Many faces of osteosarcoma on plain radiographs

Osteosarcoma is the most common primary malignancy of bone. It is a very rare form of cancer with an annual incidence of 3:1 000 000 and so will not be seen by many surgeons. Coupled with this are the many different subtypes of this cancer that can have different appearances on imaging ranging from densely sclerotic to lytic or even cystic. They can be medullary, cortically or periosteally based. This article demonstrates the various different appearances associated with the different types of osteosarcoma which will assist surgeons in diagnosing this rare cancer.     

Human Temporal Bone Removal: The Skull Base Block Method

Objectives To describe a technique for harvesting larger temporal bone specimens from human cadavers for the training of otolaryngology residents and fellows on the various approaches to the lateral and posterolateral skull base. Design Human cadaveric anatomical study. The calvarium was excised 6 cm above the superior aspect of the ear canal. The brain and cerebellum were carefully removed, and the cranial nerves were cut sharply. Two bony cuts were performed, one in the midsagittal plane and the other in the coronal plane at the level of the optic foramen. Setting Medical school anatomy laboratory. Participants Human cadavers. Main Outcome Measures Anatomical contents of specimens and technical effort required. Results Larger temporal bone specimens containing portions of the parietal, occipital, and sphenoidal bones were consistently obtained using this technique of two bone cuts. All specimens were inspected and contained pertinent surface and skull base landmarks. Conclusions The skull base block method allows for larger temporal bone specimens using a two bone cut technique that is efficient and reproducible. These specimens have the necessary anatomical bony landmarks for studying the complexity, utility, and limitations of lateral and posterolateral approaches to the skull base, important for the education of otolaryngology residents and fellows.     

Reconstruction of Lateral Skull Base Defects with Radial Forearm Free Flaps: The Double-Layer Technique

Introduction The radial forearm flap has fallen out of favor in lateral skull base reconstruction in recent literature. However, especially when used in a double layer, a radial forearm may be able to provide the thickness of a large flap while taking advantage of the pliability for which the flap is renowned. Objective To report the results of the double-layer technique of radial forearm free flap reconstruction of lateral temporal bone defects. Design A retrospective chart review. Setting A tertiary care institution. Participants All consecutive patients who underwent lateral temporal bone resections and were reconstructed with free flaps from 2006 to 2012. Major Outcome Measures Flap success rate, complications, and rate of revision surgery. Results A total of 17 patients were identified with free flap reconstruction of the lateral skull base. Seven received reconstruction with a double-layer radial forearm flap. Reconstruction-related complications in this group included one case of facial cellulitis. The flap success rate was 100%. These results were comparable with patients who had other flaps. Conclusions The radial forearm free flap may be an effective reconstruction option for lateral temporal bone defects especially when used in the double-layer technique.     

Evaluations of guided bone regeneration in canine radius segmental defects using autologous periosteum combined with fascia lata under stable external fixation

BackgroundAlthough bone defect is one of the most common orthopaedic diseases, treatment remains a challenge and an issue of debate. Guided bone regeneration (GBR) is primarily accompanied by barrier membranes; however, optional membranes show some inherent flaws in clinical application. The purpose of this study was to observe the healing velocity and quality of repairing canine radius segmental defect using transferred autologous periosteum combined with fascia lata, which can provide better biological safety than other materials.ResultsBone union was seen in most individuals from the autologous periosteum combined with fascia lata group, within an average of 14.2 weeks. Histopathologic and SEM examinations both showed the different osteogenesis state between groups. Necropsy confirmed US findings with regard to distance of bone defects and location.ConclusionThese findings suggest that autologous periosteum combined with fascia lata is as effective as a GBR membrane, even in long tubular bone defects. With reliable biological safety, the autologous periosteum combined with fascia lata is expected to achieve increasing application in orthopaedic trauma patients.

Level of evidence

Not applicable, animal study.     

伤椎内植骨联合骨水泥强化治疗重度骨质疏松椎体压缩骨折初步疗效观察

目的 探讨椎内植骨联合骨水泥强化治疗重度骨质疏松椎体压缩骨折(SVCF)的初步疗效.方法 对非植骨组(30例)和植骨组(19例)患者手术前后疼痛程度、病变椎体前缘高度、Cobb角,以及骨水泥渗漏、邻近椎体骨折等并发症情况进行观察,并进行统计分析.结果 无肺栓塞及神经并发症发生,2组患者疼痛均明显缓解,伤椎高度和Cobb角矫正较术前明显改善,差异有统计学意义(P＜0.05).随访2～5年,平均3年2个月,骨水泥渗漏非植骨组5例,植骨组1例,邻近椎体再骨折非植骨组4例,植骨组1例.2组在骨水泥渗漏率、邻近椎体骨折发生率方面比较,差异有统计学意义(P＜0.05).结论 椎内植骨联合骨水泥强化在降低骨水泥渗漏、邻近椎体骨折发生率上具有优势,是一种较理想的治疗方法.     

胸腰椎骨折经椎弓根椎体内植骨术后伤椎愈合情况的对比

目的研究胸腰椎骨折经椎弓根植骨术后伤椎愈合的方式及影响因素。方法本次研究纳入自2011-01-2013-01诊治的74例具有完整随访结果的患者,采用经椎弓根植骨36例,同期未经椎弓根植骨38例。依据脊柱骨折负荷分享分级、笔者设计的椎体轴位9分区法明确骨折损伤程度、骨折复位及伤椎植骨情况、骨折愈合及伤椎植骨愈合情况。结果术后随访16~24个月,平均20个月。未植骨组:术后1年随访时椎体内各区形成空洞总计21.1%。植骨组:术后1年随访时椎体内各区形成空洞总计24.1%。结论胸腰椎骨折后伤椎经椎弓根植骨术中可撬拨复位塌陷及碎裂的上终板,减少髓核组织的突入发生,形成椎体内有效的可填充空腔,便于椎体内充分植骨,形成利于骨细胞爬行替代的框架结构,减少晚期上终板的塌陷及椎体内空洞的形成。