With the rapid development of omics and big data technology, there have been multiple achievements with the use of pre-cision medicine for cancer treatment. Osteosarcoma, the most common primary malignant tumor of the skeletal system, primarily oc-curs in children and adolescents. Since the 1970s, surgical resection and chemotherapy have been the main treatments for osteosarco-ma; however, the survival rate for this type of cancer has been stagnant due to high genetic heterogeneity. Precision medicine can pro-vide a precise diagnosis and tailored treatments based on the patients’biological characteristics using techniques such as omics. Therefore, application of precision medicine is promising for studying osteosarcoma and improving patient survival rates. This study aims to systematically review the progress of precision medicine in advancing osteosarcoma treatment. In addition, it discusses the prospects and future direction of osteosarcoma precision treatment.

Objective Investigate the surgical resection,reconstruction technique and follow-up of partly defect by primary bone malignancy in acetabulum.Methods Retrospective analysis 20 cases clinical data of partly defect by primary bone malignancy in acetabulum patients from January 2009 to January 2015.Resect the tumor and reconstruct the acetabulum based on the type of acetabulum tumor:type A,excise pubis and partial acetabulum,use self-femoral-head transplantation and pelvis reconstruct steels to reconstruct the bone defection of acetabulum leading edge,then transplant biological type acetabular cup;type B,excise ischium and trailing edge of acetabulum,transplant self-femoral-head and fixed with cancellous screw,for those can't maintain the acetabulum stabilization,apply acetabulum enhance ring to immobilize;type C,excise partial ilium and acetabulum superior margo to interrupt its discontinuity,self-femoral-head transplant to reconstruct acetabulum,then use enhance ring and cemented cup to rebuild hip joint.Results Total 20 cases,13 males and 7 females;the age ranges 23-69 years old,average 48 years;followed up 13-56 months,mean 34 months.Pathology types:17 cases of chondrosarcoma and 3 cases of malignant bone giant cell tumor.After surgery,3 cases of chondrosarcoma recurred (15％),1 case of malignant bone giant cell tumor relapsed and developed to pulmonary metastasis.2 cases of acetabulum prosthesis incipient dislocation performed closed replacement then fixed 6 weeks with hip joint brace.1 cases of prosthesis losing performed hip joint revision.1 case occurred deep hip infection,which performed debridement and taking out prosthesis.2 cases self-femoral-head transplant and biological total hip replacement healed well.Postoperative functional MSTS 93 score showed excellent in 13 cases,good in 6 cases,poor in 1 case.Conclusion According to the tumor type and range,determine the resection method and boundary,which is the key to acquire well oncological prognosis.On the premise of sufficient tumor resection,reconstruct function individually based on the type of acetabulum tumor,which is the key to acquire well functional prognosis and prosthesis survival rate.

Objective Create patient-derived xenograft (PDX) model of bone and soft tissue sarcoma,and analyze the success rate of PDX model,observe the effects of chemotherapy on PDX models and its coincidence,and provide a theoretical basis for screening sensitive second and third line drugs.Methods Collected 31 cases of bone and soft tissue sarcoma from January 2015 to May 2016,which included 12 male and 19 female,with an average age of (28.5±19.9) y.The tumor tissue was obtained the day of operation,and it was cut into 2 mm3 pieces and injected into the flank of BAL B/C nude mice or SCID mice.Tumor was passaged when the diameter reached 1-2 cm and the P0 tissue was froze.If there was no obvious tumor mass grows out for 3 months,the model creation will be stopped.We inoculated the mice with patients sample with or without chemotherapy,observed the effect of chemotherapy on the success rate of PDX modeling and the success rate of modeling of different pathological types,and also observed the relationship between the success rate of PDX modeling and the prognosis of patients.For the drug sensitivity test,3 mice was used in each group,and chemotherapy was given,T/C was used to evaluate the inhibition ratio after drug treatment.Results 31 PDX models were inoculated.The total success rate is 45.2％.Pathology of the PDX models and their success rates:24 osteosarcoma models,success rate is 37％;2 leiomyosarcoma models,success rate is 100％;2 chondrosarcoma models,success rate is 50％;1 Ewing sarcoma model successed;1 fibrosarcoma model and 1 synovial sarcoma model,were not successed.Post chemotherapy model success rate is 33％ (4/12),compared with 53％(10/19) of model success rate that without chemotherapy.And there is relationship between success rate of PDX model creation and patient outcome.The faster the PDX model creation,the worse the outcome.The drug sensitivity of PDX model coincides the clinical situation.Conclusion The success rate of creating PDX model of bone and soft tissue sarcoma is around 30％-40％,and it is related to the pathology and whether got chemotherapy or not,PDX models coincide sarcomas clinical situation,and it is hopefully to use PDX model in selecting personalized drugs.

Objective To evaluate the effectiveness of ultrasound (US) volume navigation technology in guiding the lum?bar transforaminal puncture with full?endoscopic technique through posterolateral approach. Methods From June 2011 to June 2013, 60 patients (37 males and 23 females;mean age:32.9 years) with single?level lumbar disc herniation who had undergone lumbar transforaminal puncture with full?endoscopic technique through posterolateral approach were enrolled in this retrospective study, and they were randomly divided into 2 groups according to whether the assistance of ultrasound volume navigation technolo?gy was used. They received the minimally invasive surgery on L4, 5 (47 cases) and L5S1 (13 cases). In the US?guidance group (29 cas?es), ultrasound volume navigation was used to guide puncture process, and in the C?arm guided group (31 cases), C?arm was ap?plied to guide the puncture process The total puncture time and C?arm fluoroscopy times were recorded. Parameters including Os?westry disability index (ODI) and visual analogue scale (VAS) were selected to evaluate the clinical efficacy. Results Patients had no obvious discomfort during the puncture procedure and no postoperative complications. In US?guidance group, the preopera?tive time was 13.7 ± 2.1 min (range, 11-16 min), and the whole process took 20.6 ± 3.1 min (range, 16-28 min), while the average time of C?arm exposure were 4.9 ± 0.8 times (range, 4-7 times). In C?arm guided group, the average time for puncture procedure was 27.9±1.7 min (range, 25-32 min), and the average times of C?arm exposure were 14.3±1.2 times (range, 13-17 times). There were significant differences between two groups. Compared with C?arm guided group, US?guidance group had the same accuracy rate of puncture (the puncture needles all reached the target area), but the fluoroscopy times and puncture timewere decreased sig?nificantly. There’s no significant difference among the pre and postoperative ODI and VAS indexes. Patients were followed?up at 3 months and 1 year postoperation. The mean follow?up period was 16.4 months (range, 12-26 months). The ODI score of the US?guidance group were 72.9%±5.9%, 17.1%±3.6%and 15.9%±3.3%before operation, 3 months postoperation and 1 year postopera?tion respectively. The ODI score of the C?arm guided group were 73.2%±4.9%, 17.3%±3.3%and 16.1%±2.9%respectively. The VAS were 7.4±0.9, 2.2±0.7 and 1.9±0.8 in US?guidance group, and were 7.2±0.9, 2.1±0.7, 1.8±0.8 in C?arm guided group. Con?clusion The ultrasound volume navigation can guide the lumbar transforaminal puncture with full?endoscopic technique through posterolateral approach accurately, reducing the puncture time and the amount of X?ray radiation significantly. Its puncture accura?cy and efficacy have no significant differences, which could be broadly used in clinical application.

BACKGROUND:There is no effective treatment for muscle atrophy caused by peripheral nerve damage. Skeletal muscle cel s, a structural unit of muscle contraction, can be used for studies on muscle atrophy when cultured in vitro.
OBJECTIVE:To investigate the promotion effect of neuron-secreted factors on the growth of skeletal muscle cel s in vitro.
METHODS:Skeletal muscle cel s primary cultured in vitro were divided into two groups:experimental group with neuron-secreted factors, and control group with common culture medium, respectively. Afterwards, the number of skeletal muscle cel s and expression level of alpha actin were detected by hematoxylin-eosin staining and immunohistochemical staining, respectively.
RESULTS AND CONCLUSION:The number of skeletal muscle cel s and expression level of alpha actin in the experimental group were significantly higher than those in the control group (P<0.05). In conclusion, neuron-secreted factors have the ability of promoting the growth of skeletal muscle cel s and may be helpful for denervated muscle atrophy.

BACKGROUND:It has been an urgent problem of how to promote cartilage repair of the knee and shorten the total course through a tissue engineering approach. Fortunately, microfracture plus stem cel transplantation may open up a new path for this issue. OBJECTIVE:To investigate the clinic feasibility of arthroscopic microfracture technique plus stem cel transplantation for repair of articular cartilage injury of the knee. METHODS:From October 2010 to March 2012, a total of 16 patients with articular cartilage injury of the knee were enrol ed, including 12 males and 4 females, with the average age of 38.6 years (16-52). Al cases of cartilage injury were confirmed by arthroscopy. Autologous bone marrow was extracted from patients at 2 weeks before treatment to isolate, culture and amplify bone marrow mesenchymal stem cel s in vitro. The cel culture solution of 3-5 mL (about 107 cel s) was harvested. The articular cavity was clean by arthroscopy and microfracture technique was performed at the area of cartilage injury that was then covered with hemostatic gauze through a minimal y invasive incision and the prepared bone marrow mesenchymal stem cel s were injected. The knee was bandaged with the elastic bandage after aspirating the joint cavity effusion by vacuum suction. Functional exercises were performed early by CPM.RESULTS AND CONCLUSION:After fol ow-up of 4-18 months, there were 13 cases of excel ent, 2 cases of valid and 1 case of ineffective. According to Lysholm knee scores, the average scores were improved from 42 points (33-67 points) to 89 points (75-99 points) at 4 weeks after treatment. The function was satisfied and al patients were fol owed up without recurrence or worse. Under the arthroscopy, the combination of microfracture technique and autologous bone marrow mesenchymal stem cel transplantation is proved to be effective for articular cartilage injury of the knee and it can notably improve the clinic symptoms and recover the function of the knee.

Objective To investigate the surgical indication,approach,resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving high level (S1,S2).Methods 5 cases of primary malignant sacral tumors treated by total sacrectomy via posterior approach and iliolumbar reconstruction from March 2010 to March 2011 were analyzed retrospectively.There were 3 males and 2 females.The mean age was 41,ranging from 32 to 55.The imageology examination showed osteolytic destruction,among which there were 4 cases of obvious soft tissue mass,1 case of obvious sacral foramina expansion with bone damage.MRI showed 1 case of the tumors in S1-S5,1 case of the tumors in S1 、S2,1 case of the tumors in S1-S3.The smallest tumor was 9.2 cm×7.6 cm×4.1 cm,while the largest was 22.0 cm× 19.0 cm× 16.0 cm.Preoperative TTNB were done on the 5 patients.Pathological diagnosis:2 cases of chordoma,1 case of malignant neurilemmoma,1 case of chondrosarcoma and 1 case of malignant hemangioendothelioma.5 patients had sacrococcygeal pain or lumbocrural pain before the surgery.Visual analogue scale (VAS):2 cases of 2,2 cases of 6 and 1 case of 8.Ilium stability reconstructions were all performed on 5 patients with spine pedicle screw-rod system.Results The mean operation time was 6.5 hours (range,4.5-11 hours),with the mean intraoperative blood loss of 3 700 ml (range,2 000-7 200 ml).There was no perioperative death.The mean follow-up time was 17 months (range,9-23 months).There were 2 cases of wound complications 2 weeks after surgery and healed by second intention with washing and drainage after debridement.There was no deep infection.1 case of rectal injury,which was performed with colostomy during the operation,and stoma returned 12 weeks after surgery.4 cases of sciatic nerve symptom of lower limbs and plantar flexion dyskinesia after bilateral S1 nerve roots resection.The patients walked with ankle brace fixed after the surgery.There was 1 case of implant breakage and no obvious spine down.5 patients had functional disability in sphincter after surgery.1 case of hemangioendothelioma recurred locally 9 months later.Local radiotherapy was performed since there was no reoperation indication.The patient is currently on the 13th month follow-up and survives with tumors.Compared with combined approach,the selection of posterior approach alone has relatively strict surgery indications.Conclusion Total sacrectomy via posterior approach is an effective way to treat the primary high-level malignant sacral tumors.The good surgical resection boundary is important to achieve the good oncology prognosis.The occurrence rate of postoperative complication is high,which has great influence on patients' postoperative neurological function.

Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.

Objective To explore clinical and radiographic outcomes of unstable distal clavicle fractures (Neer ⅡB) fixed with lateral clavicle anatomic locking compression plate (LCP).Methods Between January 2009 and October 2010,eleven consecutive patients with unstable fractures of the distal clavicle (Neer ⅡB) were treated using lateral clavicle anatomic LCP.There were 9 men and 2 women,with the mean age of 37.2 years (range,23-43 years).The right shoulder was involved in 6 patients and the left in 5 patients.The interval between injuries to operation was 24-72 h (mean,48 h).After fracture reduction,the plate was place on superior of the distal clavicle.According to the distal fragment length,3 to 6 locking screws were carefully inserted,3 locking screws were used to fix proximal fractures.Coracoclavicular ligament was not repaired.Functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) rating scale score.Plain radiographs of clavicles were used to assess bony union.Results All the patients were followed up for 9 to 12 months (mean,10.3 months).Solid bony union was eventually achieved in all patients.The mean ASES scores were 89.1 (range,84-91) on the injured side versus 96.2 (range,94-100) on the contralateral side.No implant-related fracture,fixation failure and rotator cuff injury occurred.Conclusion Lateral clavicle anatomic LCP fixation in the treatment of distal clavicular fractures is a reliable and simple technique.

Objective To discuss the relations between optimal surgical margin and local recurrence and the impact of preserving segment of sacral nerve root on neural functions based on the clinical and pathological features of giant cell tumor(GCT).Methods From August 1996 to August 2008,48 patients with sacral GCT undergoing tumor resection were respectively analyzed,including 20 males and 28 females with an average of 34.7 years(range,19-74).The tumors were located in S1-S5 in 4 patients,S1-S4 in 7,S1-S3 in 15,S1,2 in 12,S2-S5 in 8,and S3-S5 in 2.Surgical methods included single posterior approach in 29 cases,combined anterior-posterior approach in 19.The surgical margins adopted were en-bloc in 2 patients,marginal in 15,marginal and curettage in 25,and curettage in 9.Results Forty-one of 48 cases were successfully followed up,the average time was 43.5 months(range,18-115).The average blood loss during surgery was 3560 ml(range,550-12 000).Benign lung metastasis occurred in one case 6 years after operation,2 patients died of malignant transformation.Local recurrence occurred in 15 cases.The recurrence rates in patients with en-bloc resection,marginal resection,marginal resection combined with curettage,and curettage were 0,18.2%,40.9%,66.7%,respectively.The recurrence rate of marginal group was significantly lower than that of the curettage group.Of 27 cases with bilateral S3 nerve root preservation,2 sufiered from urine or fetal dysfunction.with an incidence rate of 7.4%.While 4 of 12 patients with unilateral S3 nerve root preservation suffered from sphincter disturbance,with an incidence rate of 33.3%.The significant difference between groups in nerve root preservation was confirmed.Conclusion Optimal surgical margin for sacral GCT is of great importance to local control of tumor recurrence,the surgical procedure of sacral GCT should aim at the marginal resection on the basis of rational sacral nerve roots preservation;preservation of bilateral S3 nerve roots contributes to the recovery of sphincteral function in most patients.