长骨病理性骨折56例手术治疗体会

1995年 2月～ 2 0 0 0年 2月 ,我院骨科手术治疗长骨病理性骨折患者 5 6例 ,现报告如下。一般资料 :本组男 33例 ,女 2 3例 ;年龄 16～ 6 9岁 ,平均 2 4岁。均为一个长骨病理性骨折。骨折位于股骨 35例 ,胫骨 11例 ,肱骨 7例 ,桡骨 3例。病因 :良性骨肿瘤及瘤样病变 30例 (骨巨细胞瘤 14例 ,孤立性骨囊肿 8例 ,非骨化性纤维瘤 3例 ,骨纤维异样增殖症 5例 ) ,恶性肿瘤 2 6例 (骨肉瘤 16例 ,骨转移瘤 4例 ,纤维肉瘤 2例 ,软骨肉瘤 3例 ,尤文肉瘤 1例 )。5 6例患者之诊断均经术后病理检查证实 ,均为闭合性骨折。手术方法 :良性骨肿瘤和瘤样病损…     

骨恶性肿瘤的心理护理

1998～2001年,我院共收治骨恶性肿瘤患者150例,取得了满意的效果。现报告如下。 临床资料:本组男132例,女18例;平均年龄18.3岁。骨肉瘤83例,尤文氏瘤19例,软骨肉瘤20例,骨巨细胞瘤5例,其他骨转移瘤23例。肺转移118例,骨转移32例。     

异体骨移植与人工假体治疗骨巨细胞瘤的疗效比较(附56例报告)

56例骨巨细胞瘤患者，瘤段切除后分别采用异体骨移植与人工假体治疗并作随访。认为两种手术方法都能有效减少骨巨细胞瘤的复发。〈30岁者较适于采用异体骨移植术，而假体置换术更适用于≥30岁者及肿瘤破坏严重者。     

组配式假体治疗侵袭性骨肿瘤的临床疗效

目的评价组配式假体在侵袭性骨肿瘤治疗中的临床效果。方法对63例经病理确诊侵袭性骨肿瘤患者采用瘤段截除、物理及化学灭活、组配式假体植入进行保肢,其中肱骨近端假体13例,股骨近端假体5例,股骨远端假体20例,胫骨近端假体18例,人工半骨盆假体4例,定制肩胛骨1例。结果术后24 h临床死亡1例,61例随访13~72个月,Ennecking评分系统对于骨与软组织肿瘤术后肢体功能评定标准进行功能评价。61例评分结果中优27例,良24例,可6例,差4例,优良率83.6%.结论组配式假体在侵袭性骨肿瘤保肢治疗中效果可靠,不但保留肢体完整外观还在很大程度上保留患肢的功能。     

瘤段切除,带血管蒂自体腓骨移植术治疗骨肿瘤4例报告

1988年以来,我们采用显微外科技术对4例骨肿瘤患者施行瘤段切除、带血管蒂自体腓骨移植术,获得满意效果。1.一般资料:本组男3例,女1例;年龄为18～39岁;包括肱骨近段骨肉瘤、骨巨细胞瘤、胫骨纤维异样增殖症、腓骨下端骨巨细胞瘤各1例。2.手术方法与结果:手术分两组进行,瘤段切除为甲组,游离切取腓骨为乙组。甲组按术前拟定的瘤段切除范围和备吻接的血管逐层显露瘤体。要求瘤体周围保留1～     

骨肉瘤的分类

在骨肿瘤中,55.7%为良性,27.7%为恶性。在原发恶性骨肿瘤中,骨肉瘤(OS)占44.6%,软骨肉瘤占14.2%,纤维肉瘤占6.6%,骨髓瘤占6%,尤文氏瘤占4.6%。骨肉瘤和原发性骨肿瘤好发年龄为11～30岁。以股骨和胫骨多见,占51.3%。次为肱骨、骨盆、颌骨和椎骨。     

软骨肉瘤

骨恶性肿瘤中以骨肉瘤最为常见,软骨肉瘤发病率决于骨肉瘤,且易被误诊为骨肉瘤或其它良性骨肿瘤。若误诊为良性肿瘤,则不能及时给予彻底的手术处理,延误早期治疗的时机;误诊为骨肉瘤,能导致无原则的放弃治疗。实际上软骨肉瘤早期一般无远处转移,若早期给予适当处理,预后较骨肉瘤为佳,故对本病正确诊断具有实际意义。今将我院从1952年—1963年诊治的10例软骨肉瘤介绍如下,以供参考。     

MMP-2和VEGF在骨软骨瘤、骨巨细胞瘤和骨肉瘤组织中的表达及临床意义

目的 探讨基质金属蛋白酶2(MMP-2)及血管内皮生长因子(VEGF)在软骨瘤、骨巨细胞瘤和骨肉瘤组织中的表达及临床意义.方法 采用免疫组化法检测MMP-2和VEGF在骨软骨瘤、骨巨细胞瘤和骨肉瘤组织各20例中的表达,并分析其与年龄、性别和复发、转移等因素的关系.结果 VEGF和MMP-2在骨巨细胞瘤和骨肉瘤组的阳性表达率(60%,70%;90%,80%)明显高于软骨瘤组(25%,30%)(P<0.05,P<0.01),且两者的表达有显著正相关性(P<0.05).MMP-2和VEGF的阳性表达与复发和转移显著相关(P<0.05,P<0.01),与年龄和性别无关.结论 MMP-2和VEGF可作为骨巨细胞瘤和骨肉瘤的预后指标.     

髋臼加强环联合全髋关节置换术治疗髋臼周围肿瘤的临床回顾

目的回顾分析13例髋臼周围肿瘤行手术切除,应用髋臼加强环联合全髋关节置换术重建髋关节的临床疗效。方法13例髋臼周围肿瘤患者,其中骨肉瘤1例,软骨肉瘤3例,腺泡状软组织肉瘤1例,骨巨细胞瘤3例,恶性纤维组织细胞瘤2例,转移性肿瘤3例。手术切除髋臼肿瘤,使用髋臼加强环联合全髋关节置换重建髋关节,均使用生物性股骨假体。其中8例行S-P入路,5例行髋关节前外侧入路。术后对患者进行随访。按Enneking（MSTS）术后功能评分标准进行功能评估。结果随访5～26个月,平均18．3个月,2例于术后3个月和6个月局部复发,1例术后4个月出现肺转移,其余患者髋关节功能恢复良好,均无瘤生存,且无全身及局部并发症。术后下肢功能优良率84％。结论髋臼加强环作为髋臼周围肿瘤切除术后重建的一种方式,术前严格判断使用指征,手术创伤相对较小、失血少,短期随访可获得良好的髋关节功能。     

人工髋关节置换术后股骨假体周围骨折9例治疗分析

目的分析人工髋关节置换术后股骨假体周围骨折的病因、治疗方法和效果。方法回顾分析9例人工髋关节置换术后股骨假体周围骨折的临床资料。其中2例非手术治疗,3例使用非骨水泥型股骨假体,1例使用骨水泥型股骨假体,3例使用植骨和记忆合金环抱器。结果 2例非手术治疗骨折者1例未愈合,1例愈合,7例手术治疗者骨折全部愈合。结论假体稳定的A型骨折可以非手术治疗,B2型骨折使用非骨水泥柄假体,B1型和C型骨折使用植骨和记忆合金环抱器。     

Neoplastic heart disease -- the Muenster experience with 108 patients

BACKGROUND: Tumours of the heart are rare. Different histological subtypes are known. The most common tumour entity is benign cardiac myxoma. Malignant heart tumours are less common. Tumours originating in other organs such as the kidney may also affect the heart by tumour progression via the inferior caval vein. A large experience with surgical treatment of different types of heart tumours is presented. METHODS: Between January 1989 and April 2004, 108 patients with a heart tumour were included in a database. All patients underwent radical surgical resection, except for 2 patients who had malignant lymphoma of the heart. RESULTS: Histological findings included 78 myxomas (72.2 %), and 6 other benign cardiac tumours in 5.6 % of the patients. Primary malignant heart tumours were seen in 10 (9.2 %) and renal cell carcinoma with cardiac involvement in 6 (5.6 %) patients. Eight patients presented with tumour metastases inside the heart (7.4 %). Mean overall survival was 12.7 years for myxoma patients and 5.6 years for patients with other benign heart tumours. Patients with primary malignant heart tumours survived 5.5 years on average. CONCLUSIONS: Heart tumours are rare, but usually life-threatening. Radical surgical resection is the therapy of choice and may offer excellent long-term survival, even in cases with malignant heart tumours.     

Non-myxomatous cardiac tumours: twenty-year experience

Eighty-eight patients underwent surgery for various cardiac tumours from January 1978 to June 1998 at our Institute. Seventy-seven tumours were myxomas, 10 were non-myxomatous and one was secondary cardiac tumour. Case records of the patients with non-myxomatous primary cardiac tumours and one secondary tumour were reviewed. Six of these primary tumours were benign and four, malignant. Age of the patients ranged from 26 days to 47 years. Among patients (3 children, 8 adults) with non-myxomatous primary cardiac tumours, dyspnoea on exertion was the commonest symptom and was the cause of presentation in seven out of 11 patients. Of the eight adults, six were in New York Heart Association functional class II/III and two in class IV. Echocardiographic diagnosis was possible in all the patients. Complete excision of the tumour was possible in all benign and two of the four malignant tumours. Incomplete resection was done in the secondary tumour. Of the six benign tumours, three were rhabdomyomas and one each of fibroma, haemangioma and lipoma. The malignant tumours were one each of fibrosarcoma, angiosarcoma, unclassified sarcoma and malignant mesothelioma. The secondary tumour was a malignant thymoma. Follow-up ranged from 1 to 10 years (mean 7.2 years). Of the patients with benign tumours, four out of six are alive; one patient died on the first post-operative day and one lost to follow-up. Two of the four patients with malignant cardiac tumours died, one was lost to follow-up and one is alive two years after surgery. The patient with secondary malignant thymoma to the superior vena cava was lost to follow-up three months after an uneventful recovery from surgery.     

CASE REPORT: A hepatocellular carcinoma metastasis in the distal pancreas

Hepatocellular carcinoma is a highly malignant neoplasm. Extrahepatic metastases are found in 64% of patients with hepatocellular carcinoma. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of metastases. Pancreatic metastases are not common (<5%). A case report of a hepatocellular carcinoma with a metastasis in the distal pancreas is presented. A resection of the primary tumour and metastasis was carried out with the patient still alive 16 months after resection. This case illustrates that hepatic resection for hepatocellular carcinoma with a single local metastasis can be reasonably considered although a cure has not been established.     

Dedifferentiated chondrosarcoma—a fatal disease

Background We report on 13 patients with dedifferentiated chondrosarcomas. The mean age of the patients at diagnosis was 59.8 years. Nine patients were classified as stage IIB and four as stage III.Methods In 11/13 cases surgery was performed. Mostly, limb salvage with tumour resection and implantation of a megaprosthesis was done; three patients needed amputation or disarticulation. In one out of three patients with a pelvic tumour resection was followed by implantation of a pelvic replacement; the other two patients received tumour resection with autologous stabilisation of the pelvis. Surgical margins were wide in six patients, marginal in two and intralesional in three. Adjuvant chemotherapy was given to five patients.Results Recurrence was detected in 5/11 of the patients operated on: in two with wide, in one with marginal, and in two with intralesional resection. No recurrence was seen in 5/11 patients: in four after wide and in one after marginal resection. In one patient the stage was unknown. At follow-up 11 patients were dead of disease (DOD), one dead of unknown reason (DOU) and one alive with disease (AWD). The mean survival time was 9.7 months. Metastasis to different anatomical sites was evident after a period of 10 months.Conclusions Our results resemble those reported in the literature. DDCS is rare and is the primary malignant bone tumour with the worst prognosis. Surgery is the most important procedure, although it is unclear whether a radical resection improves the long-term results. Information regarding neoadjuvant and/or adjuvant therapy with chemotherapy is very limited.     

The multicentric epitheloid hemangioendothelioma of bone: a case example and review of the literature

Epitheloid hemangioendothelioma of bone is a rare primary bone malignancy. Diagnosis can be difficult for physicians who are not experienced with bone neoplasms. We also had difficulties in diagnosis and treatment in one of our patients with a multicentric epitheloid hemangioendothelioma involving the pelvis, left femur, and left tibia. We recommend a complete skeletal survey with magnetic resonance imaging because it can reveal previously undetected lesions on conventional radiographs. We performed an extraarticular resection of the hip joint including the spina iliaca anterior inferior, resection of the femur, and amputation of the lower leg. The femur was replaced by a modular endoprosthesis. The patient is provided with an above-knee prosthesis and is able to walk even longer distances with a cane 2 years after surgery. In our opinion it is necessary to perform a wide resection of this tumour in order to treat a patient with curative intention. Palliative radiotherapy should only be used for a non-resectable tumour or in metastatic disease. Chemotherapy is not a treatment option.     

Malignant transformation of a vestibular schwannoma after gamma knife radiosurgery

Stereotactic radiosurgery is used to treat benign tumours, but its long-term effects are not fully understood. Here we describe a vestibular schwannoma that underwent malignant transformation 6 years after gamma knife radiosurgery applied to the tumour remnant after a primary resection. Histological specimens of the original specimen did not show any atypical features. Genotyping showed a TP53 mutation in the recurrent tumour, which did not exist in the original tumour. Our results suggest that radiosurgery induced the malignant transformation, and we propose a cautious application of this treatment for benign tumours.     

Liver transplantation for malignant tumours

Despite considerable overall progress in human liver transplantation the results obtained in patients with malignant tumours have not improved significantly over the past years. One of the crucial questions in the ongoing controversial discussion remains the identification of tumour patients with the most favourable prognosis. In a consecutive series of 114 patients who received hepatic transplants for various malignant tumours of the liver and biliary tract, at least some factors could be shown to play a prognostic role. Regarding the histological type of tumour, fibrolamellar carcinoma, epitheloid haemangioendothelioma, and endocrine hepatic metastases seem to have a better long-term survival, whereas cholangiocellular carcinoma and other liver metastases had the worst outcome. In patients with primary liver or proximal bile duct cancer there was a significant influence of the pathological tumour stage at the time of transplantation: significant palliation or cure was almost essentially restricted to patients with early tumour stages as compared with advanced primary tumours and extrahepatic spread where early tumour recurrence developed in all recipients. Thus, the present concept for the treatment of malignant hepatobiliary tumours should include partial as well as total hepatectomy with subsequent liver replacement. In cases of non-resectable lesions or intrahepatic tumour recurrence following previous resection, liver transplantation offers the only chance for long-term survival.     

Primary malignant fibrous histiocytoma of the left atrium. Surgical and chemotherapeutic management.

A primary malignant fibrous histiocytoma of the left atrium was diagnosed in a 27 year old woman. After surgical excision the tumour recurred together with enlargement of the right hilar lymph nodes. The patient was then treated with nine courses of chemotherapy using a combined drug regimen. During the first course the tumour regressed, and after nine courses almost complete remission was achieved. Subsequently, the residual tumour was removed by resection of the right lung, the right hilar, paratracheal, and paraeosophageal lymph nodes and by cardiotomy with partial resection of the right and left atria and atrial septum followed by a reconstruction of the atrias. To date, more than two years after initial presentation, the patient is alive and well.     

Primary gastric non-Hodgkin's lymphoma in Finland, 1972-1977. Clinical presentation and results of treatment

During the period 1972-1977, 66 patients were treated for primary gastric non-Hodgkin's lymphoma in various hospitals in Finland. Most frequently, the disease occurred in middle-aged or old patients and had a male predominance. Clinical symptoms were non-specific. An abdominal mass was felt in 21% of the patients. Roentgenologic findings were mostly non-specific but suggested a malignant tumour. A definitive diagnosis was difficult to confirm by endoscopic examination. Forty-four patients had surgical resection, 30 patients curative resection, and 14 palliative resection, and 16 patients had only explorative laparotomy. Eighty-five per cent of the patients who had curative resection survived 5 years, compared with 15% of those who underwent palliative resection. Curative resection gave the best survival of 5 years. The stage of the disease was a very important prognostic factor: the 5-year survival was 85% for patients with stage-I disease but only 3% for those with stage-IV disease.     

Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus

Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned is replacement with a modular endoprosthesis. Little is known about clinical and radiologicial results in these rare circumstances. Between 1993 and 1997 we treated 21 patients (22 shoulders) with enlarged osteolytic destructions of the proximal humerus caused by metastatic spread or primary malignant tumours. Patients with additional involvement of the glenoid were excluded from this study. The average follow-up was 3.9 years. Every 3 months all patients were followed-up clinically and radiographically. Prior to surgery, diagnosis was established by incisional biopsy and the outcome determined the therapeutic algorithm (radiotherapy, chemotherapy, surgery). In most cases of metastatic lesions, surgery was the first treatment. According to the regional spread of the tumour, various amount of bone and soft tissues had to be removed. The distal stem of the prosthesis was inserted in a cementless way and secured to bone with two interlocking screws. The length of the diaphyseal part depended on the site of osteotomy. Soft-tissue coverage of the large implant was achieved in all patients. Early complications were lymphogenic oedema and superficial wound dehiscence. One patient developed a deep infection, which had to be managed surgically. According to the functional rating system of the Musculoskeletal Tumour Society for the upper extremity the overall results were inversely proportional to the extent of resection. None of our patients achieved unrestricted motion of the shoulder concerned. The most important finding was a proximal migration of the prosthesis causing a painful subacromial impingement, mainly a consequence of the resection of the deltoid muscle and the rotator cuff. In summary, a modular endoprosthesis cannot be recommended generally as the method of choice. If the muscular balance of the shoulder is too weak to act as a joint centralizer the endoprosthesis has no advantage over a simple diaphyseal spacer. Received: 9 July 1999 / Accepted: 23 December 1999