磷酸钙生物陶瓷在治疗手部内生软骨瘤中的临床应用

目的 探讨磷酸钙生物陶瓷(人工骨)在治疗手部内生软骨瘤中的疗效.方法 2004年10月-2008年10月,对30例手部内生软骨瘤的患者,采用病灶刮除、瘤壁烧灼、人工骨植入术进行治疗.随访内容包括肿瘤的控制、人工骨与自体骨融合情况及病理性骨折愈合情况、有无并发症等方面.结果 术后全部患者切口均I期愈合,平均随访时间为8个月,内生软骨瘤无复发及恶变,人工骨与自体骨均完全融合,无排斥或过敏等并发症发生.术后手功能恢复优良率为86.7%.结论 磷酸钙生物陶瓷是治疗手部内生软骨瘤的一种安全、可靠、实用的植骨材料.     

磷酸钙生物陶瓷在治疗手部内生软骨瘤中的临床应用

目的 探讨磷酸钙生物陶瓷(人工骨)在治疗手部内生软骨瘤中的疗效.方法 2004年10月-2008年10月,对30例手部内生软骨瘤的患者,采用病灶刮除、瘤壁烧灼、人工骨植入术进行治疗.随访内容包括肿瘤的控制、人工骨与自体骨融合情况及病理性骨折愈合情况、有无并发症等方面.结果 术后全部患者切口均I期愈合,平均随访时间为8个月,内生软骨瘤无复发及恶变,人工骨与自体骨均完全融合,无排斥或过敏等并发症发生.术后手功能恢复优良率为86.7%.结论 磷酸钙生物陶瓷是治疗手部内生软骨瘤的一种安全、可靠、实用的植骨材料.     

Maffucci综合征在功能和肿瘤方面的表现

Maffucci综合征属于先天性、非遗传性疾病,是由于中胚层发育异常而引起,表现为多发性内生软骨瘤和血管瘤,很大一部分内生软骨瘤发生了恶性变,且患者常并发多种肌肉和骨骼畸形.外科手术是该疾病功能和肿瘤并发症的主要治疗方法.     

可注射型人工骨治疗手部内生软骨瘤

目的 探讨可注射型人工骨治疗手部内生软骨瘤的疗效和优势.方法 2011年5月至2012年1月,对28例手部内生软骨瘤患者,采用肿瘤病灶刮除、瘤壁灼烧、可注射型人工骨植入的方法进行治疗.结果 术后随访3～11个月,平均5.6个月.所有患者伤口均Ⅰ期愈合,未见肿瘤复发,未发生病理骨折.人工骨基本溶解吸收,可见新生骨形成.结论 可注射型人工骨是一种治疗手部内生软骨瘤方便、安全、有效的骨移植材料.     

手部内生软骨瘤治疗进展

内生软骨瘤是手部最常见的骨肿瘤,其症状主要为病变部位的肿胀、疼痛和畸形.内生软骨瘤与软骨肉瘤的鉴别诊断较困难.内生软骨瘤的治疗方法可分为保守治疗和手术治疗.目前,对于手术辅助物使用、术后空洞的处理以及合并病理性骨折患者手术时机选择仍存在争议.该文就手部内生软骨瘤的治疗进展进行综述.     

手部单发性内生软骨瘤的临床研究

目的 探讨手部单发性内生软骨瘤的发生、治疗及疗效.方法 回顾1997-2006年间我院收治的63例手部单发性内生软骨瘤患者,均行肿物刮除术,其中43例行自体骨移植,17例行异体骨移植,3例未予植骨.结果 术后3例接受异体骨移植者伤口出现红肿,经用地塞米松治疗后,症状缓解.伤口均Ⅰ期愈合.术后随访2～10年,1例接受自体骨移植者术后复发,62例未见肿瘤复发.结论 手部单发性内生软骨瘤手术治疗效果满意;异体骨移植在手部应用应慎重.     

手部单发性内生软骨瘤的临床研究

目的 探讨手部单发性内生软骨瘤的发生、治疗及疗效.方法 回顾1997-2006年间我院收治的63例手部单发性内生软骨瘤患者,均行肿物刮除术,其中43例行自体骨移植,17例行异体骨移植,3例未予植骨.结果 术后3例接受异体骨移植者伤口出现红肿,经用地塞米松治疗后,症状缓解.伤口均Ⅰ期愈合.术后随访2～10年,1例接受自体骨移植者术后复发,62例未见肿瘤复发.结论 手部单发性内生软骨瘤手术治疗效果满意;异体骨移植在手部应用应慎重.     

单纯病灶刮除治疗手部内生软骨瘤的疗效分析

目的 探讨单纯病灶刮除治疗手部内生软骨瘤的临床疗效.方法 2004年7月至2009年12月,对13例掌、指骨内生软骨瘤患者,采用单纯病灶刮除术进行治疗.疗效评判为分别测量病灶最大处的骨骼直径、手指主动运动度,以及观察X线片改变.结果 术后随访8～37个月,平均21.3个月.所有病灶均有新骨生成及塑形,病灶最大处骨骼直径减小.手部关节功能无显著影响,手指主动运动度无明显改变.影像学结果依据手部内生软骨瘤疗效的Tordai分级,1级占84.6%(11/13),2级占15.4%(2/13),3级为0.术后均未发生病理性骨折,肿瘤无复发.结论 单纯病灶刮除治疗手部内生软骨瘤,手术操作简单、创伤小、疗效肯定,是有效的治疗方法.     

影像学检查在内生软骨瘤与Ⅰ级软骨肉瘤鉴别诊断中的价值

内生软骨瘤与Ⅰ级软骨肉瘤是常见的软骨源性肿瘤,两者病理组织学和细胞学表现相似。利用X线、CT和MRI检查的影像学征象和表现可为病理学诊断及治疗方案制定提供参考,并有助于准确鉴别诊断内生软骨瘤与Ⅰ级软骨肉瘤。该文就影像学检查在内生软骨瘤与Ⅰ级软骨肉瘤鉴别诊断中的价值作一综述。     

多孔生物陶瓷人工骨移植治疗手部内生软骨瘤

[目的]探讨多孔生物陶瓷人工骨移植治疗手部内生软骨瘤的效果.[方法]15例手部内生软骨瘤的患者,采用先刮除瘤体,然后植入多孔生物陶瓷修复骨缺损的方法治疗.平均随访时间30个月,通过影像学及手部功能评价疗效.[结果]所有患者术后均无并发症,手功能恢复良好,影像学观察发现多孔生物陶瓷与自体骨骨性愈合.其中2例可见部分多孔生物陶瓷吸收.[结论]多孔生物陶瓷治疗手部内生软骨瘤是安全、简便、有效的方法.     

Ultrasonography in sternal fractures]

Conventional radiography is the widely accepted diagnostic method in patients after the sternal trauma, but the fracture cannot always be detected. Sonography, that is not able to demonstrate deeper portions of the bone, allows imaging its cortex proximal to the transducer as an intense hyperechoic interface with distal shadowing. Its disruption as a result of the trauma can be well seen, especially in flat bones. Authors present three cases, in which sonography made with a linear 7.5 MHz transducer allowed to reveal a sternal fracture in two patients and to exclude it in another patient, what couldn't be diagnosed on the lateral chest radiograms. Authors suggest using sonography in patients after the sternal fracture, not only with negative radiography.     

Tumors of the bones of the feet: the clinicopathologic features of 150 cases.

The small bones of the feet may be affected by a full spectrum of benign and malignant processes. Essentially all tumors which may arise elsewhere in the skeletal system may also occur in the feet. Although investigators have completed exhaustive studies detailing the occurrence of tumors of the skeletal system at large, few series have adequately summarized such tumors as they occur in the small bones of the feet. A study was made of 150 consecutive cases of mass-forming tumors of the bones of the feet, which were diagnosed over a 15-year period at a major cancer center. This series confirms that the bones of the feet are affected by a full spectrum of mass-forming tumors; however, such lesions arise with an incidence that is unique to this site. The various tumors identified in this series are presented and the associated epidemiologic data are discussed. Unusual trends in incidence, apparently unique to this location, are stressed.     

Resection and reconstruction for primary sternal tumors

Radical resection can offer a definitive cure of primary malignant sternal tumors, but the surgical management may be difficult because of the local aggressiveness of these tumors and a high recurrence rate. This article describes improvements in reconstruction techniques with musculocutaneous flaps that have made coverage of wide sternal defects reliable. A rigid reinforcement of the sternum can now be achieved with titanium bars and clips after a total sternectomy. Large sternal defects are safely reconstructed with a musculocutaneous flap. The completeness of the resection and the histologic grade of the tumors are the strongest survival predictors.     

Mediastinal tracheostomy

Upper airway obstruction in primary or recurrent carcinomas of the head and neck extending into the mediastinum may demand surgical intervention despite severe technical difficulties in patients with tumors previously considered inoperable. In fact, many of these tumors may be operable and some perhaps curable. A technique has been developed based in part on our experience with previously described procedures. A preliminary sternal split is used to demonstrate the extent of the mediastinal involvement as well as to provide enhanced exposure and proximal control of the great vessels. The pectoralis major muscle is used with a generous flap of overlying skin comprising nearly half of the anterior portion of the chest. A tracheostomy is then created in a fashion similar to the placement of a cardiac valvular prosthesis by creating a circular defect in the pectoralis major flap and suturing it to the tracheal remnant. This technique offers a reasonably safe and reliable means of creating a low anterior mediastinal tracheostomy for tumors previously considered inoperable. The preliminary sternal split makes the procedure safer and easier to perform, and the use of a very large pectoralis major island flap allows for reliable closure of the resulting mediastinal and sternal defects.     

经胸骨上端行颈胸段脊柱前路手术的影像及解剖研究

目的 探讨部分切除胸骨上端行颈胸段脊柱前路手术的可行性.方法 采用100例行胸部CT检查者的胸部薄层CT影像,测量胸骨柄最窄部位及对应颈胸段椎体宽度;采用100例行颈胸段MRI检查者的颈胸段正中矢状位MRI影像,测量胸骨角及对应颈胸段椎体解剖关系.根据术前CT及MRI上测量数据进行胸骨上端截骨,对12具新鲜成人尸体标本进行模拟手术,观察颈胸段脊柱显露情况.结果 胸骨柄最窄部位宽度大于对应椎体宽度,胸骨角水平低于T3,4椎间隙.模拟手术,根据术前测量数据进行胸骨上端截骨,能够良好的显露颈胸段脊柱C7～T3,能提供足够的术野宽度进行T3及以上椎体的手术操作.结论 经前路部分切除胸骨上端是处理上胸椎病变较理想的入路.     

Re-operation of pectus excavatum

We performed surgical reconstruction on 1655 cases of deformed thoracic cage, we later operated again on 11 of these to repair postoperatively re-deformed anterior chest walls. Based on these experiences, we have concluded as follows. 1: Postoperative recurrence of funnel chest deforming is mainly due to insufficient resection of costal cartilages. In particular transection of the sternum at low levels during sternal turn-over procedure results in postoperative recurrence of depression in the upper anterior chest wall. 2: In young children who have undergone sternal turn-over procedure, the first and second costal bones and cartilages overgrow and protrude anteriorly, and in compensation their junctions to the sternum recess posteriorly. This results in a depression in the upper anterior chest wall. 3: We recommend sternal turn-over with overlapping of the sternum for repair of postoperative funnel chest deformity. Through this procedure, the extent of resection of costal cartilages can easily be determined and the depression of the anterior chest wall satisfactorily reconstructed. 4: In re-do surgery, we obtained pathological evidence confirming our clinical experience that our sternal turn-over technique does not interfere with blood circulation or development of the turned-over sternum even though the sternum is not connected to the rectus abdominus muscle pedicle, preserved internal mammary vessels, or anastomosis of the internal mammary vessels.     

Aneurysmal bone cyst of the sternum.

A very rare case of aneurysmal bone cyst of the sternum is described. Aneurysmal bone cyst is a tumorlike bone lesion occumng commonly in the metaphysis of long bones and in the vertebrae. This report is one of the very few cases in the literature of aneurysmal bone cyst of the sternum. Total resection of the tumor and reconstruction of the sternal defect using autogenous fibula are presented     

Reconstruction of anterior chest wall: a clinical analysis

Objective

To investigate the methods and clinical efficacy of reconstruction of chest defects with titanium sternal fixation system after the surgical resection of sternal tumors.

Methods

A total of 6 patients with sternal tumor who were diagnosed and underwent resection and repair of the chest wall defects by titanium plates system, from 2017.3 to 2017.11 in our hospital were reviewed. Their pathological types, surgical reconstruction methods, follow-up results were analyzed.

Results

Six cases of sternal tumor were completely resected and the sternums were reconstructed with titanium sternal fixation system. There was no operative death, postoperative chest wall deformity, abnormal breathing or complications of respiratory circulation. After 3 to 10?months of follow-up, there was no loose screw or plate exposure. Not only the thoracic appearances were good, but patients’ satisfaction was high.

Conclusions

Surgical resection is the best treatment for sternal tumors, no matter it is benign or malignant. Titanium sternal fixation system combine with other soft materials can reconstruct the chest wall well after resection, and this technique is efficient as well as easy to learn.

     

Resection of Sternal Tumors and Reconstruction of the Thorax: A Review of 15 Patients

Purpose We report our experience of resecting sternal tumors, followed by reconstruction of the skeletal and soft-tissue defects, and discuss the usefulness of sandwiched Marlex and stainless-steel mesh. Methods Fifteen patients underwent resection of a sternal tumor and chest wall reconstruction with autologous bone grafts, sandwiched Marlex and stainless-steel mesh or a titanium plate, and musculocutaneous flaps. The sternal tumors were from locally recurrent breast carcinoma in ten patients, metastasis from other organs in three, and primary chondrosarcoma in two. Results All patients were extubated without paradoxical respiration just after surgery. There was no operative mortality. A wound infection developed in the acute phase after a sandwiched Marlex and stainless-steel mesh reconstruction in one patient. A second repair with Marlex and stainless-steel mesh was required in two patients; for flail chest after an autologous bone graft in one; and following re-recurrence of breast carcinoma in another patient who had undergone a musculocutaneous flap repair. No signs of breakdown, dislodgment, severe depression, or deformity were seen in any of the six patients who underwent reconstruction with Marlex and stainless-steel mesh during a median follow-up period of 56 months. Conclusions Wide resection of sternal tumors provides good local control. Reconstruction with Marlex and stainless-steel mesh seems to be the most effective technique for repairing a wide anterior chest wall defect.     

Solitary eosinophilic granuloma of sternum

Primary bone tumors of the chest wall are uncommon, although a wide variety of both benign and malignant tumors arise within the chest wall. Among those tumors, sternal tumors are rare and usually malignant. We report an extremely rare case of eosinophilic granuloma developed in the sternum in a 30-year-old woman. She presented anterior chest pain and somewhat tender mass over the sternum. Chest roentgenogram, computed tomography scanning of the thorax, and total body bone scintigraphy revealed an isolated lytic lesion in the corpus sterni. A tru-cut biopsy of the mass exhibited the typical histologic appearance of eosinophilic granuloma. The solitary lesion was removed completely surgically. This rare condition should be kept in mind in differential diagnosis of sternal lesions.