In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.
ObjectiveTo review the current research and application progress of three-dimentional (3D) printed porous titanium alloy after tumor resection, and provide direction and reference for the follow-up clinical application and basic research of 3D printed porous titanium alloy. MethodsThe related literature on research and application of 3D printed porous titanium alloy after tumor resection in recent years was reviewed from three aspects: performance of simple 3D printed porous titanium alloy, application analysis of simple 3D printed porous titanium alloy after tumor resection, and research progress of anti-tumor 3D printed porous titanium alloy. Results3D printing technology can adjust the pore parameters of porous titanium alloy, so that it has the same biomechanical properties as bone. Appropriate pore parameters are conducive to inducing bone growth, promoting the recovery of skeletal system and related functions, and improving the quality of life of patients after operation. Simple 3D printed porous titanium alloy can more accurately match the bone defect after tumor resection through preoperative personalized design, so that it can closely fit the surgical margin after tumor resection, and improve the accuracy and efficiency of the operation. The early and mid-term follow-up results show that its application reduces the postoperative complications such as implant loosening, subsidence, fracture and so on, and enhances the bone stability. The anti-tumor performance of 3D printed porous titanium alloy mainly includes coating and drug-loading treatment of pure 3D printed porous titanium alloy, and some progress has been made in the basic research stage. ConclusionSimple 3D printed porous titanium alloy is suitable for patients with large and complex bone defects after tumor resection, and the anti-tumor effect of 3D printed porous titanium alloy can be achieved through coating and drug delivery.
Objective To evaluate the effectiveness of prosthetic revision using custom-made long stem prosthesis and allograft-prosthesis composite (APC) for aseptic loosening after bone tumor resection. Methods Between January 2002 and June 2008, 14 patients with aseptic loosening after bone tumor resection were treated. There were 8 males and 6 females,aged 21-70 years (mean, 43.9 years). The locations were distal femur (8 cases), proximal femur (2 cases), and proximal tibia (4 cases). Pain of the affected l imb occurred after 6-31 years of prosthesis replacement and worsened when bearing and walking; 6 patients had shortened l imb. The functional results were assessed quantitatively according to the functional rating system of the Musculoskeletal Tumor Society (MSTS). The MSTS score was 16.36 ± 1.50 before revision. The X-ray films showed obvious prosthetic loosening and subsidence. The average time of symptom was 4.5 years (range, 3-9 years). In 7 patients having severe bone loss (the decrease of the thickness of cortical bone was more than 50%) and the prosthetic subsidence was more than 2 cm, the revision operation with the APC was performed; in 7 patients having less bone loss (the decrease of the thickness of cortical bone was less than 50%), the custom-made long stem prosthesis was performed. Results All wound healed by first intention. Two patients had temporary peroneal nerve paralysis and recovered after 3 months. All the patients were followed up 3.6 years on average (range, 2 years and 2 months-7 years) after revision. After revision, pain was rel ieved and the range of joint was improved. The MSTS score was 23.43 ± 2.56 at 12 months after revision showing significant difference when compared with the preoperative score (t=8.910, P=0.024). The X-ray films showed that lucency space l ine around stem cement in 2 patients at 12 months, and no prosthesis loosening and infection occurred. Conclusion The prosthetic revision after l imb salvage surgery with prosthesis for bone tumors was acceptable. The good functional results can be achieved by the revision with the APC or the custom-made long stem prosthesis according to the bone loss.
Objective To investigate the clinical application and complicationof the lyophilized small-segment allogeneic bone used in repairing bone defectscaused by benign bone tumor and tumor-like lesions after resection and curettage. Methods From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56years, averaged 32.8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm×0.8 cm to 10.0 cm×2.0 cm, andthe bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. ResultsThere was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bonetransplantation. The wounds in 196 patients were healed by the first intension.The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30cases; the wound had delayed healing in 4, including 3 whose wounds were healedby changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang’s standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14.78%) patients were not satisfied. Conclusion The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.
ObjectiveTo explore the effectiveness of excision and reconstruction of bone tumor by using operation guide plate made by variety of three-dimensional (3-D) printing techniques, and to compare the advantages and disadvantages of different 3-D printing techniques in the manufacture and application of operation guide plate.
MethodsBetween September 2012 and January 2014, 31 patients with bone tumor underwent excision and reconstruction of bone tumor by using operation guide plate. There were 19 males and 12 females, aged 6-67 years (median, 23 years). The disease duration ranged from 15 days to 12 months (median, 2 months). There were 13 cases of malignant tumor and 18 cases of benign tumor. The tumor located in the femur (9 cases), the spine (7 cases), the tibia (6 cases), the pelvis (5 cases), the humerus (3 cases), and the fibula (1 case). Four kinds of 3-D printing technique were used in processing operation guide plate:fused deposition modeling (FDM) in 9 cases, stereo lithography appearance (SLA) in 14 cases, 3-D printing technique in 5 cases, and selective laser sintering (SLS) in 3 cases; the materials included ABS resin, photosensitive resin, plaster, and aluminum alloy, respectively. Before operation, all patients underwent thin layer CT scanning (0.625 mm) in addition to conventional imaging. The data were collected for tumor resection design, and operation guide plate was designed on the basis of excision plan. Preoperatively, the operation guide plates were made by 3-D printing equipment. After sterilization, the guide plates were used for excision and reconstruction of bone tumor. The time of plates processing cycle was recorded to analyse the efficiency of 4 kinds of 3-D printing techniques. The time for design and operation and intraoperative fluoroscopy frequency were recorded. Twenty-eight patients underwent similar operations during the same period as the control group.
ResultsThe processing time of operation guide plate was (19.3±6.5) hours in FDM, (5.2±1.3) hours in SLA, (8.6±1.9) hours in 3-D printing technique, and (51.7±12.9) hours in SLS. The preoperative design and operation guide plate were successfully made, which was used for excision and reconstruction of bone tumor in 31 cases. Except 3 failures (operation guide plate fracture), the resection and reconstruction operations followed the preoperative design in the other 28 cases. The patients had longer design time, shorter operation time, and less fluoroscopy frequency than the patients of the control group, showing significant differences (P<0.05). The follow-up time was 1-12 months (mean, 3.7 months). Postoperative X-ray and CT showed complete tumor resection and stable reconstruction.
Conclusion3-D printing operation guide plates are well adapted to the requirements of individual operation for bone tumor resection and reconstruction. The 4 kinds of 3-D printing techniques have their own advantages and should be chosen according to the need of operation.
Chitosan is a kind of biological material with good histocompatibility and gradual biodegradability in vivo. It has no toxicity or side-effect. For its gradual degradation, chitosan and adriamycin were mixed and formed drug delivery system (DDS). The release test of DDS and exudant of DDS in inhibiting OS-116 were examined in vitro. The results were as following: the DDS could release adriamycin in slow and stable way. The SO-116 inhidition rate of the exudant of the DDS on the 1st, 20th, 40th and 60th day was 58.11%, 36.48%, 24.32% and 21.62% respectively. It was concluded that the drug delivery system was a slow release system. It could maintain the concentration of adriamycin in a certain level. It was also suggested that the chitosan was a good carrier for slow release of chemotherapeutic drug in local therapy for postoperative treatment of bone tumor.
From 1972 to 1990,121 cases of bone tumor were treated by segmental resection of tumor and followed by artifical joint re- placement. All of the prostheses were designed and manufactured by our hospital. One hundred and two cases were followed up for an average of 7.4 years and the curative rate with the affected limbs preserved was 85.28%. The indication, the advantages and disadvantages, the material and the type of artifical joints, and the assessment of functional reconstruction following operation were discussed.
Objective To discuss the reconstructive method of the bone defect after resection of the upper extremity bone tumor and to assess the outcome of the autograft to reconstruct the bone defect after the bone tumor resection. Methods From August 1998 to March 2004,16 patients aged 7~45 years suffering from bone tumor of the upper extremity were treated with the wide resection of the bone tumor and the reconstruction of the bone defect by the autograft. The following diagnoses were confirmed by pathological examination:Ewing’s sarcoma and osteosarcoma of theproximal humerus in 1 patient each; Ewing’s sarcoma of the distal humerus in 2 patients;giant cell tumor in 8 patients, highgrade chondrosarcoma in 2, malignant fibrohistiocytoma in 1; and osteosarcoma in 1 of the distal radius. Substitution of the proximal humerus with the clavicle was performed in 2 patients, andthedistal humerus with the fibula in other 2 patients. Of the 12 patients with tumor in the distal radius, 1 was reconstructed with autograft of the iliac bone and 11 with autograft with the fibula. The functional outcome was evaluated by the MSTS score. Results The follow-up for 36 and 12 months respectively revealed that in the 2 patients undergoing the autograft with the clavicle in the proximal humerus, good shoulder functions of flexion and extension were obtained although the function of abduction was poor, with the MSTS scores of 23 and 22 respectively. In the 2 patients undergoing the autograft with the fibular in the distal humerus, good elbow function and bone union were observed according to the followup for 3 and 4 months respectively, with the MSTS scores of 24 and 19 respectively. Of the 12 patients undergoing the autograft in the distal radius, 11 had an excellent or good function with no complication, with the average MSTS score of 22.6 (ranging from 18 to 27), accordingto the follow-up for 6-75 months; only 1 had no bone union 10 months after operation and lost the follow-up afterwards. Conclusion Reconstruction ofthe bone defect with the autograft after the wide resection of the upper extremity bone tumor is an ideal and reliable method for some suitable patients, especially for some children.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.
