OBJECTIVE: Both primary and metastatic tumor of spine can influence spinal stability, spinal cord and nerves. The principles of dealing spinal tumor are resection of tumor decompression on spinal cord and reconstruction of spinal stability. METHODS: Since Aug. 1993 to Oct. 1996, 15 cases with spinal tumor were treated, including 4 primary spinal tumor and 11 metastatic tumor. Tumor foci were mainly in thoracic and lumbar spine. Graded by Frankel classification of spinal injuries, there were 1 case of grade A, 1 of grade B, 3 of grade C, 5 of grade D and 5 of grade E. Tumors of upper lumbar spine and thoracic spine were resected through anterior approach. Posterior approach also was adopted once posterior column was affected. Tumors of lower lumbar spine were resected by two-staged operation: firstly, operation through posterior approach to reconstruct spinal stability: secondly, operation through anterior approach. After resection of tumor, the spines were fixed by Kaneda instrument, Steffee plate or Kirschner pins. To fuse the spine, bone grafting was used in benign tumor and bone cement used in malignant tumor. RESULTS: Except one patient died from arrest of bone marrow, the others were followed up for 3 to 20 months. Postoperatively, 11 patients could sit up on one foot with the help of body supporter, and 9 patients could walk in two weeks under careful monitoring. There was no exacerbation of symptom and failure of fixation. The function of spinal cord was improved: 1 case from grade B to grade E, 1 from A to C, 2 from C to E and 4 from D to E. CONCLUSION: The spine can be reconstructed for weight bearing early by internal fixation. The symptom can be relieved and the nervous function can be improved by resection of tumor and decompression.
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.
Objective To study and summarize the clinical experience and significance of the skeleton reconstruction of human hand allografts. Methods From January 2001 to October 2003, human hand allografts were appliedto treat 4 cases of traumatic hand defect(6 hands) at different levels. During operation, the ulna and radius were reduced anatomically and fixed firmly with 3.5 mm AO-plates and screws according to AO internal fixation principle. The X-ray films were taken periodically andthe function recovery of hand allografts was observed and estimated. Results The 4 cases were followed up for 4-36 months postoperatively. The clinical healing of fracture in 4 cases(6 hands) was achieved after 9 weeks,and by means of comprehensive assessment including the joint function, muscle strength, sensation, appearance, sequela and the ability of work, the satisfactory effects were gained eventually. Conclusion It is significant forhuman hand allografts to reconstruct skeleton firmly.
Twenty five children with congenital biliary dilatation were treated with hepatico-jejuno-duodenostomy following excision of choledochal cysts between 1983 and 1985. The age ranged from two months to eleven years. The last follow-up ranged from 6-9 years (mean 7.5 years). All patients were free of jaundice with normal growth and development and none had peptic ulcer. The results from the last follow-up was better than that of the first one. This procedure was safe, effective and physiologically appealing.
Objective To evaluate the methods of the pedicle screw-rod fixationsystem combined with allograft bone or polymethylmethacrylate (PMMA) for the reconstruction of pelvic girdle after the complete resections of primary malignantbone tumor and the metastatic lesion of ilium. Methods From July 1999 to July2004, 16 patients with iliac malignant bone tumor were treated with the techniques of the complete resection and reconstruction. There were 9 males and 7 females at the age of 16 to 80 years. The 10 patients with primary malignant bone tumor included 4 cases of chondrosarcomas, 3 cases of osteosarcomas, 2 cases of Ewing sarcomas, and 1 case of malignant giant cell tumor of bone. The 6 patients with the metastatic lesion consisted of 2 cases of breast carcinoma, 1 case of lung carcinoma, 1 case of kidney carcinoma, 1 case of thyroid carcinoma and 1 case of prostate carcinoma. A solitary skeletal metastatic lesion was demonstrated in all metastases. There were 2 cases of stage ⅠA and 8 cases of stage ⅡB in primary malignant bone tumor according to the Enneking classification. The pedicle screwrod fixationsystem combined with allograft bone was used to reconstruct the pelvic girdle in primary malignant tumor. The patients with metastases underwent the pedicle screwrod system fixation with PMMA or without PMMA. The postoperative complication of reconstruction, local recurrence and bone healing were investigated. The postoperative function was analyzed according to the method reported by Enneking. Results The average followup was 35.6 months (5 to 65 months). Of all patients, 2had suspected deep infection, 2 had internal fixation loosening and 1 had nonunion of allograft bone. The mean healing time of the osteotomy site was 5.8 months (4.2 to 8.4 months). No immune rejection was seen. There were 2 patients with local recurrences, 3 patients with pulmonary metastases and 2 deaths due to metastases. The average functional score was 24.8(82.7%) in 8 survival. The functional results also were classified as excellent in 4, good in 3 and fair in 1. The median survival was 11.8 months (4.6 to 48.5 months) in metastases. Four patientshad lived for 1 year or longer after surgical intervention. The internal fixation loosening occurred in 2 patients, new destruction in 3 patients and no infectionoccurred. All patients immediately alleviated the pain and could walk with or without support after operation. At follow-up after 1 year, the average functional score was 21.7(72.3%). The functional results also were classified as excellent in 2 and good in 2. Conclusion Because of less complication and good function, the pedicle screwrod fixation system combined with allograft bone orPMMA are advisable for the reconstructions of pelvic stability after the complete iliac resections of primary malignant bone tumor and the metastatic lesion.
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.
OBJECTIVE To emphasize the importance of reconstruction and repair after resection of soft tissue sarcoma. METHODS From November 1990 to November 1996, in 107 cases of soft tissue sarcoma 32 cases had received various reconstructive or reparative operations. Among the 32 cases, 4 cases were primary sarcomas and 28 cases were recurrent sarcomas. In surgical grading, 3 cases were of I B, 3 cases of II A and 26 cases of II B. Radical resection was performed in 13 cases, widen local resection in 17 cases and local excision in 2 cases. After operation, 13 cases received chemotherapy and 7 cases received radiotherapy. Reconstruction of blood vessels was performed in 3 cases, reconstruction of kinetic function in 16 cases, and repair of defect was carried out in 23 cases. RESULTS Thirty patients were followed up for 4 months to 6 years and 6 months. The clinical results showed that the local control rate of sarcoma was 80%, limb-salvage rate after reconstruction of blood vessels was 100%, the excellent and good rate after reconstruction of kinetic function was 87.5%, and the survival rate of the tissue flap of transplantation and transposition was 96%. CONCLUSION It was concluded that the reconstruction and repair after resection of soft tissue sarcoma was the extension of operative treatment, and was very important in lowering the recurrence rate and improving the life quality of the sufferings.
OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
It is one of the difficult clinical problems to repair the large bone defect created by excision of benign tumors and to rebuilt the bone shelf. On the basis of the animal experiment, we excised thoroughly the effected bone subperiosteally and repaired the bone defect by fibula without its periosteum of other materials. The bone framework was successfully reconstracted. From Jan. 1984 to Dec. 1992, a series of seven cases were treated accordingly. The patients were followed up for 1 to 9 years. The skeletal framework in each was rebuilt rigidly. There was no recurrence and the functions of the extremity was recovered. In part of thesubperiosteum of fibula supplier bave regeneration of a new fibula with normal size at the site where the fibula was excised subperiosteally.
For the reconstruction of lacrimal passage in obligue facial cleft, three methods were performed in 4 cases. According to the difference in local pathology canaliculorhinestomy, transfer of vein or oral mucosa, or modified dacryocystorhinostomy was performed. The patients were followed for 6 to 12 months with satisfacting results.