脊椎及椎旁组织对原发脊柱肿瘤局部屏障作用的组织学评价

目的：评价脊椎及椎旁组织对原发性脊柱肿瘤局部侵袭的屏障作用。方法：将10例脊柱脊索瘤与7例脊柱骨巨细胞瘤患者手术切除标本分为骨皮质组、软骨组、骨松质组、肌肉组、脂肪组和瘢痕组，观察肿瘤侵袭前缘瘤周组织完整性，分别测量其肉眼边界（MSM）、组织学边界（HLM）与分子边界（MCM）的长度，并进行边界长度组内比较和MSM—HLM、MSM—MCM差值组间比较。结果：瘤周骨皮质、软骨结构多保持完整，其余4组瘤周组织存在不同程度破坏。各组MSM、HLM和MCM长度组内单因素方差分析，除骨皮质组与软骨组外，其余各组内边界长度间均存在显著性差异（P〈0．05），其中骨松质组、肌肉组存在非常显著性差异（P〈0．01）。骨松质组及肌肉组MSM的长度显著大于组内HLM、MCM的长度（P〈0．05），脂肪组及瘢痕组MSM长度显著大于MCM长度（P〈0．05）。骨松质组、脂肪组MSM—HLM与MSM—MCM差值显著大于软骨组、骨皮质组（P〈0．05）；肌肉组、瘢痕组MSM—HLM、MSM—MCM差值显著大于软骨组（R0．05），瘢痕组MSM—MCM差值显著大于骨皮质组（P〈0．05）。结论：骨皮质及骨膜、软骨终板、椎间盘、关节突软骨是限制原发性脊柱肿瘤局部侵袭的天然屏障，而骨松质、肌肉、脂肪组织及瘤旁瘢痕组织不具备屏障作用。     

脊柱骨巨细胞瘤的综合治疗

脊柱骨巨细胞瘤是一种原发于脊柱的良性肿瘤,血运丰富,侵袭性生长,易复发,并可发生肺转移,因此治疗难度大.文中综述了各种治疗方法及其效果,包括外科治疗、放射治疗、动脉栓塞治疗及其发生肺转移时的治疗方法.结果显示:目前,对于脊柱骨巨细胞瘤,最有效的治疗方法是广泛或边界的整块切除,如果不能达到边界切除,则应辅助放射治疗,消灭可能残留的肿瘤细胞,巨大的骶骨骨巨细胞瘤可采用连续动脉内栓塞治疗.对于发生肺转移的脊柱骨巨细胞瘤,可以通过肺叶切除和(或)采用化疗来控制.     

脊柱原发性恶性肿瘤的外科治疗策略

<正>位于脊柱的原发恶性肿瘤少见,约10%的原发恶性骨肿瘤发生于脊柱和骶骨,约80%的成人脊柱肿瘤是恶性肿瘤[1～3]。脊柱原发肿瘤中,骨髓瘤最多见,其次是骨巨细胞瘤、脊索瘤、软骨肉瘤、骨母细胞瘤等。由于     

脊柱原发肿瘤切除术后复发原因的探讨

目的探讨脊柱原发肿瘤复发在手术技术方面的原因。方法对1989至2002年间以广泛性肿瘤切除手术方法治疗的38例脊柱骨巨细胞瘤、骨母细胞瘤、软骨肉瘤和脊索瘤术前、术后X线平片、CT和MRI、手术记录以及随访资料进行回顾性分析。结果32例患者得到随访,平均随访5．1年,17例复发,复发率为53％。肿瘤生长的部位特殊(颈椎和颈胸段)和侵袭广泛程度是导致肿瘤切除不彻底乃至复发的原因;对于暴露简单、病变局限的肿瘤,或者通过增加辅助切口的方法,术后复发率低。结论对于部位特殊、范围广泛、暴露困难的肿瘤,切除前没能将肿瘤游离,广泛切除,是造成肿瘤复发的原因;肿瘤复发可能与分块切除无关;术前精确的手术设计,术中充分的显露是达到广泛切除范围的保证,其中入路的选择至关重要。     

脊柱原发性肿瘤的特点及治疗进展

原发性肿瘤在脊柱肿瘤中所占的比例不到10％,但因其破坏骨质和浸润性生长的特点,往往导致较高的发病率和治疗上的困难.本文就多发性骨髓瘤、动脉瘤样骨囊肿、骨样骨瘤和骨母细胞瘤、血管瘤、骨巨细胞瘤、脊索瘤、软骨瘤和软骨肉瘤、尤文肉瘤、骨肉瘤这九类较常见的原发性脊柱肿瘤的特点及最新治疗研究情况进行综述,希望能为脊柱肿瘤的诊断和治疗带来新的思路.     

骶部肿瘤手术14例报告

骶部肿瘤分为原发和继发两类,原发者多为脊索瘤及巨细胞瘤,继发者多为转移瘤。由于骶椎的解剖特点,出现症状时肿瘤病变已非早期,治疗颇为棘手。我们近年来收治了14例骶椎肿瘤患者,采用自行设计的手术方法进行了治疗,现报告如下。 临床资料 1一般资料 本组患者男9例,女5例,年龄为17～61岁。职业为工人、农民及军人。有局部疼痛、骶部软组织肿块、括约肌功能障碍的病史。X线指示:骶骨呈溶骨改变,范围广泛,皮质变薄或消失,边缘不齐,无新生骨。本组14例手术后经病理证实:9例为脊索瘤,3例为巨细胞瘤,2例为转移性腺癌。 2手术方法 2.1临床研究; …     

枢椎肿瘤切除与重建技术探讨

目的：研究枢椎肿瘤的不同手术入路，肿瘤切除术及内固定重建的治疗效果。方法：对枢椎肿瘤的性质，病理类型，临床表现，各种手术途径，术式及其预后进行分析，本组18例中，骨巨细胞瘤6例，骨母细胞瘤1例，软骨肉瘤1例，骨髓瘤2例，脊索瘤2例，血管内皮细胞瘤1例，恶性淋巴瘤1例，神经纤维瘤1例，转变癌3例。5例行囊内切除，5例包膜切除，6例广泛切除，单纯枕颈后路植骨CD Cervical或Cervifix内固定术2例。结果：1例骨巨细胞瘤患进术后10d因四肢瘫痪状加重，呼吸循环衰竭死亡，1例转移癌患者术后13d因肺部感染，高热，呼吸循环衰竭死亡，术后随访6个月－4年，16例术后近期疗效较满意，局部疼痛和神经症状改善或缓解，2例转移癌患者分别于术后13个月和19个月全身多处转移，全身衰竭死亡，1例骨细胞瘤、1例软骨肉瘤术后1个局部复发。结论：应根据枢椎肿瘤具体部位，范围选择相应的手术入路和术式。肿瘤的性质，手术方式极术后综合治疗对患者预后具有重要影响。枕颈CD Cervical或Cervifix内固定术有利于保持上颈椎的稳定。     

脊柱肿瘤的手术治疗

目的 :探讨对于脊柱肿瘤一期全脊椎切除及脊柱稳定性重建的手术方法和临床效果。方法 :对 12例脊柱肿瘤行前、后路或前、后联合入路Ⅰ期全脊椎切除、脊髓减压 ,椎间植骨融合、内固定术。结果 :术后 11例获得随访 ,按照Frankel分级较术前均有 1级以上提高 ,所有患者局部疼痛症状消失。术后复查平均植骨融合时间 3个月。1例脊索瘤术后 1年复发 ,1例巨细胞瘤术后 9个月复发。结论 :针对脊柱肿瘤的性质、部位 ,通过不同的手术入路行一期全脊椎切除、植骨融合内固定 ,彻底切除肿瘤 ,重建脊柱稳定性并体现了个体化的治疗方向     

脊柱肿瘤的外科治疗现状与进展

脊柱原发骨肿瘤相对少见,约占全身骨肿瘤的6.6％～8.8％,其中良性肿瘤的发病率约占原发骨肿瘤的1％,恶性肿瘤约占5％,而脊柱是骨转移瘤最好发生的部位,约占全身骨转移瘤的50％.原发肿瘤中以血管瘤、骨巨细胞瘤、骨髓瘤、软骨肉瘤等常见[1-2].绝大多数(80％)脊柱肿瘤发生于椎体并向椎弓侵袭,而发生于后方附件的肿瘤少见.由于脊柱具有特殊的解剖结构,前方紧邻大血管及内脏,两侧有神经根走行,椎管内是脊髓,这就使得脊柱肿瘤不能像四肢肿瘤那样进行分期,也不能像四肢长骨肿瘤那样行瘤段骨整块切除,并且脊柱肿瘤复发后再次手术切除的机会很小,因此脊柱肿瘤手术难度大,复发率高,疗效差,一直是骨肿瘤治疗中的难点.     

浅谈骨盆肿瘤的诊断与治疗

骨盆肿瘤包括髂骨(含耻骨与坐骨)和骶尾骨两个部位的肿瘤。髂骨是骨软骨瘤、软骨瘤、软骨肉瘤、尤文氏肉瘤、多发性骨髓瘤以及骨巨细胞瘤等的好发部位之一。在原发脊柱肿瘤中,骶骨是好发部位之一,其中以脊索瘤相对多见。其他如骨巨细胞瘤、神经纤维瘤以及动脉瘤样骨囊肿等亦有报道[1]。由于骨盆肿瘤的早期症状较少且较隐蔽,容易漏诊和误诊;加之骨盆内有重要脏器、血管和神经,故手术难度较大;此外骨盆是人体负重的重要部位,术后稳定性的重建仍是需要解决的课题。为此,作者复习国内外有关文献并结合自己的临床实践,就骨盆肿瘤的诊断和治疗浅谈…     

Surgical treatment of primary tumors of the sacrum

Twenty-two patients with primary tumors of the sacrum were surgically treated between 1983 and 1997. Seventeen male and 5 female patients were followed up for a mean of 53.6 months (range 12-203 months). The histopathologic diagnoses were giant cell tumor (GCT) in 7 patients, chordoma in 4 patients, aneurysmal bone tumor in 3 patients, chondrosarcoma in 2 patients, osteoblastoma in 2 patients, synovial sarcoma in 2 patients, Ewing's sarcoma in 1 patient, and simple bone cyst in 1 patient. Currettage and thermo- or chemocauterization was applied to 8 patients, a subtotal sacrectomy was done in 11 patients, and total sacrectomy and lumbopelvic stabilization was done in 3 patients. The surgical margins were wide in all patients with GCT. The surgical margins were wide in 3 patients and wide contaminated in 1 patient with chordoma. The 2 patients with chondrosarcoma had high sacral lesions and were managed with total sacrectomy and lumbopelvic fixation. The surgical margin was wide in 1 patient and wide contaminated in the other, who relapsed locally and systemically in the 30th postoperative month. Three patients with aggressive aneurysmal bone cyst and 1 patient with simple bone cyst were managed by curettage and thorough debridement. One patient with low sacral Ewing sarcoma was managed by subtotal sacrectomy with wide margins. The two osteoblastomas were localized to the posterior elements of the sacrum. None of the patients relapsed. Most of the tumors of the sacrum are benign aggressive lesions or low grade malignancies. Intralesional resections in the form of curettage, with the addition of chemo- or thermocauterization, provide a complete cure for benign lesions. In contrast, wide resections are necessary for complete disease control in radio- and chemoresistant malignancies. Nerve root dissection should be performed in order to achieve wide margins.     

Total spondylectomy for primary tumor of the thoracolumbar spine

STUDY DESIGN: Six patients with primary malignant tumor of the thoracolumbar spine who underwent total spondylectomy (TS) by en bloc resection were reviewed retrospectively. OBJECTIVES: To report surgical technique and preliminary results of TS and to evaluate its oncological curability. SETTING: Japan. METHODS: Six patients were treated by TS by en bloc resection of the vertebral tumor. TS through a posterior approach was performed in three cases (T1 osteosarcoma, L1 osteosarcoma and L1 chordoma) and in the others through a single stage anterior and posterior combined approach (T6-8 recurrent giant cell tumor. L4 chordoma and L5 giant cell tumor). Surgical margins of the specimens were evaluated histologically. All patients were followed, and their status was evaluated by clinical and imaging studies. RESULTS: There were no complications related to surgery. Programmed sacrifice of nerve roots were performed in three cases for oncologic excision. A wide surgical margin was achieved in one case, a marginal one in four, and an intralesional margin in one. Five patients were alive without evidence of tumor and one was alive with disease at follow-up evaluation after 2.0-4.8 years. Local recurrence was found in one case of T1 osteosarcoma with an intralesional margin. CONCLUSIONS: These preliminary results suggested that TS is an effective procedure in control of local recurrence with acceptable complications.     

骨巨细胞瘤组织周边生物学行为研究

目的 研究骨巨细胞瘤（GCT）肿瘤组织与其周边组织的关系,探讨手术后复发及良性GCT远隔转移的病理学基础.方法 收集1998 年至2005 年第四军医大学西京医院手术切除的12 例良性GCT瘤段标本,对GCT肿瘤组织及周边组织进行病理学研究.肿瘤部位：股骨远端6 例、胫骨近端3 例、胫骨远端1 例、腓骨小头1例、髌骨1 例.放射影像学Campanacci＇s 分级Ⅰ级2 例,位于腓骨小头和髌骨;Ⅱ级2 例;Ⅲ级8 例,2 例合并病理性骨折,3 例病灶突入软组织内形成软组织内肿物.6 例为复发的GCT.Enneking 外科分期：ⅠA 5 例、ⅠB 7例.光镜下观察GCT肿瘤与周围组织（包括皮质骨、松质骨、软骨、软组织、周边血管、瘤内血管）多个边界的关系.结果 与皮质骨交接处可见9 例肿瘤组织侵蚀皮质骨,以形成骨吸收陷窝的行为进行侵蚀;2 例肿瘤组织呈现为＂指状突起＂的生长行为,深入到周围正常骨组织内.与松质骨交接处5 例可见一层反应性硬化骨或编织骨存在,2 例病灶外正常松质骨内有跳跃病灶存在.与软骨交接处肿瘤组织边界较整齐,全部标本的关节软骨面完整.与软组织交接处7 例肿瘤组织突破骨性界限,4 例可见两层正常的纤维组织间夹有肿瘤组织;9 例肿瘤组织周围软组织内血管增多、扩张、血管壁增厚.与周边血管交接处1 例肿瘤组织周围完整的骨壳外扩张的血管内有肿瘤组织存在;与瘤内血管交接处微动脉较微静脉厚,微静脉壁薄,2 例可见血管平滑肌被多核巨细胞侵袭而变薄、不完整甚至血管壁破溃,多核巨细胞进入血管中.结论 GCT肿瘤组织的边缘生物学行为与术后复发、转移密切相关,其特征性表现为手术治疗方法 的选择提供了参考依据.     

腺泡状软组织肉瘤外科治疗的预后分析

 目的 探讨腺泡状软组织肉瘤的临床特点与外科治疗的预后相关因素。方法 回顾性分析1982年1月至2010年10月期间资料完整的腺泡状软组织肉瘤29例,男18例,女11例;年龄9~58岁,平均24.4岁,中位年龄21岁。最终接受手术治疗的26例纳入研究,软组织为首发23例,骨首发3例。临床表现主要为局部的无痛性肿块17例（65.4%,17/26）,伴有疼痛症状9例（36.4%,9/26）。纳入分析的指标包括性别、年龄、肿瘤体积、Enneking外科分期、外科边界以及辅助化疗与否。肿瘤学评价包括局部复发率、转移率和生存分析。肿瘤体积与外科边界对局部复发率、辅助化疗对转移率的影响采用单因素分析;多因素分析局部复发率采用Logistic回归分析;生存因素采用Cox回归分析。结果 Enneking外科分期Ⅱ期14例,Ⅲ期12例。手术行边缘切除9例、广泛切除17例。随访时间5~226个月,平均45.9个月,中位随访时间为31个月,最终12例存活（46.2%）。Ⅱ期和Ⅲ期病例五年生存率分别为79.5%和23.4%。局部复发7例（26.9％）,广泛切除与边缘切除复发率的差异有统计学意义。Ⅱ期患者接受与未接受化疗转移发生率的差异无统计学意义。肿瘤直径>5 cm和< 5 cm的患者五年生存率分别为40.7%和80.0%。Logistic回归分析显示外科边界与局部复发率明显相关,Cox回归分析表明Enneking外科分期和肿瘤体积是死亡的独立预后因素。结论 腺泡状软组织肉瘤典型表现为无痛包块,易发生早期转移;外科边界是局部复发率的独立预后因素;Enneking外科分期与肿瘤体积是影响生存的独立危险因素;辅助化疗对于控制新发转移率和提高生存率的无明显改善。     

Chondroid chordoma of the L5 spinous process and lamina: a case report

Chordoma is a rare bone tumor that originates from the remnants of the notochord. These tumors have axial distribution particularly at the upper and lower ends of the vertebral column. This paper reports a rare occurrence of a chordoma in the posterior elements of the L5 vertebra. A differential diagnosis of a benign tumor (giant cell tumor, aneurysmal bone cyst or osteoblastoma) was made initially. Other differential diagnoses included plasmacytoma and metastasis. The tumor was removed enbloc. Histopathological examination revealed the tumor mass to be chordoma. There were no clinical or radiological signs of recurrence at 21 months follow-up. Chordomas are tumors of the axial skeleton. However, they may occur in unusual sites in ectopic notochordal tissue. The case is being presented for its unusual site of occurrence.     

上肢腱鞘巨细胞瘤术后复发相关因素分析

目的：了解上肢腱鞘巨细胞瘤患者的性别、年龄、肿瘤生长部位、术中化学处理情况和肿瘤术后复发的相关性。方法：回顾分析2000年1月至2011年8月47例上肢腱鞘巨细胞瘤住院患者的病史,对其性别、年龄、肿瘤生长部位、术中是否接受化学灭活处理、手术并发症、肿瘤复发情况及病理结果做统计和分析。本组女28例,男19例;年龄17～78岁,平均38.15岁。所有病例接受手术局部切除。14例术中使用化学方法灭活肿瘤细胞（术中使用乙醇或碘酒浸泡手术创面）。对患者定期随访,观察创口愈合情况、病理结果、肿瘤是否复发,并做必要的影像学检查。结果：47例平均随访53.89个月（22～129个月）,其中4例术中采用乙醇灭活的病例术后出现创口红肿、坏死组织排出、创口延迟愈合等并发症;15例报告肿瘤组织生长活跃,1例为低度恶性的腱鞘巨细胞瘤。术前X线发现有骨质破坏组术后复发率明显增高（P=0.003）;术中接受化学方法灭活的病例术后复发率小于未接受化学方法灭活病例（P=0.042）。结论：上肢腱鞘巨细胞瘤患者术后是否复发与肿瘤生长部位、是否有骨质破坏、是否采取术中化学灭活密切相关。局部切除是治疗上肢腱鞘巨细胞瘤的有效方案,配合术中化学方法灭活能够降低术后复发风险。如何在术中确定复发高危人群,降低其复发率及重建广泛切除肿瘤后的手功能是将来研究的重点和难点。     

良性骨巨细胞瘤周边生物学行为及SMAa微血管标记的意义

目的：检测良性骨巨细胞瘤（Giant Cell Tumor of Bone,GCT)周边组织病理学改变及瘤组织对微血管的侵袭。方法：收集1995－1998年我科切除的8例良性GCT瘤段,对其病灶周边进行组织病理学及血管平滑肌肌动蛋白a(Smooth Muscular actin,SMAa)免疫组织化学研究。结果：组织学良性GCT可具有侵蚀皮质骨、松质骨及周围软组织的能力,边界处有大量新生微血管密度形成,肿瘤中多核巨细胞可侵袭微静脉,肿瘤细胞可由此进入血管。结论：良性GCT仍具有局部侵袭和潜在转移的能力。     

Safety margins in resection of sacral chordoma: analysis of 18 patients

Background  Local recurrence after resection of sacral chordoma is a challenging problem for the orthopedic oncologists. That is why analysis of its margins of safety is of outmost importance. Material  Eighteen cases of sacral chordoma were retrospectively reviewed. All the patients were followed for determination of their status clinically and radiographically. The surgical margins for every resected tumor were evaluated proximally, ventrally, and at the postero-lateral aspect of the sacrum. Results  Ventrally, the surgical margins were seven marginal and ten wide margins. Proximally, there were three marginal, nine wide and five curative margins. Postero-laterally, there were one intra-lesional, one marginal, 12 wide and three curative margins. Local recurrence encountered postero-laterally in six cases with five wide and one intra-lesional margin. On the other hand, no local recurrence was disclosed ventrally or proximally despite marginal resections were employed to the ventral resection in seven and proximally in three cases. With a mean follow-up of 11 years, six patients died of their disease, and 12 patients were alive. The 5-, 10- and 15-year survival rates were 81, 70, and 33%, respectively. Conclusions  The appropriate surgical margin for complete removal of the chordoma differs according to the location of the tumor and tissues involved. Marginal margin ventrally and wide margin proximally are sufficient while postero-laterally including the gluteus maximus muscles a curative or radical margin seems to be the appropriate surgical margin to prevent tumor recurrence.     

Histomorphometric description of allograft bone remodeling and union in a canine segmental femoral defect model: a comparison of rhBMP-2, cancellous bone graft, and absorbable collagen sponge.

The purpose of this study was to determine the effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) on the histomorphometry of femoral allograft-host bone union and allograft remodeling. A 6 cm mid-diaphyseal femoral defect was created and filled with an allograft stabilized with an interlocking nail in 21 dogs. Dogs were randomly divided into three equal groups and the allograft-host bone junctions and the mid-diaphyses of the allografts were treated with either an absorbable collagen sponge (ACS) loaded with rhBMP-2 (BMP group), an autogenous cancellous bone graft (CBG group), or ACS loaded with buffer solution (ACS group). All dogs received daily tetracycline until sacrifice at 24 weeks to label new bone formation. Histomorphometric analyses on sections of proximal and distal allograft-host bone junctions and the mid-diaphyseal portion of allografts were performed using fluorescent and regular light microscopy. Analyses of the host bone and junctions between allograft and host bone revealed significantly greater new bone formation and larger osteon radii in the BMP group compared to CBG and ACS groups and contralateral intact bone. Porosity in CBG and ACS groups was significantly higher than in the BMP group, which had similar values to intact bone. In transverse sections of allografts, the largest pore diameters were present in the CBG group. Based on all parameters measured, significantly higher bone turnover occurred in the outer cortical area of the allograft in all groups as compared to the inner cortical and mid-cortical areas. New bone formation and osteon radius/osteon width in allografts were similar for all three groups. Higher porosity and larger pore diameters in the CBG and ACS groups suggested higher bone resorption versus formation in these groups compared to the BMP group. The results of this study reveal more balanced allograft bone resorption and bone formation in the BMP group, with greater resorptive activity in the CBG and ACS groups. However, neither rhBMP-2 nor autogenous bone graft increased allograft incorporation when compared to the negative control (ACS group).     

恶性骨肿瘤活检安全性评估

目的 研究恶性骨肿瘤穿刺及切开活检道后被肿瘤污染的发生率及活检的安全性.方法 选取2005年7月至2007年10月恶性骨肿瘤行穿刺活检后的病理标本48例,男37例,女11例;年龄10～64岁,平均23.3岁;骨肉瘤37例,恶性纤维组织细胞瘤5例,皮质旁骨肉瘤1例,髓内高分化骨肉瘤1例,骨膜骨肉瘤1例,骨原发恶性黑色素瘤1例,软骨肉瘤2例.活检至再次手术间隔0～2个月,平均1.3个月;均行保肢治疗.选取同期行切开活检病理标本26例,男21例,女5例;年龄8～59岁,平均21.9岁;骨肉瘤20例,Ewing肉瘤1例,软骨肉瘤2例,间叶性软骨肉瘤1例,恶性纤维组织细胞瘤1例,淋巴瘤1例.活检至再次手术间隔1～4个月,平均2.3个月.活检道的手术切除范围均为其内外各2cm,连同瘤段整块切除.对活检道途经的组织取材,以病理为标准判断活检道途经的组织有无恶性肿瘤污染,并确定被肿瘤污染的发生率及范围.结果 48例穿刺活检患者中44例获得随访,随访时间4～39个月,平均17.6个月.4例(4/48,8.3%)活检道存在恶性肿瘤种植污染.末次随访时,4例发生非活检道肿瘤复发.26例切开活检患者均获得随访,随访时间2～29个月,平均12.9个月.2例活检道病理可见肿瘤,阳性率为7.7%(2/26).末次随访时,3例发生非活检道肿瘤复发.结论 恶性骨肿瘤进行穿刺活检和切开活检虽存在活检道被肿瘤污染的危险,但在最终手术时活检道连同肿瘤一同切除后不会发生因活检而造成的肿瘤复发.

Abstract：

Objective To investigate the incidence and extent of biopsy tract contamination in malignant bone tumors by either core needle biopsy or open biopsy and detect the safe extent in resection of biopsy tract. Methods Forty-eight cases were performed core needle biopsy, including 37 osteosarcomas, 5 malignant fibrous histiocytomas, 1 juxtacortical osteosarcoma, 1 low grade central osteosarcoma, 1 periosteal osteosarcoma, 1 primary malignant melanoma of bone and 2 chondrosarcomas. There were 37 males and 11 females with a mean age of 23.3 years (range, 10-64 years). The mean time between core needle biopsy and definitive surgery was 1.3 months (range, 0-2 months). All the patients were performed limb salvage surgery.Twenty-six cases were performed open biopsy, including 20 osteosareomas, 1 Ewing's sarcoma, 2 chondrosarcomas, 1 mesenchymal chondrosarcoma, 1 malignant fibrous histiocytoma, 1 lymphoma. There were 21males and 5 females with a mean age of 21.9 years (range, 8-59 years). The mean time between open biopsy and definitive surgery was 2.3 months (range, 1-4 months). The tumor and tissue around the biopsy tract at least 2 cm were resected. The pathological examination was performed in specimens via the biopsy tract, including the normal soft tissue outside the tumor, deep fascia, subcutaneous tissue and skin. The incidence and extent of biopsy tract contamination were evaluated with pathological examination. Results Forty-four cases were followed up. The mean follow-up time was 17.6 months (range, 4-39 months). In core needle biopsy group, four of forty-eight cases were found malignant tumor cells seeding in biopsy tract, the positive rate was 8.3%. In open biopsy group, all the cases were followed up with the mean time of 12.9 months (range, 2-29 months), and two of twenty-six cases were found malignant tumor cells seeding in biopsy tract,the positive rate was 7.7%. Conclusion Biopsy of malignant bone tumors has the risk of biopsy tract contamination. The tumor cell seeding exists in both core needle biopsy and open biopsy. The biopsy tract should be performed en bloc resection with the tumor.