among malignant soft tissue lesions.Both primary and metastatic bone tumors were very rare.Forefoot was the most common site where foot and ankle tumors happened.There was no correlation between tumor size and types of soft tissue tumor,while there was a high correlation between tumor size and types of bone tumor.Among 44 patients with malignant tumor,16 patients underwent limb salvage surgery,while 28 patients underwent amputation.The mean duration of follow-up was 32.4 months.Six patients survived with no evidence of disease.The 5-year survival rate was 16.13％.Conclusion Benign and soft tissue tumors are the most common tumors in the foot and ankle.Most malignant tumors occur in patients over 40 years of age.Skin lesion is a useful symptom in diagnosing malignant tumor.Forefoot is the most common site where tumor happened.There is a high correlation between tumor size and tumor types.The prognosis of malignant tumor is very poor.

Objective To evaluate the clinical outcomes of a hovel porous β-tricalcium phosphate (β-TCP)and control allograft for the repair of lacunar bone defects caused by solitary bone cyst curettage.Methods From January 2003 to December 2008,the patients with solitary bone cyst were randomized into an experimental(55 cases)and a control(40 cases)group.The control group received particulate allograft bone as the graft material,and the experimental group received β-TCP.At 1 week,1,2,3,6,12,24,48months after surgery,a new radiographic scoring system was employed to calculate the biodegradation of bone graft and evaluate the influence of multiple factors.Histologic characteristic of the degradation process of β-TCP were also evaluated.Results All the cases were followed up for average 28.4 months.Radiographic semi-quantitative analysis revealed that the biodegradation effieiencies were not significantly difierent between β-TCP and allografts(P=0.424).Degradation percentage of the implanted β-TCP or allograft was higher in younger patients than those in the older ones.Degradation of β-TCP was significantly higher than that of allografts over 3 years after surgery(P=0.04).In the experimental group,β-TCP degradation was greater in the loose packing treatment than that in the dense packing treatment (P=0.03).Histological observation demonstrated that the process of new bone formation accompanied the degradation of β-TCP.Conclusion The interporous β-TCP could be an advantageous alternative to allografts for repair bone defects caused by bone cyst.The clinical application of β-TCP is safe and reliable,which shows better biodegradation and osteogenesis than allografts in long-term follow-up.

Objective To analyze the image and histological results of the combined use of allograft/extracorporeally frozen tumor-bearing bone and vascularized fibular flap for the reconstruction of bony defects following tumor resection,guiding clinical practice.Methods From March 2007 to June 2013,we enrolled 63 patients who had combinative biological reconstruction after bone tumor resection (11 in humerus,22 in femur,21 in tibia,4 in calcaneus).There were 36 male and 27 female in this series.The average age at time of operation was 20 years,ranging from 9 to 48 years.The follow-up ranged from 16 to 102 months with average of 48 months.We investigated the X-ray and CT images for all patients and histological findings of two patients.Patients were assessed functionally with the Musculoskeletal Tumor Society 93 score.Results Three patients with local soft tissue recurrence and one patient with infection underwent amputation.The survival of construct was 93.6％.Bone union achieved in all cases with the average MSTS score of 92.8％.Bone union ranged from 11 to 28 months in allograft group and 9 to 14 months in devitalized tumor bearing bone group.Significant difference of bone union time was found between two groups (Z=-3.638,P=0.000).Viability of the fibular grafts was verified in 58 of 63 patients (92％).Three types of images were observed in complex.Osteopenia and spongy change in fibula were found in 51 patients (81％) with stable fixation of the complex.Five complexes with failed blood supply of fibula and stable fixation revealed no density change of fibula,small amount of callous formation and relative delayed union.In seven complexes (11％) with unstable complex due to patients' incompliance,fibula reacted with dense hypertrophy and microfracture.Fusion of grafts with amount of callus was obviously observed.Union at allograft-host bone junctions occurred by residual host bone-derived external callus and fibular-derived internal callus that bridged the junction and filled the gap between abutting cortices.Callus from fibular graft was mature than that from periosteum of residual host bone.Internal repair was observed at the internal surface of the allografts.Fibula showed significant spongy changes.Conclusion Recycled tumor-bearing bone in combined with fibular flap is a reliable reconstruction as an alternative to traditional Capanna technique.The survival of the fibula is a cornerstone in success of complex reconstruction.Sponginess of fibula and internal repair of allograft compromise the intensity of complex,necessitating the strong instrumentation during reconstruction.

Objective To investigate the effects of subthalamic nucleus (STN)-deep brain stimulation (DBS) on expression of dopamine and adenosine 3'5'-monophosphate-regulated phosphor-protein(DARPP-32) and its phosphorylated proteins in corpus striatum of rat models with levodopa-induced dyskinesia. Methods The rat models of levodopa-induced dyskinesia were set up and were given STN-DBS (stimulation group). The expression of DARPP-32 and its phosphorylated proteins in corpus striatum (damage side and normal side) were detected and compared with sham-stimulation group and sham-operation group. Results There was no significant difference in the expression of DARPP-32 total protein in corpus striatum of rats with dyskinesia among three groups (P>0.05). The expression of Phosphor-Thr34-DARPP-32 protein in the damage side of corpus striatum in stimulation group was significantly lower than that in sham-stimulation group and sham-operation group (P<0.05), while the expression of Phosphor-Thr75-DARPP-32 protein in the damage side of corpus striatum in stimulation group was significantly higher than that in sham-stimulation group and sham-operation group (P<0.05). Conclusion DARPP-32 and its phosphorylated proteins play an important role in the pathogenesis of levodopa-induced dyskinesia.