胸骨肿瘤切除髂骨移植胸廓重建一例

病例介绍　患者女 ,35岁。因右胸壁肿块 1年半 ,增大3周入院。胸部X线平片报告 :胸骨肿瘤。CT显示 :胸骨柄恶性肿瘤累及右侧锁骨头、前胸壁和上纵隔。检查 :右前胸壁触及 7cm× 5cm肿块 ,表面光滑 ,边界清楚 ,固定 ,无压痛 ,与皮肤无粘连。在全麻下手术 ,取T形切口 ,横切口沿锁骨下缘自左锁骨中点经胸骨上窝到右锁骨中点 ,纵切口沿胸骨正中线自胸骨上窝到第 3肋水平。切断双侧胸大肌在胸骨、锁骨、肋软骨及肋骨上的起点 ,向两侧游离肌皮瓣 ,显露肿瘤。见肿瘤大小为 7cm× 5cm× 4cm ,在剥离骨膜、切断右侧第 1、2肋间肌后 ,于第 2肋间横断…     

自体髂骨移植联合钛板胸骨重建一例

胸骨是胸廓的枢纽性成分,上部和两侧分别与锁骨及肋骨相连,在保护胸壁稳定性方面发挥重要作用。胸骨切除通常会产生大的节段性胸壁缺损,导致胸壁漂浮,必须进行胸骨重建。本文报道1例62岁胸腺鳞状细胞癌伴胸骨转移男性患者,完善相关检查,排除手术禁忌后行胸腺切除、胸骨肿瘤切除并同期行自体髂骨移植联合钛板胸骨重建术。术后随访6个月,患者呼吸运动功能正常,胸廓外观良好。     

胸骨肿瘤切除与胸骨重建

目的探讨胸骨肿瘤切除后采用医用有机玻璃重建胸骨的可行性。方法1996年7月～2005年7月,对3例胸骨肿瘤切除后患者,行胸骨重建。例1瘤体15cm×8cm×6cm,切除范围18cm×14cm;例2瘤体16cm×12cm×10cm,切除范围22cm×16cm;例3瘤体5cm×5cm×4cm,切除范围13cm×10cm。术前依据患者胸骨及相应肋骨形状,将厚3mm有机玻璃板切割成型。代胸骨宽40mm,代肋骨宽15mm,常规消毒备用,术中进一步修整塑形。代胸肋骨断端分别与相应胸肋骨断端用钢丝结扎固定。结果3例手术均成功,前胸壁外观较好,术后未发生排斥反应。例1术后追加放疗,已生存5年零3个月;例2未加放化疗,失访;例3追加化疗,已生存2年。结论医用有机玻璃硬度及稳定性好,不发生排斥反应,便于切割塑形及固定,便于消毒灭菌,可穿透X线,是重建胸骨的理想材料。     

6例原发胸壁巨大恶性肿瘤根治切除后胸廓重建

６例原发胸壁巨大恶性肿瘤根治切除后胸廓重建郭宝东，蔡宝仁，李之兴，郝光辉，徐赤宇原发性胸壁巨大恶性肿瘤，根治性手术治疗必将造成胸壁全层大块缺损。胸廓重建是一个重要问题。１９８８年５月至１９９３年４月，我们为６例原发性胸壁巨大恶性肿瘤病人进行广泛根治性...     

钛网应用于胸骨缺损修复的临床疗效分析

目的探讨钛网应用于修复胸骨缺损的可行性。方法 2012年3月～2018年12月收治的胸骨肿瘤病人9例。所有病人均在全麻下行胸骨肿瘤完整切除,并通过设计所需钛网的形状,并一期完成胸骨缺损的修复。结果无围术期死亡;手术时间130～175分钟,术中出血量100～240 ml。合并切除部分锁骨或锁骨头3例,切除局部受侵肺1例;合并胸腺切除1例,合并胸大肌肌皮瓣移植2例,其余均采用手术切口周围软组织直接缝合覆盖胸壁。术后限制肩关节活动,避免固定松动。术后5～7天拔除胸壁引流管,复查切口无感染,可见胸壁完整稳定,无胸壁浮动和反常呼吸;胸片显示钛网与骨性胸廓固定情况良好。术后发生肺部感染1例,胸腔积液1例,均予以保守治疗后痊愈。术后病理切缘阴性。结论钛网对胸骨肿瘤切除后重建胸壁塑形效果较好,手术操作简单,并发症少。     

钛板固定在心脏术后胸骨正中切口感染治疗中的应用

目的 探讨应用钛板内固定,增强胸骨稳定性,提高心脏手术后胸骨正中切口感染的临床治疗效果.方法 采用回顾性调查的方法,对26例应用钛板内固定,治疗胸骨切口感染的病例进行分析.结果 2009年1月至2011年12月应用钛板内固定治疗26例,均为慢性感染患者,感染持续时间均超过3个月.3例深部感染患者采用伤口持续负压吸引(VAC)的方法辅助创面准备.26例患者均行胸大肌肌瓣转移,无一例发生钛板感染需再次手术取出,且无一例因胸骨再次感染而需二次手术.结论 应用钛板内固定可以加强胸骨稳定性,减少局部组织渗出,提高心脏手术后胸骨正中切口感染的临床治疗效果.     

胸骨肿瘤患者全胸骨切除胸壁重建一例

患者 男，58岁。胸前区有一包块，进行性增大伴疼痛6个月。查体：胸骨中上段及旁边触及固定、边界不清、质硬的肿物，轻度压痛。胸部CT示：胸骨柄和胸骨体骨质破坏，伴巨大软组织肿块，双肺未见异常。临床诊断：胸骨肿瘤。     

锁定钛板联合重建钛板固定治疗肱骨干下1/4骨折

2007年12月～2010年12月,我科采用肱骨远端锁定加压钛板联合重建钛板内固定治疗22例肱骨干下1/4骨折患者,效果优良,报道如下。1材料与方法1.1病例资料本组22例,男16例,女6例,年龄19～61岁。均为闭合骨折;无桡神经损伤。骨折按AO分型:A3型4例,B1型6例,B2型6例,B3型3     

重建钛板治疗锁骨骨折30例

目的观察切开复位重建钛板内固定治疗锁骨骨折的疗效。方法本组30例锁骨骨折,X线片显示骨折端均有错位,全部行切开复位重建钛板内固定。结果30例均获随访,随访时间7~20个月,平均9.2个月,X线片随访显示骨折有1例钛板断裂,余全部愈合,平均愈合时间3.3个月,无感染。取内固定后无再骨折,肩无畸形、疼痛,上臂活动正常。结论重建钛板治疗锁骨骨折复位良好,固定确切,有利于患者早期进行肩关节功能锻炼,是一种值得推荐的治疗方法。     

应用钛板、钛网行胸骨柄肿瘤切除胸壁重建术13例临床分析

目的探讨胸骨柄肿瘤切除术后,应用钛板、钛网行胸壁重建术的临床效果及患者的生活质量。方法回顾性分析13例2012年1月至2016年12月期间中山医院收治的原发性、继发性胸骨柄肿瘤病例,其中男8例,女5例,中位年龄56岁(41~72岁),原发性胸骨柄肿瘤11例,纵膈肿瘤侵犯胸骨柄1例,乳腺癌转移至胸骨柄1例。行外科手术切除肿瘤后即刻应用钛板、钛网行胸壁重建修复。以欧洲五维健康量表(EQ-5D)和EQ-5D直观模拟评分量表(ED-VAS)评估患者术前、术后3个月时的生活质量,并于术后3个月拍摄CT。以Wilcoxon秩和检验进行数据分析。结果所有患者手术均顺利完成,12例围手术期无严重并发症、无死亡,切口一期愈合,术后恢复好;1例术后出现反常呼吸,予呼吸机支持,术后9 d反常呼吸消失。13例患者术后3个月的CT显示钛板、钛网无移位,无变形。均无明显上肢功能障碍。中位随访时间为25个月(7~41个月),1例软骨肉瘤患者因复发于术后11个月死亡。EQ-5D评分中疼痛或不适一项,术前为(1.85±0.80)分,术后为(1.15±0.38)分,差异具有统计学意义(P=0.013)。其余4个维度手术前、后得分差异无统计学意义(P>0.05)。术前EQ-5D问卷总分为(7.08±2.02)分,术后为(5.45±0.52)分,差异具有统计学意义(P=0.010)。术前ED-VAS得分(85.69±7.58)分,术后为(92.54±2.53)分,差异具有统计学意义(P=0.008)。结论钛板、钛网应用于胸骨柄肿瘤切除即刻胸壁重建,是安全有效的方法,可提高患者生活质量。     

Using a bioabsorbable copolymer plate for chest wall reconstruction

Reconstruction of the chest wall in a child is an uncommon problem for pediatric surgeons. The available material for chest wall reconstruction typically has been borrowed from the adult experience. The authors describe their recent experience with a commercially available bioabsorbable plate in a variety of conditions that require chest wall reconstruction.     

Novel titanium constructs for chest wall reconstruction in children

Purpose

We have previously reported the use of the vertical expandable prosthetic titanium rib (VEPTR) for treatment of thoracic dystrophy. This report describes our experience with this device and other novel titanium constructs for chest wall reconstruction.

Methods

This is a retrospective chart review of all children and adolescents undergoing chest wall reconstruction with titanium constructs between December 2005 and May 2010.

Results

Six patients have undergone chest wall reconstruction with VEPTR or other titanium constructs. Four had chest wall resection for primary malignancy, 1 had metastatic chest wall tumor resection, and 1 had congenital chest wall deformity. There were no immediate complications, and all patients have exhibited excellent respiratory function with no scoliosis.

Conclusions

Chest wall reconstruction after tumor resection or for primary chest wall deformities can be effectively accomplished with VEPTR and other customized titanium constructs. Goals should be durable protection of intrathoracic organs and preservation of thoracic volume and function throughout growth. Careful preoperative evaluation and patient-specific planning are important aspects of successful reconstruction.     

胸骨内生软骨瘤1例

胸骨肿瘤包括原发性肿瘤和继发性肿瘤,胸骨肿瘤的治疗临床一般选择手术切除的方式.内生软骨瘤是一种软骨源性骨肿瘤,最多见于手足等短管状骨,其次位于肱骨、股骨等长骨,也有生长于盆骨等处.本文介绍1例较为罕见的胸骨内生软骨瘤患者,该患者实施了胸壁重建术.     

微型钛板重建椎管方法在多节段髓内肿瘤切除术后的应用

目的 探讨微型钛板重建椎管方法在多节段髓内肿瘤切除术后应用的优点。方法 多节段髓内肿瘤24例,均采用桐田法切除整块椎板,其中7例以微型钛板固定回植已切除的椎板,椎管成形,重建脊柱稳定性。结果 经回植椎板行椎管成形的病人没有发现椎管狭窄、脊柱后突及不稳;未经回植椎板椎管成形病人中有5例出现脊柱后突畸形,2例出现呼吸障碍,5例出现括约肌功能障碍,5例出现脑脊液漏合并颅内感染,3例出现硬膜外积液。结论 应用桐田法切除整块椎板后微型钛板固定椎板回植法对多节段髓内肿瘤切除术病人术后脊柱的稳定性意义重大,能减少术后并发症的发生。     

Diaphragm reconstruction combined with thoraco-abdominal wall reconstruction after tumor resection

Background: Thoraco-abdominal wall resection including diaphragm resection results in a challenging surgical defect. Various methods have been used for diaphragm reconstruction. The aim of this study was to describe our methods of diaphragm and thoraco-abdominal wall reconstruction after combined resection of these anatomical structures.

Methods: Twenty-one patients underwent diaphragm resection at our institution between 1997 and 2015. We used a mesh or direct closure for diaphragm defect and a mesh for chest wall stabilization. A pedicled or free flap for soft tissue coverage was used when direct closure was not possible.

Results: Indications for resection were primary sarcoma (n?=?14), cancer metastasis (n?=?4), desmoid tumor (n?=?2), and solitary fibrous tumor (n?=?1). The median patient age was 58.9 years. The diaphragm was pulled to its original position and sutured directly (n?=?15) or reconstructed with mesh (n?=?6). Chest wall reconstructions were performed with a mesh (n?=?14), mesh and a pedicled flap (n?=?4), mesh and a free flap (n?=?3). No perioperative mortality occurred. One-year and 5-year survival rates were 85.7 and 65.9%, respectively, while overall recurrence-free rates were 80.4 and 60.8%, respectively.

Conclusions: We have described our surgical methods for the resection of tumors of the chest or abdominal wall, including our method of distal diaphragm resection with wide or clear surgical margins. The method is safe and the reconstructions provided adequate stability, as well as water-tight and air-tight closure of the chest cavity. There were no cases of paradoxical movement of the chest or of diaphragm or thoraco-abdominal hernia.     

Scoliosis after chest wall resection

Background data

There has been an increased focus on the role of rib abnormalities in the development of scoliosis. Rib resection may influence the development of scoliosis. Although scoliosis has been identified in patients after thoracotomy, most of the currently available information is from case reports.

Methods

We examined records of 37 patients who underwent a chest wall or rib resection for rib lesions at our institution during the period of 1992 to 2005. Adequate data was available in 21 patients. We gathered data on demographic information, location of resection, and changes in curvature after resection based on radiograph or scout CT films at the latest follow-up appointment.

Results

Fourteen of 21 patients developed scoliosis with a mean Cobb angle of 25.8° (10°–70°). Eleven of these 14 patients had a progressive spinal deformity after chest wall resection with an average change in curvature of 29° (10°–70°). Eight of those 11 developed a convex toward the resection, while 3/11 developed a convex away from the resection. Seven of the eight patients with resections that included a rib superior to the sixth rib developed scoliosis, while four of 13 with resections below the sixth rib developed scoliosis.

Conclusion

Patients who have had a rib or chest wall resection are at risk for developing scoliosis, particularly if the resection is performed above the sixth rib.     

Full-thickness chest wall reconstruction using autologous tissue grafts after resection of recurrent desmoid tumor

We report the case of a 62-year-old woman with a recurrent desmoid tumor of the chest wall who successfully underwent a full-thickness chest wall resection as well as skeletal and soft tissue reconstruction. In chest wall reconstruction, we used various kinds of autologous tissue grafts, i.e. rib, fascia lata and the transverse rectus abdominis myocutaneous flap. Judging from the reconstructed wall’s strength, shape and flexibility, as well as wound healing, it is possible to conclude that this combined procedure is feasible because benefits of the procedure outweigh the disadvantage of additional operations for harvests.     

Chondrosarcoma of the chest wall: a clinical analysis

Purpose. To discuss the management of different histological types of chondrosarcoma (CS) in the chest wall based on our clinical experience. Methods. The subjects of this study were 16 patients with CS of the chest wall surgically treated by resection at our institute between September 1981 and August 2000. There were 11 men and 5 women ranging in age from 23 to 74 years. The median follow-up period was 54 months. The tumor was located only in the ribs in ten patients, in the sternum and ribs in three, only in the sternum in two, and in the ribs and spine in one. The surgical margins were wide in 12 patients and marginal in four. Reconstruction using Marlex mesh combined with moldable metal plates was carried out to prevent flail chest in nine patients, resection alone was performed in five patients, and a muscular flap was used in two patients. Results. The survival rate was 86% after a median follow-up period of 54 months. One operative death (6.2%) occurred, and another required temporary tracheostomy. There were no infections in this series. Oncological outcome was clinically related to surgical margins and recurrence. The postoperative respiratory function test result was 10% less than the preoperative one. Conclusion. This series demonstrated that wide resection is the treatment of choice for chest wall CS and that Marlex mesh combined with metallic mouldable plates is a reliable technique for reconstruction. Received: April 3, 2001 / Accepted: November 20, 2001     

A new method of stabilizing the chest wall following major chest wall resection

Summary Prosthetic materials, such as metals, marlex mesh and methyl methacrylate have been used for stabilization of the chest wall after resection of large areas of rib cage. Such materials are contraindicated in an infected area. A new method of providing a stable chest wall using autogenous tissue is presented.