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V A Trishkin V I Stoliarov V A Kochnev A A Koriukov 《Vestnik khirurgii imeni I. I. Grekova》1991,146(3):24-27
Data of 13 patients with tumors of the locomotor system subjected to +interscapular-thoracic resection (ITR) are presented. Main technical aspects of ITR are described. Complications took place in 6 patients, including marginal necrosis of the skin in 4 patients. As a whole the 5-year survival made up 49.9% +/- 13.8%. Data are presented on rehabilitation measures which allow to widen the functional possibilities of the extremity. 相似文献
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目的:探讨在骨肌系统肿瘤患者中采用凯赛特正压接头式留置针后用生理盐水封管的间隔时间对留置针回血、堵管发生率和每日平均封管成本的影响。方法将180例骨肌系统肿瘤患者随机分为三组(每组各60例),分别采用8 h、12 h和16 h时间间隔进行生理盐水封管,观察各组发生回血、堵管、平均留置时间和每日平均封管成本的差异。结果和8 h时间间隔比较,12 h时间间隔封管不会增加回血和堵管率,但16 h时间间隔封管则显著增加了回血和堵管发生的概率,且12 h时间间隔封管在不增加封管成本的情况下显著延长留置时间。结论采用12 h时间间隔封管具有良好的时间-成本效益,值得在临床上推广。 相似文献
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Turgut Akgül İsmail Cem Sormaz Murat Aksoy Adem Uçar Harzem Özger Levent Eralp 《Acta orthopaedica et traumatologica turcica》2018,52(6):409-414
Objectives
This paper aims to evaluate the extremity function and vascular outcome after limb-sparing surgery for extremity musculoskeletal tumors invading vascular structure required reconstruction.Methods
Of the 507 patients with musculoskeletal tumors, who underwent surgery between 2004 and 2007, 17 (3,3%) patients with major vessel involvement were included in the study. The mean age was 37.8 ± 14.5, with a female/male ratio of 8/9. Thirteen (76.4%) patients had Stage IIb disease, and 2 (11,7%) patients had Stage III disease. In 2 (11,7%) patients have locally aggressive tumor that had Stage 3. Fifteen (88.2%) of the cases involved lower extremity, whilst 2 (11.8%) of them involved upper extremity. An arterial reconstruction was carried out in all patients. Wide tumor resection and endoprosthetic reconstruction were performed in 6 (35.2%) patients. Other 11 (65.8%) patients were treated with wide resection and soft tissue reconstruction. Postoperative data included; perioperative morbidities such as bleeding, infection, graft thrombosis, rupture, metastatic local recurrence and mortality. Ankle brachial index (ABI) and color-flow-duplex-scan (CFDS) were done at the final follow-up of the study, in order to prove the efficacy of reconstruction. Functional outcome was evaluated with International Society of Limb Salvage (ISOLS) criteria.Results
The mean follow-up was of 39 months (range 3–120). Perioperative complications were arterial graft thrombosis occurred in 3 (17.6%) patients treated acutely with thrombectomy, uncontrolled deep wound infection occurred in 2 patients whom extremities were amputated.The most frequent complication after surgery was limb edema according to possibly venous and lymphatic obstruction, staged as C1, C2 and C3 disease was established in 6 patients (two patients in each group), and 1 patient was classified as C6 disease. Three (17.6%) patients had local recurrence (1/3 patient died and 2/3 (11.7%) patients underwent transfemoral amputation). At the last follow-up, 9 (52.9%) patients were alive without evidence of disease, 8 (47.1%) patients were died due to primary disease. There were 8 (47.1%) patients alive with an intact limb. Although functional outcome scores were satisfactory, emotional acceptance scores were low. The limb salvage probability was 74.0%.Conclusion
Limb-sparing oncological surgery in musculoskeletal tumors with vascular invasion provides a satisfactory limb function, which may lead to an improved life quality. Arterial reconstruction has a high rate of patency in the long term. The surgeon should be aware of early perioperative complication related to vascular reconstruction and infection that effect on the rate of extremity survival.Level of evidence
Level IV, Therapeutic study 相似文献5.
The purpose of this study was to assess the value of F-18 FDG whole body positron emission tomography in the primary and follow-up diagnosis of musculoskeletal tumors.Between May 1994 and January 2000, 79 patients [36 females, 43 males; mean age: 44 years (9-78)] suffering from different musculoskeletal tumors were additionally examined with PET.In total, 100 whole body PET examinations (48 for primary staging, 52 for follow-up) were performed using a PET scanner [ECAT EXACT 47 (921)] with an axial field of view of 16.2 cm. The tracer was 370 MBq F-18 FDG. The results were compared to those achieved with conventional diagnostic tools such as CT, MRT, bone scan, and histology.In the primary staging, PET exhibited a sensitivity of 100% and a specificity of 50% (two false-positive results). In examinations for follow-up purposes, we found a sensitivity of 88.9% and a specificity of 92.0%. In the diagnosis of skeletal and extraskeletal metastases (100 PET inspections), the sensitivity was 87.5% and the specificity 89.7%.Besides this, PET was compared with standard diagnostic tools used in the follow-up procedures of those patients who had received chemo- and/or radiotherapy. In addition, the procedure was used to search for the unknown primary tumors in cases of secondary metastases in the skeleton and compared as well.PET with F-18 FDG as tracer has become an important additional method in the diagnosis of musculoskeletal tumors. It can be used for primary staging, search for metastases, and post therapeutic control.Negative results were seen when PET was used to search for metastases when the tumor was smaller than 5 mm, in cases of inflammatory diseases, and the differentiation of low-grade malignant tumors from benign lesions. 相似文献
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Seventy-six patients with severe isolated head trauma (GCS score of 7 or less) were prospectively studied in order to valuate the prognostic power of the APACHE II system. In nonsurvivor patients the APACHE II score was higher than in survivor patients (24.7 +/- 3.2 (SD) vs 18.7 +/- 3.1; p less than .001). With an APACHE II cut-off point of 20 the sensitivity was 100% and the specificity was 70% while a cut-off point of 21 the sensibility decreased to 97.2% but the specificity increased to 72.5%. We conclude that the APACHE II is an effective mean to predict the prognosis of severe brain-injured patients. 相似文献
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Tomohiro Fujiwara Toshiyuki Kunisada Ken Takeda Joe Hasei Eiji Nakata Ryuichi Nakahara Aki Yoshida Toshifumi Ozaki 《Journal of orthopaedic science》2018,23(6):1045-1050
Background
Although emerging evidence has suggested that computer-assisted navigation allows surgeons to plan the optimal level of resection without compromising the surgical margins, the precise accuracy of the procedures has been unclear. The aim of this study was to investigate the accuracy and safety of the musculoskeletal tumor resection using O-arm/Stealth intraoperative navigation assistance.Methods
A retrospective study of six patients with bone and soft tissue tumors who underwent surgical resection using O-arm/Stealth navigation system was performed. The histological diagnosis was osteosarcoma, metastatic bone tumor, leiomyosarcoma, undifferentiated sarcoma, and synovial sarcoma, respectively. Tumor resection was performed according to planned osteotomy planes determined on O-arm/Stealth three-dimensional intraoperative images. The resection accuracy, length of time for the procedures, surgical margins, and perioperative complications were evaluated.Results
The distances between the entry and exit points for the planned and actual cuts were 1.5 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean discrepancy of the osteotomy angle was 2.8 ± 1.2°. The mean length of time required for navigation was 14 min. A histological examination revealed clear margins in all patients. There were no complications related to navigation, and no patients developed local recurrence during a mean follow-up of 30.6 months.Conclusions
The O-arm/Stealth intraoperative CT navigation system provides safe and accurate osteotomy in musculoskeletal tumor resections. However, surgeons should keep in mind and be careful of minimal errors during osteotomy, which are around 2 mm from the planned line. 相似文献9.
Jun Aoki Keigo Endo Hideomi Watanabe Tetsuya Shinozaki Takashi Yanagawa Adel Refaat Ahmed Kenji Takagishi 《Journal of orthopaedic science》2003,8(3):435-441
Positron-emission tomography (PET) can provide an in vivo method for evaluating metabolism and physiology in normal and diseased
tissues. Clinical trials with [18F]2-deoxy-2-fluoro-d-glucose (FDG), the most commonly used radiolabeled tracer for PET imaging, have demonstrated increased accumulation of FDG
in several cancer tissues. In this article, we introduce the basic principles of FDG-PET and review current knowledge about
FDG-PET for evaluating musculoskeletal tumors. Recent reports and our own experience suggest that FDG-PET cannot be a screening
method for differential diagnosis between benign and malignant musculoskeletal lesions, including many neoplasms originating
from different tissues altogether. FDG-PET might not accurately reflect the malignant potential of musculoskeletal tumors,
but rather might implicate cellular components included in the lesions. A high accumulation of FDG can be observed in histiocytic,
fibroblastic, and some neurogenic lesions, regardless of whether they are benign or malignant. More specific uses of FDG-PET,
such as grading, staging, and monitoring of musculoskeletal sarcomas, should be considered for each tumor of a different histologic
subtype.
Received: October 2, 2001
RID="*" 相似文献
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Satoshi Tsukushi Mitsuru Takahashi Norifumi Miyagi Shigeru Matsushima Manabu Andoh Yasutomi Kinosada 《Journal of orthopaedic science》2002,7(5):524-527
The magnetization transfer method is a relatively new technique that creates contrast by the exchange of magnetization protons
associated with macromolecules and bulk water protons through cross-relaxation or chemical exchange. We measured the magnetization
transfer ratio (MTR) and compared it with the DNA index to determine whether MTR can serve as an indicator of malignancy in
musculoskeletal tumors. The DNA index correlated with MTR in such musculoskeletal tumors (P < 0.05). This suggests that MTR can be used as a parameter to quantitatively indicate malignancy.
Received: January 7, 2002 / Accepted: April 11, 2002 相似文献
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A computerized follow-up system for patients with malignant tumors is described. This system is in use in the "Chirurgische Klinik der Universitat Munster" and in the "Fachklinik Haus Hornheide". As a special service to these clinics a central cancer registry furnishes periodically lists of patients. These lists are used as surveys of treated cancer patients. It is possible to contact those patients by letter, who do not present themselves for clinical examination. Goals of the system are the documentation of the course of disease, the analysis of survival and the follow-up of the patients. Thus, the clinics manage a comprehensive cancer care program with a minimum lost of contact. 相似文献
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OBJECT: The authors analyzed changes in depression and contemporary functional states by using valid tools in a population-based study sample during a 1-year follow-up period. METHODS: The study population consisted of 77 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery. Each patient's depressive status, according to the Beck Depression Inventory (BDI), and functional outcome, based on the Karnofsky Performance Scale (KPS), were evaluated before the tumor was surgically treated as well as 3 months and 1 year after surgery. Before surgery 27 patients (35%) had BDI scores indicating the presence of depression. These scores were significantly higher in patients with a history of depression (p = 0.017) and in those with a lower functional outcome (p = 0.015). In the entire study sample the severity of depression decreased statistically significantly (p = 0.031) at 3 months postsurgery. A lower functional status (KPS score < or = 70) in patients was significantly associated with high depression scores at the 3-month (p = 0.000) and 1-year (p = 0.005) assessments. The decrease in the level of depression was significant in patients with an anterior tumor (p = 0.049) and those with a pituitary adenoma (p = 0.019). CONCLUSIONS: Affective disorders among patients with brain tumors must be considered immediately after surgery, especially in persons with a depression history and in those with a coincident physical disability. 相似文献
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H Akaza Y Homma K Koiso O Yoshida K Suzuki H Hisazumi R Tsugawa K Matsumoto T Kawai T Nagayama 《European urology》1988,14(2):107-110
A simplified classification for primary urethral tumors is proposed. The T stage for tumors of male or female and of the upper or lower urethra has been combined into a single system. The system has been applied to 104 cases of urethral tumors. Although the cases were not necessarily very well qualified, a retrospective survival study demonstrated a general trend to a poorer prognosis in higher stages. Such a unified system might be useful for a simple classification of urethral tumors, a rare neoplasm with various clinical manifestations depending on sex or tumor site. 相似文献
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Renard AJ Veth RP Schreuder HW Pruszczynski M Keller A van Hoesel Q Bökkerink JP 《Archives of orthopaedic and trauma surgery》2000,120(3-4):188-194
The first purpose of this study was to evaluate the saddle prosthesis in patients with periacetabular tumors in terms of the functional results obtained after several postoperative intervals. The second purpose was to evaluate the complications and how they might be prevented in the future. Functional results according to the MSTS functional rating system were evaluated at several postoperative intervals in 15 patients treated with internal hemipelvectomy and reconstruction with the saddle prosthesis because of periacetabular primary (n = 9) or secondary (n = 6) malignancies. All complications were evaluated. Three months postoperatively, 7/9 patients with a primary tumor and 2/4 patients with a secondary tumor were able to walk outside without pain. Median functional results 3 and 6 months postoperatively were 40% and 50%, respectively. Deep infection occurred in 4 patients and fracture of the iliac remnant in 2. Heterotopic ossifications along the interpositional component were seen in 5 patients, but they did not negatively influence the functional outcome. Three (relative) contraindications to reconstruction with the saddle prosthesis could be ascertained: osteoporosis, extended involvement of the iliac wing by tumor, and insufficient soft-tissue quality after previous procedures. (Short-term) functional results after reconstruction with the saddle prosthesis are satisfactory if the above-mentioned contraindications are taken into consideration. 相似文献
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Bickels J Jelinek JS Shmookler BM Neff RS Malawer MM 《Clinical orthopaedics and related research》1999,(368):212-219
Biopsy is a key step in the diagnosis of bone and soft tissue tumors. An inadequately performed biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Poorly performed biopsy remains a common finding in patients with musculoskeletal tumors who are referred to orthopaedic oncology centers. The principles by which an adequate and safe biopsy of musculoskeletal tumors should be planned and performed are reviewed, and the surgical approach to different anatomic locations is emphasized. 相似文献