Clinicopathological analysis of osteosarcoma of jaw bones

OBJECTIVES: To identify clinicopathological characteristics and prognosis of osteosarcoma of the jaw bones (JOS) and to compare the data with results of similar studies. To study the effectiveness of different treatment modalities currently available for this malignancy. SUBJECTS AND METHODS: Nineteen cases of JOS diagnosed from 1993 to 2003 were retrieved from the departmental archives. These were categorized into histopathological subtypes and graded according to the severity of the malignancies and the data analyzed. Fourteen cases were followed up and the success rate with different treatment modalities assessed. RESULTS: The mean age for JOS was 34.1 years. There were 11 mandibular lesions and eight maxillary lesions. Osteoblastic variant (53%) was the commonest histopathological subtype. High grade (grades III and IV) was more prevalent. All 14 followed up patients underwent surgical excision--five with adjuvant radiotherapy and six with adjuvant chemotherapy. Local recurrence was the commonest complication. Nine of the 14 were surviving with a survival rate of 64.2% for a median follow-up period of 5.25 years. CONCLUSIONS: JOS is a distinct group of lesions with a better prognosis if diagnosed and treated early. It does not show any ethnic variability. Existing histopathological typing and grading may not indicate the prognosis of JOS. Adjuvant chemotherapy is a better treatment modality than adjuvant radiotherapy.     

颧骨缺损不同修复重建方法和预后的回顾性分析

目的: 探讨颧骨缺损不同治疗方法的修复效果及特点。方法: 选择2012年8月至2019年8月于北京大学口腔医院口腔颌面外科就诊的颧骨缺损行修复重建的37例患者。根据颧骨缺损涉及的部位,将缺损分为四类:0类,缺损不涉及颧骨区段结构,仅为厚度(突度)变化;Ⅰ类,单个缺损位于颧骨体部或只涉及一个突起方向的缺损;Ⅱ类,单个缺损累及两个突起方向;Ⅲa类,单个缺损累及三个突起方向以上的缺损;Ⅲb类,颧骨缺损同时累及相应上颌骨的大范围缺损。统计分析各类颧骨缺损的病因、缺损时间、缺损大小及特点、采用的修复重建方式,并随访记录术后并发症等。术后CT评价颧骨突度及对称性恢复效果,进行色谱差值分析评价术后稳定效果。结果: 本组患者中,由创伤引起的颧骨缺损有25例(67.57%),肿瘤切除引起的颧骨缺损有11例(29.73%),另1例为骨发育畸形导致的颧骨缺损。19例患者行单纯自体骨移植修复,6例患者行血管化组织瓣修复,5例患者仅使用外植入物,另外7例患者使用血管化组织瓣联合外植入物修复。导航组和非导航组健、患侧颧骨突度差值中位数分别为0.45 mm(0.20~2.50 mm)和1.60 mm(0.10~2.90 mm),两组差值有统计学意义(P=0.045)。2例使用钛网结合股前外侧皮瓣修复的患者术后钛网发生明显变形或断裂,2例铸造个性化钛修复术后因感染而取出。结论: 对于无明显结构改变的颧骨缺损,可以用自体骨游离移植或异体材料修复。颧骨缺损存在骨支柱破坏、慢性炎症、口鼻腔相通或伴有明显软组织量不足时,建议带蒂颅骨骨膜瓣或血管化骨组织瓣修复。钛网可用于修复大量骨组织缺损的病例,同时建议联合血管化骨组织瓣移植修复。     

Sonographic assessment of clubfoot

PURPOSE: This study was performed to develop a standardized methodology for the sonographic assessment of clubfoot at birth and at the end of both conservative treatment and surgical correction. METHODS: Forty-two congenital clubfeet and 42 normal feet were examined sonographically in the position of spontaneous alignment and during passive manual correction. Scans along 4 planes provided information relevant to the assessment: sagittal posterior, sagittal anterior, coronal lateral, and transverse. RESULTS: Sagittal posterior sonograms demonstrated the progressive gain of dorsiflexion ability during the different steps of treatment for clubfoot. Sagittal anterior sonograms could not demonstrate the normal alignment of the navicular in clubfeet because of the bone's medial displacement. On transverse sonograms, the talar head and the medially displaced navicular may lie on the same plane, depending on the severity of the deformity. Coronal lateral sonograms provided for estimation of the relationships between the calcaneus and cuboid, which were described by the calcaneal-cuboid angle. CONCLUSIONS: Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps.     

Divergent elbow dislocation with radial shaft fracture,distal ulnar deformation,and distal radioulnar joint instability: an unclassifiable Monteggia variant

Originally described by Monteggia and later classified by Bado, elbow dislocations with concurrent radial and ulnar shaft fractures with distal radioulnar joint (DRUJ) disruption are considered operative cases with high-energy injurious etiologies. Here, we present an unclassifiable Monteggia variant fracture suffered through a high axial load mechanism in a 47-year-old female. The fracture pattern initially exhibited included a divergent elbow dislocation, a radial shaft fracture, plastic deformation of the distal ulna, and DRUJ instability. Here we describe the pattern in detail, along with definitive treatment and clinical outcome at 1 year follow-up.     

人工智能骨龄评测系统评估儿童腕骨骨龄

目的 探讨人工智能（AI）系统评测儿童腕骨骨龄的可行性。方法 回顾性分析130幅1~13岁儿童左手骨龄X线片。以3名中高年资放射科医师腕骨骨龄评测结果为参考标准,计算并对比AI系统（简称模型）及3名低年资放射科医师（医师1、2、3,简称医师）与参考标准之间腕骨骨龄和腕骨成熟度分值的均方根误差（RMSE）及平均绝对误差（MAE）;采用组内相关系数（ICC）评价模型、医师与参考标准之间评测骨龄结果的一致性;比较模型与医师间骨龄测评时间。结果 模型与参考标准之间腕骨骨龄的MAE、RMSE与医师1、2与参考标准之间MAE、RMSE差异均有统计学意义（P均<0.05）,与医师3的MAE、RMSE差异无统计学意义（P均>0.05）。模型与参考标准之间腕骨成熟度分值的MAE、RMSE与医师1、参考标准之间MAE、RMSE差异均有统计学意义（P均<0.05）,与医师2、3的MAE、RMSE差异均无统计学意义（P均>0.05）。模型与参考标准之间腕骨骨龄评测结果的ICC=0.997,医师1、2、3与参考标准之间ICC分别为0.994、0.996、0.997。模型对骨龄的测评时间均小于医师（P均<0.001）。结论 AI骨龄评测系统能够准确、快速评估儿童腕骨骨龄。     

蛇床子素与金雀异黄酮对大鼠峰值骨量影响的比较研究

研究蛇床子素（Osthole,OST）与金雀异黄酮（Genistein,GEN）对大鼠峰值骨密度与骨质量的影响。方法：采用随机分组法将36只1月龄SD雌性大鼠（125±3）g分为3组：对照组（CON,等体积蒸馏水,n=12）,蛇床子素组（OST,9mg·kg^-1d^-1i．g．,n=12）,金雀异黄酮组（GEN,10mg·kg^-1d^-1i．g．;n=12）。每周监测体重,每月用双能x射线骨密度仪（DEXA）检测全身骨密度。3个月后处死所有动物,采用酶联免疫法测定血清骨钙素（Osteocalcin,0C）和抗酒石酸性磷酸酶5b（Tartaficacid phosphatase 5b,TRACP 5b）含量,用DEXA测定股骨骨密度,用μCT分析股骨组织微结构,树脂包埋不脱钙骨组织切片技术做胫骨骨形态分析,用万能材料试验机测定股骨生物力学,称量心、肝、胃、肾、肾上腺和子宫湿重,计算器官指数,并做常规病理学检测。结果：大鼠的体重、器官指数差异无统计学意义（P〉0．05）;病理学观察未见异常发生;第1、2个月全身骨密度无明显差异（P〉0．05）,第3个月后OST组全身骨密度显著高于CON组、GEN组,上述3组中股骨骨密度与全身骨密度的变化呈相同趋势（P〈0．05）。与对照组相比,OST组、GEN组血清OC水平升高,而与CON组、GEN组相比,0ST组的TRACP5b含量下降（P〈0．05）;OST组的骨体积百分率、骨小梁厚度和骨小梁数量均高于CON组,但骨小梁分离度和模型系数均显著低于CON组（P〈0．05）,OST组与GEN组的上述指标虽未出现统计学差异（P〉0．05）,但平均值OST组高于GEN组;OST组骨小梁厚度和骨小梁数量均高于CON组、GEN组,但骨小梁分离度低于CON组、GEN组;OST组股骨最大载荷、弹性模量和屈服强度均明显高于CON组（P〈0．05）,OST组与GEN组虽未出现统计学差异（P〉0．05）,但平均值OST组高于GEN组。结论：口服蛇床子素能有效提高大鼠峰值骨量,从而?     

不同强度正弦交变电磁场对大鼠骨密度及骨形态计量学的影响

目的 ：研究50 Hz不同强度正弦交变电磁场（sinusoidal electromagnetic fields,SEMFs）对SD大鼠骨密度和骨形态计量学的影响。方法：将30只雌性SD大鼠随机分为3组：A组（正常对照组）,B组（0.1 m T磁场组）和C组（0.6 m T磁场组）。除对照组外,分别给予各磁场组每日3 h的磁场干预。实验8周后处死大鼠,用双能X线骨密度仪检测各组大鼠全身、股骨及椎体骨密度,并对左侧胫骨及椎体L4分别进行骨组织静态和动态分析评价。结果：与A组相比,B组大鼠全身、股骨和椎体骨密度显著增加;股骨和椎体骨小梁面积百分数、骨小梁数量和骨小梁宽度显著增加,骨小梁分离度明显降低;观察双标记有明显变化。C组骨小梁数目与A组相比差异有统计学意义,其余指标差异均无统计学意义。结论：50 Hz 0.1 m T磁场强度的正弦交变电磁场,能够有效增加大鼠骨密度,改善大鼠的骨组织微结构,促进骨形成。     

跟舟联合切除及趾短伸肌肌瓣置入手术治疗症状性跟舟联合的疗效分析

目的 探讨症状性跟舟联合患者跟舟联合切除及趾短伸肌肌瓣置入的手术疗效。方法 回顾性分析2016年2月-2018年3月北京同仁医院足踝外科9例(10足)症状性跟舟联合患者的临床资料。其中男6例、女3例,年龄11~63(平均30.3)岁,骨性联合2足、纤维性联合8足。患者均行跟舟联合切除及趾短伸肌肌瓣置入手术治疗,术后观察有无出现伤口感染、术区疼痛、跟舟联合复发、周围关节退变及足部畸形,比较患者手术前后疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分。结果 9例患者随访17~42个月,平均29.1个月。所有患者症状缓解,未出现伤口感染、复发、周围关节退变及后足力线异常。患者末次随访疼痛VAS为(1.50±0.97)分,较术前(4.30±1.49)分明显降低,差值3(2,3)分,差异有统计学意义(Z=2.859, P＜0.01);末次随访AOFAS评分为(90.40±7.04)分,较术前(77.30±7.66)分明显提高,差值(13.10±5.70)分,差异有统计学意义(t=7.262, P＜0.01)。所有患者对治疗结果表示满意。结论 对于症状性跟舟联合患者,保守治疗失败时可行手术治疗,跟舟联合切除后用趾短伸肌肌瓣置入可有效预防跟舟联合的复发,临床疗效肯定。