Objective To investigate the method and the cl inical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula. Methods The cl inical data were retrospectively analyzed, from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009 (test group). Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group. There was no significant difference in gender, ages, disease duration, and tumor site between 2 groups (P gt; 0.05). Lateral stress test was performed after operation; X-ray films were taken to measure the joint space. Musculoskeletal Tumor Society (MSTS) functional score system was used to evaluate the joint function. Results All incisions healed by first intention in 2 groups. Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection. The patients in both groups were followed up 12 to 36 months, with an average of 30 months. One patient with osteosarcoma of the test group developed local recurrence, and died of lung and systemic metastases after 12 months; the other patients had no recurrence. At last follow-up, the results of knee lateral stress test were negative in the test group, and the joint space increased and was classified as grade A; the results of knee lateral stress test were positive in the control group, and the joint space was classified as grade D. The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group, showing significant difference (t=2.85, P=0.01). Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe, rel iable, and simple technique to reconstruct knee stabil ity after resection of tumors of the proximal fibula.
Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
Objective To retrospectively reviewed the operative therapy of the terrible triad of the elbow. Methods From October 2003 to September 2007, 10 cases of terrible triad were treated, with an elbow dislocation and an associated fracture of both the radial head and the coronoid process. There were 3 males and 7 females with the age of 18-66 years. The injury was caused by traffic accidents in 4 cases, fall ing from a height in 4 cases, and tumbl ing in 2 cases. The coronoid process fractures of the patients were 5 cases of type I, 3 cases of type II and 2 cases of type III according to Regan- Morrey classification. The radial head fractures of the patients were 1 case of type I, 6 cases of type II and 1 case of type IIIaccording to Mason classification, and their radial heads of the other 2 patiants were resected before they were in hospital. The general approach was to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule to radial head to lateral l igament complex to common extensor origin. And selected cases were repaired of the medial collateral l igaments and assisted mobile hinged external fixation to keep the forearm fixed in functional rotation position. The function of the elbows were evaluated with the criteria of the HSS2 score system. Results The other wounds healed by first intention except 1 case which had infection 7 days after operation and whose soft tissue defect in posterior elbow were repaired with the pedicle thoracoumbil ical flap. The patients were followed up 6 to 51 mouths (mean 24.9 mouths). The fracture heal ing time was 6 to 20 weeks (mean 9.6 weeks). Six mouths postoperatively, the mean flexion-extension arc of the elbow was 106.5° (85-130°), and the mean pronation-supination arc of the forearm was 138°( 100-160°) respectively. According to the criteria of the HSS2 score, the results were excellent in 4 cases, good in 4 cases, and fair in 2 cases. No compl ications such as stiffness and ulnohumeral arthrosis occurred. The radial nerve injury was found in 1 patient 1 day after operation who was treated with neurolysis, and the nerve function was recovered after 4-6 months. And heterotopic ossification occurred in 6 patients 6 months after operation and radiographic subluxation developed in 1 patient 36 months after operation, and conservative treatment weregiven. Conclusion The terrible triad of the elbow can lead to serious elbow instabil ity and should be treated with operationto restore the anatomic structures, to repair the articular capsule and the collateral l igament, using the adjuvant hinged external fixation and early exercise to avoid immobil ization and recover the articular function.
Objective To investigate the value of computer-aided design (CAD) in defining the resection boundary, reconstructing the pelvis and hip in patients with pelvis tumors. Methods Between November 2006 and April 2009, 5 cases of pelvis tumors were treated surgically using CAD technology. There were 3 males and 2 females with an average age of 36.4 years (range, 24-62 years). The cause was osteosarcoma, giant cell tumor of bone, and angiosarcoma in 1 case, respectively,and chondrosarcoma in 2 cases. According to the Enneking system for staging benign and mal ignant musculoskeletal tumors, regions I, I + II, III, IV, and I + IV is in 1 case, respectively. According to the principle of reverse engineering, 5 patients with pelvis tumors were checked with lamellar CT/MRI scanning, whose two-dimensional data were obtained in disease area. The three-dimensional reconstruction of pelvic anatomical model, precise resection boundary of tumor, individual surgical template, individual prosthesis, and surgical simulation were precisely made by computer with CAD software. Based on the proposal of CAD, the bone tumor was resected accurately, and allograft il ium with internal fixation instrument or allogeneic il ium with personal ized prosthetic replacement were used to reconstruct the bone defect after tumor was resected. Results The operation was successfully performed in 5 cases. The average operation time was 7.9 hours, and the average blood loss was 3 125 mL. Hemorrhage and cerebrospinal fluid leakage occurred in 1 case, respectively, and were cured after debridement. Five patients were followed up from 24 to 50 months (mean, 34.5 months). All patients began non-weight bearing walk with double crutches at 4-6 weeks after operation, and began walk at 3-6 months after operation. Local recurrence developed in 2 patients at 18 months after operation, and resection and radiotherapy were performed. According to International Society of Limb Salvage criteria for curative effectiveness of bone tumor l imb salvage, the results were excellent in 2 and good in 3. Conclusion The individual surgical template, individual prosthesis, and surgical simulation by CAD ensure the precision and rel iabil ity of pelvis tumors resection. The CAD technology promotes pelvis tumor resection and the reconstruction of pelvis to individual treatment stage, and good curative effectiveness can be obtained.
Objective To summarize the therapeutic effectinevess of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist. Methods Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, l imitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm × 4.5 cm to 11.3 cm × 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm × 5.0 cm to 12.5 cm × 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft. Results Bl ister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P lt; 0.05). Conclusion Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
OBJECTIVE: To study the reconstructional method and effect of shoulder joint function in the older obstetrical palsy with medial rotation contracture deformity. METHODS: From April 1996 to July 1999, 7 patients of older obstetrical palsy were adopted in this study. Among them, there were 5 males and 2 females, aged from 13 to 21 years old. No previous operation history and the main deformity was medial rotation contracture of shoulder. During operation, these patients were treated with "Z"-shape elongation of the tendon of subscapular muscle, transfer of the tendons of latissimus dorsi and teres major muscle to the tendons of supraspinous and infraspinous muscles. RESULTS: Followed up for 6 to 44 months(averaged 19 months), the Gilbert grading and Mallet scoring were 1.57, 7.57 preoperatively versus 3.45, 10.86 postoperatively, the abduction and external rotation of the shoulder joints recovered obviously. CONCLUSION: It is an effective operation for the older obstetrical palsy with medial rotation contracture of shoulder.
Objective To study the repair and function reconstruction of complex soft tissue defect of posterior of hand and forearm. Methods From May 2001 to November 2003, 8 cases of soft tissue defect of posterior of hand and forearm were repaired with thoracico abdominal flaps with hilum for primary stage. The tendon transplantation and allogeneic tendon function reconstruction of hand were performed for secondary stage. The range of the flap was 9 cm×15 cm to 12cm×38 cm. Allogeneic tendon amounted to 6.Results All the flaps survived. The flap countour was good. The results of allogeneic tendon transplantation were satisfactory and the function of hand was good. Conclusion Repairing complex soft tissue defect of posterior of hand and forearm and reconstructing hand function by use of thoracico abdominal flaps with hilum and transplantation of allogeneic tendon have the satisfactory clinical results.
Objective To analyze the reason of tumor treatment-related premature ovarian failure, and to review the progress of ovarian functional reconstruction. Methods The l iterature about the effects of radiotherapy and chemotherapy on ovarian function and reconstruct ovarian function was reviewed, analysed and summarized. Results Radiotherapy and chemotherapy can both affect ovarian function. The ovarian function reconstruction included fresh ovarian transplantation and ovarian cryopreservation and transplantation. Frequent ovarian cryopreservation was procedure slow-freezing protocols and vitrification protocols. Some laboratory and animal models of ovarian function reconstruction have come to gratifying results. Conclusion Ovarian function reconstruction has a potential cl inical value and provides a promising future.
ObjectiveTo investigate the effects of fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery. MethodsBetween July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection (group A) and 38 underwent fibular head preservation (group B). There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups (P>0.05). The complications and the position of the components were observed, and American society for bone tumors scoring system (MSTS93) was used to evaluate the joint function. ResultsAll patients were followed up 12-150 months (mean, 87 months). Incision infection occurred in 1 patient (2.63%) of group A and 6 patients (15.79%) of group B, showing significant difference (χ2=3.934, P=0.047). Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups (χ2=0.106, P=0.744). ConclusionFibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage, and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.
Objective To evaluate the cl inical outcomes of the wide resection and the functional reconstruction for treating mal ignant tumors of the proximal femur. Methods The cl inical data were analysed from 62 patients with mal ignant tumors of the proximal femur treated between January 1987 and December 2007. There were 29 males and 33 females with a median age of 35 years (range, 14-73 years). In 41 patients with primary mal ignant tumors having a disease course of 0.5-14.0 months, there were 16 cases of osteosarcoma, 7 cases of fibrosaroma, 6 cases of chondrosarcoma, 6 cases of mal ignant fibrous histiocytoma, 4 cases of mesenchymal sarcoma,1 case of Ewing sarcoma, and 1 case of angiosarcoma, including 3 cases of type IB, 2 cases of type IIA, 35 cases of type IIB, and 1 case of type III according to Enneking stage. In 21 patients with metastatic tumors, 16 had a mal ignant tumor history; the disease course was 0.1-28.0 months (3.4 months on average). Radical resection was performed in 9 cases, extensive resection in 39 cases, and marginal resection in 14 cases. After resection, 39 cases underwent reconstruction with prostheses (prostheses group) and 14 cases underwent reconstruction with allograft-prosthetic composites (APC, APC group). Results All incision healed by first intention. Twenty-six cases died of tumor metastasis,their postoperative survive time was 16-56 months (28 months on average). The average follow-up time was 64 months (range, 28-221 months) in 36 survival patients. The local recurrence rate of primary mal ignant tumors was 4.88% (2/41). In prostheses group, dislocation of femoral head occurred in 2 cases, fracture of prosthetic stem in 1 case, hip pain in 3 cases, acetabular wear in 3 cases, and stem loosening in 5 cases. In APC group, nonunion of APC occurred in 3 cases and acetabular wear in 1 case. At last follow-up, the average Musculoskeletal Tumor Society (MSTS) functional scores were 77.69% ± 6.50% in prostheses groupand 85.71% ± 7.45% in APC group, showing significant difference (P lt; 0.001). Conclusion When the wide resection isperformed for mal ignant tumors of the proximal femur, better local control could be achieved. Compared with econstruction of the prosthesis, the APC reconstruction can provide better function.