骨水泥型人工双极股骨头置换治疗股骨近段骨转移瘤

目的:探讨骨水泥型人工双极股骨头置换治疗股骨近段转移瘤的临床疗效。方法:回顾性分析2012年1月至2019年6月华中科技大学同济医学院附属协和医院收治的54例行骨水泥型人工双极股骨头置换的股骨近段转移瘤患者的资料。采用疼痛视觉模拟评分(visual analogue scale,VAS)、国际骨肿瘤协会(musculoskeletal tumor society system,MSTS)功能评分、国际保肢学会(international society of limb salvage,ISOLS)影像评分、Harris髋关节功能评分量表(Harris hip score)、Karnofsky功能状态(Karnofsky performance status,KPS)评分和诺丁汉健康调查问卷(Nottingham health profile,NHP)评分评定患者疼痛、肢体功能和生存质量。Kaplan-Meier法分析生存情况。结果:患者随访时间为10⁹9个月,平均42.17个月。患者手术时间(79.68±6.17)min,术中出血量(524.00±39.25)mL...     

股骨近端肿瘤合并病理骨折的手术治疗

 目的分析股骨近端病理骨折的手术方法及效果。方法３９例患者接受手术治疗，平均随访３８．５个月。结果　恶性肿瘤及复发性骨巨细胞瘤采用异体骨段复合人工假体置换，骨囊肿等行刮除植骨术，多病灶型骨纤维结构不良行外翻截骨及内锁髓内钉固定术，术后总评优良率７６．９％。肿瘤复发、植骨吸收是常见的术后并发症。结论病变的性质、侵袭范围、股骨近端的应力分布等是手术选择的依据。良性病变瘤壁上残存肿瘤组织的灭活方法仍需继续探讨。     

儿童股骨近端良性骨肿瘤病理骨折的手术治疗

目的报告23例儿童股骨近端良性骨肿瘤所致病理性骨折的特征和手术治疗经验。方法我科1990年1月至2007年12月收治的167例14岁以下儿童股骨近端良性骨肿瘤中23例伴有病理性骨折,占总例数的13．7％。23例中孤立性骨囊肿15例,骨的纤维结构不良5例,骨巨细胞瘤1例,动脉瘤样骨囊肿2例,其中2例为陈旧性骨折。23例均经病灶内切除和内固定手术治疗,平均随访时间38．2个月。手术采用病灶刮除、50％氯化锌烧灼骨壁、异体骨粒或磷酸三钙人工骨粒充填骨腔,骨折均采用内固定治疗,病灶范围较大、骨壁破碎严重的III型骨折使用髓内固定,其他采用钢板固定。结果1例骨的纤维结构不良患儿手术后5年复发,其余均达到满意的临床骨愈合,未见内固定断裂、感染等并发症。结论儿童股骨近端良性骨肿瘤所致病理性骨折因骨质薄弱往往破碎严重,所在部位邻近髋关节,使外科治疗面临许多困难。尽管骨折破坏明显,但骨膜等成骨结构一般保存完好,为肿瘤的病灶内切除后的骨重建提供了先决条件。手术设计时对病灶性质、范同、骨骺生长发育等问题应全面考虑,合理使用内固定,可获得满意治疗效果。     

PFNA治疗股骨粗隆间骨折分析

目的探讨PFNA在治疗股骨粗隆间骨折中的临床疗效。方法2010年2月至2012年5月对42例股骨粗隆间骨折采用闭合复位PFNA内固定治疗。按Evans分型：Ib型21例,Ic型8例,Id型7例,II型6例。术后无需外固定。结果所有患者均安全完成手术,随访5—24个月,平均18．5个月;骨折端均显现有明显骨痂形成,无内固定物失败。临床结果按Sanders评估标准,优34例,良6例,可1例,差1例,优良率95．2％。结论PFNA具有操作简便、符合生物学固定原则、固定可靠、创伤小、骨量丢失少、并发症少,尤其适合老年患者等优点,是治疗股骨粗隆间骨折的理想方法之一。     

股骨近端转移瘤病理性骨折20例外科治疗

目的 探讨股骨近端转移性肿瘤病理性骨折的手术方法及其意义.方法 2005年 6月至2009年6月收治股骨近端转移瘤病理性骨折20例,其中原发癌乳腺癌8例,肺癌5例,宫颈癌2例,其他癌症转移5 例.男8例,女12例,平均年龄63.8岁.行肿瘤病灶刮除双动股骨头置换6例,内固定结合填充骨水泥14例.结果 3例失访,17例随访时间3-26个月,其中3个月内死亡1例,半年内死亡9例,1年内死亡2例,2 年内死亡1例,3年内死亡的1例,近半年内手术患者1例仍带瘤生存,近1年内2例带瘤生存.患者髋关节的活动度均有不同程度丧失,4例行人工股骨头置换的患者术后感觉腹股沟区不适及轻微疼痛,1例患者行动态髋螺钉（DHS）内固定术后局部伤口二期愈合,17例患者髋部疼痛均减轻.能够下床生活自理.结论 股骨近端转移瘤病理性骨折的患者如一般情况允许,应积极采取手术治疗,可以缓解局部疼痛症状,提高生活质量.     

Outcome of pathologic fractures of the proximal femur in nonosteogenic primary bone sarcoma

Pathologic fractures of the proximal femur resulting from primary bone sarcomas are often difficult to treat and some are often not recognized resulting in inappropriate interventions prior to the correct diagnosis being made. The aim of the study was to identify factors determining the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas.

Patients and methods

We retrospectively reviewed 72 patients with nonosteogenic primary bone sarcomas of the proximal femur (chondrosarcoma in 34 patients, spindle cell sarcoma in 25 and Ewing’s sarcoma in 13). There were 40 male and 32 female patients. The mean age was 49 years. We analyzed patient, tumor, and treatment factors in relation to overall survival. The mean follow up was 55 months (range 0-302 months).

Results

The overall 5-year survival rate was 44% (Ewing’s sarcoma 60%, chondrosarcoma 57%, spindle cell sarcoma 30%, and dedifferentiated chondrosarcoma 0%). The diagnosis of spindle cell sarcoma and dedifferentiated chondrosarcoma was the only significant factor adversely affecting survival. There was no difference in survival resulting from timing of the fracture, site of the fracture, age at diagnosis, surgical margin, limb salvage or amputation.

Conclusions

The key-factor adversely affecting the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas is the histological diagnosis of dedifferentiated chondrosarcoma and spindle cell sarcoma.     

股骨近端骨纤维结构不良伴严重内翻畸形的矫形

目的探讨严重内翻畸形的股骨近端骨纤维结构不良（fibrous dysplasia,FD）的治疗方法。方法2001年1月至2011年12月,收治26例股骨近端严重髋内翻伴肢体短缩畸形的FD患者。颈干角35°-100°,平均78°,股骨相对长度较对侧短缩2．0～9．5cm,平均4．2cm。26例均行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定。结果术后23例获得随访,随访时间6个月至10．5年,平均4．8年。22例内固定可靠,1例DHS内固定物股骨头螺纹钉术后1年切割出股骨头2mm,疼痛,经取出内固定物后治愈。股骨力线均基本矫正,截骨面达骨性愈合,髋内翻畸形的颈干角矫正为95°～130°,平均119°,股骨相对长度矫正后较术前延长2．5～8．6cm,平均3．7cm,术前肢体短缩基本纠正。术后17例患者步态正常;2例扶单拐行走,5例不扶拐轻度跛行。术后19例疼痛消失,4例疼痛明显减轻。所有患者无感染、再骨折和畸形进展。结论股骨近端FD严重髋内翻伴肢体短缩畸形行股骨近端畸形顶点附近外翻截骨,股骨头、颈及截骨断端打压式植骨,嵌插复位DHS或DCS钢板固定是一个简单有效的治疗方法。同时,股骨近端加长的DHS或DCS钢板对FD患者的骨质结构有明显的加强作用,特别是维持股骨近端及颈干角的解剖力线能起到很大的作用,以避免畸形复发。     

股骨近端骨肿瘤和瘤样病变：附152例分析

我院1955～1990年治疗的股骨近端骨肿瘤和瘤样病变152例,发现(1)股骨近端病变良性为65.13%,其中孤立性骨囊肿28.19%,骨纤维异常增殖症19.08%,骨软骨瘤9.54%,而年轻患者绝大多数是良性病变;(2)病史和临床症状对本部位肿瘤的诊断意义不大;(3)本组7例转移性肿瘤均位于股骨粗隆和粗隆下部位。成年组(≥20岁)股骨头和股骨颈肿瘤共44例,其中侵袭性肿瘤和恶性肿瘤占68.18%,而且大部分病例在 X线上显示类似其它部位良性病变的表现,甚至少数病例发生囊性变或动脉瘤样骨囊肿样改变。我们推测这些现象可能与髋关节的解剖结构和生物力学有关,因此在诊治股骨近端骨肿瘤时,临床和病理工作者应高度重视避免失误。     

Trends in the incidence and treatment of parathyroid cancer in the United States

BACKGROUND: Parathyroid cancer is a rare cause of hyperparathyroidism. The objectives of this study were to determine the patterns of disease, treatment trends, and outcomes among patients with parathyroid cancer by using a population-based data source. METHODS: Surveillance, Epidemiology, and End Results (SEER) cancer registry data were used to identify patients who were diagnosed with parathyroid cancer from 1988 through 2003. To assess whether the incidence rate, treatment, tumor size, and cancer stage changed over time, the Cochrane-Armitage trend test was used, and Cox proportional-hazards modeling was used to identify the factors associated with an improved overall survival rate. RESULTS: From 1988 through 2003, 224 patients with parathyroid cancer were reported in the SEER data. Over that 16-year study period, the incidence of parathyroid cancer increased by 60% (1988-1991, 3.58 per 10,000,000 population; 2000-2003, 5.73 per 10,000,000 population). Most patients (96%) underwent surgery (parathyroidectomy, 78.6% of patients; en bloc resection, 12.5% of patients; other, 4.9% of patients). The rate of surgical treatment increased significantly during the study period. The 10-year all-cause mortality rate was 33.2%, and the 10-year cancer-related mortality rate was 12.4%. Patient age (P<.0001), sex (P=.0106), the presence of distant metastases at diagnosis (P=.0004), and the year of diagnosis (P=.0287) were associated significantly with the overall survival rate. Tumor size, lymph node status, and type of surgery were not associated significantly with the overall survival rate. CONCLUSIONS: Although parathyroid cancer is rare, the incidence increased significantly in the United States from 1988 through 2003. Young age, female gender, recent year of diagnosis, and absence of distant metastases were associated significantly with an improved survival rate.     

Intraosseous schwannoma of the proximal femur

A schwannoma is a benign nerve sheath tumor commonly located in soft tissue. An intraosseous schwannoma is very rare, and only four cases involving the femur were found in a review of the English-language medical literature. We present a rare case of a schwannoma with well-defined, lytic, dumbbell-shaped and benign-appearing lesions of the proximal femur.     

股骨远端骨巨细胞瘤的外科分型与术式探讨

目的：探讨股骨远端骨巨细胞瘤的外科分型和术式。方法：回顾性分析1999年1月-2010年1月间我院收治的股骨远端骨巨细胞瘤患者62例的临床资料,其中男33例,女29例。平均年龄29.4岁。根据解剖部位及肿瘤病理学特点概括分为Ⅰ-Ⅴ型。Ⅰ型主要采用囊内刮除、50%氯化锌及磨钻处理、植骨复合内固定术;Ⅱ型主要采用边缘切除、结构性植骨复合内固定术;Ⅲ型主要采用瘤段切除、大段异体骨复合人工半关节置换术;Ⅳ型主要采用定制人工全膝关节置换术;Ⅴ型主要采用股骨中上段离断术,必要时结合放疗进行综合治疗。对相应分型给予的不同术式治疗和预后进行总结。结果：随访9-110个月（平均53.6个月）。术后复发8例,恶变2例,肺转移1例。参照Mankin等评定标准进行手术效果综合评价优良率（不包括Ⅴ型）：Ⅰ型81.5%;Ⅱ型50%;Ⅲ型75%;Ⅳ型79.2%;总优良率为78.7%。综合文献报道,术式对于相应分型的股骨远端骨巨细胞瘤效果良好。结论：股骨远端是骨巨细胞瘤的好发部位,根据解剖部位及肿瘤性质予以外科分型是科学合理的。这种分类方法和相应术式在控制肿瘤复发和指导后续治疗方面具备一定的优势。     

股骨远端骨巨细胞瘤的外科分型与术式探讨

目的:探讨股骨远端骨巨细胞瘤的外科分型和术式。方法:回顾性分析1999年1月-2010年1月间我院收治的股骨远端骨巨细胞瘤患者62例的临床资料,其中男33例,女29例。平均年龄29.4岁。根据解剖部位及肿瘤病理学特点概括分为Ⅰ-Ⅴ型。Ⅰ型主要采用囊内刮除、50%氯化锌及磨钻处理、植骨复合内固定术;Ⅱ型主要采用边缘切除、结构性植骨复合内固定术;Ⅲ型主要采用瘤段切除、大段异体骨复合人工半关节置换术;Ⅳ型主要采用定制人工全膝关节置换术;Ⅴ型主要采用股骨中上段离断术,必要时结合放疗进行综合治疗。对相应分型给予的不同术式治疗和预后进行总结。结果:随访9-110个月(平均53.6个月)。术后复发8例,恶变2例,肺转移1例。参照Mankin等评定标准进行手术效果综合评价优良率(不包括Ⅴ型):Ⅰ型81.5%;Ⅱ型50%;Ⅲ型75%;Ⅳ型79.2%;总优良率为78.7%。综合文献报道,术式对于相应分型的股骨远端骨巨细胞瘤效果良好。结论:股骨远端是骨巨细胞瘤的好发部位,根据解剖部位及肿瘤性质予以外科分型是科学合理的。这种分类方法和相应术式在控制肿瘤复发和指导后续治疗方面具备一定的优势。     

肱骨髓内钉在老年人Ⅱ型肱骨外科颈粉碎性骨折中的应用

目的评价肱骨髓内钉治疗Ⅱ型老年肱骨外科颈粉碎性骨折的疗效。方法2004年1月至2005年12月，采用肱骨髓内钉治疗Ⅱ型老年肱骨外科颈粉碎性骨折26例，对其进行随访，并对随访资料进行分析。结果26例患者获得完全随访，随访时间6～18个月，平均12个月，采用Neer肩关节功能评分标准：优13例，良9例，可4例，差0例，优良率86．6％。所有骨折在术后6～8周愈合，无固定失败，未出现肱骨头坏死病例。结论肱骨髓内钉是治疗Ⅱ型老年肱骨外科颈粉碎性骨折的一种良好方法，具有创伤小，固定可靠，术后早期即可功能锻炼，并发症少，疗效满意。     

Gastric Cancer Treatments and Survival Trends in the United States

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.