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Carry out the technical exploration in bone tumor treatment and improve the clinical treatment level
2025,33(14):1249-1251, DOI: 10.20184/j.cnki.Issn1005-8478.12044A
Abstract:
The main reason for the significant increase in the number of patients with bone tumors in recent years is the increase in bone metastases and bone- related events caused by tumors in various organs. Primary malignant bone tumors are all sarcomas with high heterogeneity, involving a wide range of sites, multiple histopathological types, and significant differences in the biological behavior and prognosis of the tumors. Bone tumor surgery is challenging. To achieve local control, not only good resection techniques are required, while to achieve satisfactory postoperative functional consequece, more reliance is placed on the bones and joint reconstruction of structural defects secondary to tumor resection. This special issue on bone tumors consists of 13 articles, covering topics ranging from the spine to the limbs, from soft tissue tumors to bone-derived tumors, and from basic research to clinical treatment. The issues of concern and research results are of considerable guiding significance. Surgical technique papers are all accompanied by beautiful surgical diagrams, which enhance the readability of the papers and are worth reading!
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2025,33(14):1252-1257, DOI: 10.20184/j.cnki.Issn1005-8478.120402
Abstract:
With the in-depth basic tumor research, the continuous improvement of clinical diagnosis and treatment techniques, and the continuous update of treatment concepts, both the cure rate and local control rate of tumors have been significantly improved. At present, tumor treatment has gradually shifted from the traditional single treatment mode, such as surgery, radiotherapy or chemotherapy to a multi-disciplinary treatment (MDT) model involving drug therapy, targeted therapy, immunotherapy, precision medicine, surgical intervention and rehabilitation support. With the wide promotion and continuous optimization of the MDT model for tumors, the life risks of patients have been significantly reduced, and the overall survival period has achieved a qualitative leap. This article elaborates on the occurrence characteristics of skeletal related events (SREs) in various tumors, the establishment of the MDT system for bone metastases, the current domestic situation of handling skeletal-related events of bone metastases, existing problems, and improvement suggestions.
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ZHANG Yuan-jian, LIU Yang, CUI Lu-kuan, GE Wen-long, ZHOU Shi-meng, HU Yong-cheng
2025,33(14):1258-1264, DOI: 10.20184/j.cnki.Issn1005-8478.120401
Abstract:
[Objective] To explore the factors impacting prognosis after resection of myxoliposarcoma and myxofibrosarcoma. [Meth ods] A retrospective study was conducted on 22 patients who had myxoliposarcoma or myxofibrosarcoma resected surgically in our hospital from January 2020 to January 2023. Clinical data were collected, and the factors that might impacting the prognosis of patients were analyzed by univariate comparison and univariate Cox proportional hazards regression. In addition, the predicted survival rate was calculated using the Kaplan-Meier method, the survival curve was plotted, and the survival difference was tested by Log rank. [Results] Among the 22 patients, 14 cases (64%) underwent radical resection, and another 8 cases (36%) underwent extensive resection. All patients were followed up for 24 to 48 months. Four cases (18%) died 3 to 24 months after the operation, with an average of (13.8±4.4) months. Regarding univariate comparison, the invasive growth subgroup had significantly higher ratio of superficial position than the non-invasiv growth subgroup (P＜ 0.05). As results of stratified comparison by growth pattern, the invasive growth subgroup was significantly shorter than the non-invasive growth subgroup in terms of actual disease-specific survival (DSS), actual local failure-free survival (LFFS) and the actual distant failurefree survival (DFFS) period (P＜0.05). In term of stratified comparison by surgical boundaries, the negative surgical margins subgroup were significantly longer than the positive surgical margins subgroup in actual DSS, LFFS and DFFS period (P＜0.05). As results of univariate Cox proportional hazards regression, the surgical margin (positive margin) and the growth pattern (invasive growth) was the independent risk factors shortening DSS, LFFS and DFFS period (P＜0.05). The Kaplan-Meier survival analysis predicted the 2-year survival rates in terms of DSS, LFFS and DFFS as 83% (95%CI: 72~94), 83% (95%CI: 72~94) and 64% (95%CI: 50~79), respectively. The Log rank test indicated that: the non-invasive growth subgroup was significantly longer than the invasive growth subgroup in the predicted DSS [(46.3±1.1) months vs (26.3±4.2) months, P=0.001], the LFFS [(45.4±1.8) months vs (24.6±4.6) months, P=0.001] and the DFFS [(43.6±1.7) months vs (22.8±3.8) months, P＜0.001]. [Conclusion] Compared with the non-invasive growth pattern, the invasive- growth myxoliposarcoma and myxofibrosarcoma have poorer prognosis. The invasive-growth pattern and positive surgical margins after resection are independent risk factors impacting the clinical prognosis.
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MOU Le-ming, LI Hong-fei, WANG Hong-yu, ZHANG Jing-yu, LIU Yan-cheng, HU Yong-cheng, LUN Deng-xing
2025,33(14):1265-1271, DOI: 10.20184/j.cnki.Issn1005-8478.120394
Abstract:
[Objective] To explore the occurrence and risk factors of adverse events prosthetic reconstruction of bone defects secondary to segment resection of extremity long bone shaft tumors to provide a basis for optimizing clinical decisions. [Methods] A retrospective study was conducted on 108 patients who underwent prosthetic reconstruction of bone defects secondary to segment resection of extremity long bone shaft tumors in two bone tumor centers from September 2010 to January 2024. The occurrence of postoperative adverse events was recorded and were classified according to the Henderson classification. Univariate comparison was used to search the risk factors related to complications, while the competitive risk analysis method was used to evaluate the cumulative risks of complications and re-operation. In addition, Kaplan-Meier analysis was conducted to evaluated the survival status. [Results] All the patients had the limb-salvage operation performed successfully with the average operation time of (142.6±41.1) min and the average intraoperative blood loss of (654.5± 437.5) mL. The patients were followed up for an average of (28.1±25.7) months, and the incidence of postoperative complications was of 16.7% (18/108), including 1 case of type I, 9 cases of type II, 4 cases of type III, 1 case of type IV, and 4 cases of type V based on Hender- son' classification, with re-operation rate of 6.5% (7/108). At the last follow-up, there was no statistically significant difference in MSTS scores between the complication group and the non-complication group [(23.4±3.3) vs (24.7±3.1), P=0.126]. As consequence of univariate analysis, there were no statistically significant differences between the two groups in terms of gender, tumor type, surgical site, preoperative pathological fracture, prosthesis type, adding plates, and bone resection length (P＞0.05). However, the complication group was significantly younger than the non-complication group [(53.7±18.1) years vs (62.9±15.3) years, P=0.026], suggesting that age might be a risk factor for postoperative complications. The cumulative complication risks at 1 year, 2 years, 5 years and 8 years after surgery with death as the competing risk were 7.5%, 9.5%, 21.4% and 21.4% respectively, while the cumulative risks of re-operation were 3.7%, 3.7%, 6.8% and 6.8% respectively. By the last follow-up, 55 patients died due to the disease, accounting for 50.9% among the 108 patients, including 8 cases (30.8%) died in the 26 patients with primary bone tumors, and 47 cases (57.3%) died in 82 patients with metastatic tumors. Kaplan-Meier survival analysis showed that the survival rates at 1 year, 2 years, 5 years and 8 years were 81%, 56.6%, 35.9% and 26.1%, respectively. [Conclusion] The prosthetic reconstruction of bone defects secondary to segment resection of extremity long bone shaft tumors can effectively restore limb function and achieve early weight-bearing. However, aseptic loosening and structural failure are the main complications, especially in the younger patients. Adding plate fixation and personalized prosthesis design may help improve stability. Long-term survival patients need to pay attention to the long-term failure risk of prostheses.
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YANG Yun, YANG Hua-qing, ZHANG Yao-hua, YANG Qi-chang, HAN Qing-hai, ZHAO Dian-zhao, QU Long
2025,33(14):1272-1278, DOI: 10.20184/j.cnki.Issn1005-8478.120207
Abstract:
[Objective] To explore the clinical outcome of the nose ring drainage (NRD) combined with tibial transverse transport (TTT) in the treatment of Wagner grade III/IV diabetic foot (DF). [Methods] A retrospective research was conducted on 38 patients who had Wag- ner grade III/IV DF treated in the Department of Orthopedics of Beijing Rehabilitation Hospital, Capital Medical University from March 2019 to October 2023. Based on the doctor- patient communication, 17 patients received the NRD combined with TTT ( the drainage group), while other 21 patients underwent TTT without NRD (the non-drainage group). The documents regarding treatment period, followup and auxiliary examination were compared between the two groups. [Results] The drainage group proved significantly superior to the nondrainage group in terms of hospital stay [(18.5±5.2) days vs (23.7±5.9) days, P=0.027], antibiotic adminstration time [(14.1±5.3) days vs (21.3±8.2) days, P=0.013], wound debridement times [(1.2±0.1) vs (2.0±0.2), P=0.047] and frequency of dressing changes [(6.8±1.2) vs (11.5±3.6), P=0.012]. During the follow-up period lasted for (28.5±6.8) months, the drainage group had significantly lower recurrence rate than that the non-drainage group (6.7% vs 17.7%, P=0.029), while the former got wound healing significantly earlier than the latter [(82.4± 18.6) days vs (102.8±23.5) days, P＜0.001]. As for blood tests, the WBC, NEU, PCT, CRP, ESR, and IL-6 were significantly improved in both groups with time preoperatively, 1 week, and 1 month after the operation (P＜0.05). The drainage group was significantly better than the non-drainage group in terms of CRP [(29.0±5.2) mg/L vs (46.6±6.1) mg/L, P=0.002], ESR [(28.2±6.0) mm/h vs (43.0±8.2) mm/h, P= 0.035] and IL-6 [(48.5±8.9) pg/mL vs ( 71.5±12.0) pg/mL, P=0.014] 1 week postoperatively. [Conclusion] The NRD combined with TTT in the treatment of DF can fundamentally improve the blood supply to the distal limbs, ensure thorough and unobstructed drainage, thereby shortening the duration of antibiotic adiministration and other treatment, and reducing the recurrence rate.
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TIAN Peng, ZHANG Ling, DING Xiao-lin, HAN Jin-xue, WAN Hao, LU Chang, WANG Ke-ju
2025,33(14):1279-1285, DOI: 10.20184/j.cnki.Issn1005-8478.110815
Abstract:
[Objective] To search the risk factors of postoperative complications in rheumatoid foot. [Methods] A retrospective study was conducted on 147 patients who had rheumatoid foot treated surgically from January 2013 to September 2024. The incidence of postoperative complications was statistically analyzed. Univariate comparison and binary logistic regression were used to search the factors related to postoperative complications of rheumatoid foot. [Results] Among the 147 patients, 16 patients (10.9%) had complications, including 8 with poor incision healing (5.4%), 4 with postoperative infection (2.7%), 2 with deformity recurrence (1.4%), and 2 with internal fixation failure (1.4%), while the remaining 131 patients (89.1%) had no complications. Regarding univariate comparison, the complication group was significantly higher than the non-complication group in the following items, including age [(68.6±7.4) years vs (60.4±7.0) years, P=0.004]. BMI [(27.9±3.3) kg/m2 vs (24.2±3.9) kg/m2 , P=0.018], cortical steroid use dosage [low/medium/high, (3/8/5) vs (13/96/22), P＜0.001] and duration [(121.5±14.6) months vs (62.1±11.3) months, P＜0.001], immunosuppressant use dosage [low/medium/high, (3/7/6) vs (16/89/26), P＜ 0.001] and the duration [(116.2±10.5) months vs (70.3±13.8) months, P＜0.001], smoking [yes/no, (11/5) vs (39/92), P=0.021], diabetes [yes/ no, (14/2) vs (23/108), P＜0.001], and operation time [(167.4±8.3) min vs (143.7±20.2) min, P=0.003]. As results of binary logistic regression, the age (OR=2.413, 95%CI: 1.345~4.578, P=0.021), diabetes (OR=2.983, 95%CI: 1.005~8.345, P=0.004), cortical steroid and immunosuppressant use (OR=3.278, 95%CI: 1.003~9.796, P＜0.001) were the independent risk factor for postoperative complications of rheumatoid foot. [Conclusion] The patients with advanced age, diabetes, cortical steroid and immunosuppressant useage are at higher risk of postoperative complications in rheumatoid foot , and perioperative management should be strengthened in clinical practice to reduce the incidence of complications.
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SUN Jing-tao, HU Yong-cheng, ZHAO Zhi-hui, WANG Yong-qing
2025,33(14):1286-1294, DOI: 10.20184/j.cnki.Issn1005-8478.120073
Abstract:
The objective of this study was to investigate the clinical features and surgical methods for cervical intraspinal osteochondro- ma complicated with spinal cord compression, as well as the consequence of progressive resection from the base. Firstly, two patients were reported, who underwent progressive resection from the base for cervical intraspinal osteochondroma complicated with spine cord compression. The surgery was successfully operated with the tumors removed completely, and the neurological function of the patients improved to different degrees after operation, without severe complications. In addition, a systematic search on the cervical intraspinal osteochondroma was conducted in the literature database. A total of 16 papers were included, involving 7 patients. Of them, 13 patients (76.5%) had the tumor with base on the cervical lamina, including the posterior arch of C1, 3 patients (17.6%) had the tumor with base on the posterior margin of the vertebral body, and 1 (5.9%) had the tumor based on the facet. In 13 articles the overall shape of the tumor was described, with the basal part smaller than the maximum cross-section of the tumor in 11 cases (84.6%), and the irregular shape in 2 cases (15.4%). Among the 17 cases included, 14 patients whose tumor originated from a location other than the posterior margin of vertebral body underwent posterior approach operation, including laminectomy and tumor resection; 2 of the 3 patients whose tumor originated from the posterior margin of vertebral body underwent combined anterior and posterior approach surgeries to better excise the tumor, protect the dural sac and maintain cervical stability, and the remaining 1 patient underwent anterior surgery. In conclusion, progressive resection from the base is an effective treatment method, and accurate preoperative evaluation, fine operation and strict postoperative observation are the key to improve the success rate of surgery and reduce complications.
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LIU Jin-wei, ZHANG Jingyu, LIU Yan-cheng, HU Yong-cheng, GUO Xiao-lei, XU Wei-guo
2025,33(14):1295-1302, DOI: 10.20184/j.cnki.Issn1005-8478.12009A
Abstract:
Development of 3D printing technology provides the basis for the innovation and clinical application of personalized artificial vertebrae. 3D printed artificial vertebral body can be accurately reconstructed and achieve immediate stability. With pore structure of the distal and proximal contact surfaces of the artificial vertebral body like trabecular bone, the endplate of the vertebral body might achieve bone ingrowth and finally obtain permanent stability. Based on the advanced retrieval function of Web of science, 7 782 literatures on 3D printed orthopedic medical devices published from 1990 to 2023 were retrieved, with explosive growth beginning in 2012 and the largest growth from 2019 to 2020. In term of literature visualization analysis, China (30.7%) was far ahead and ranked first in the world, while the United States (20.7%) ranked second. The total number of articles published by China and the United States accounts for more than half of the world's total. Medical interaction is the most prominent feature of personalized 3D printed medical devices different from traditional medical devices, and the doctor team should master the relevant principles and processes of 3D printing, propose the requirements of implant design, and implement the necessary verification of functional suitability and anatomical matching. Personalized artificial vertebra can be customized and patient-matched. The artificial vertebra is divided into two parts: the main body of the vertebra and the auxiliary device. The auxiliary fixation devices are added according to the actual needs of the implant design. Functional 3D printed medical devices loaded with growth factors, anti-tumor drugs, anti-tuberculosis drugs through surface modification is one of the future development directions.
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LI Si- ying, DONG Yi-feng, JIA Xi-hui, WANG Hong-yu, LUN Deng-xing
2025,33(14):1303-1309, DOI: 10.20184/j.cnki.Issn1005-8478.120399
Abstract:
[Objective] This study uses RNA transcriptome sequencing combined with bioinformatics analysis, aiming to identify core genes closely related to the occurrence and development of osteosarcoma, and to explore their functional annotations and the signaling pathways involved. [Method] We collected tissue and blood samples from osteosarcoma patients: including one tumor tissue sample each from the central and marginal regions and a corresponding whole blood sample; simultaneously collecting two peripheral blood samples from patients and three peripheral blood samples from healthy controls, for RNA transcriptome sequencing. We applied bioinformatics to identify differentially expressed genes (DEGs) among different samples, and performed Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses on the selected DEGs. [Results] When comparing the tumor central region with the peripheral region, a total of 4 900 differentially expressed genes were identified. In the comparison between tumor whole blood and the patient's peripheral blood, 5 312 DEGs were obtained. Meanwhile, between the patient's peripheral blood and healthy control peripheral blood, 13 549 DEGs were screened. Pathway enrichment results show that the DEGs from the tumor central region compared to the peripheral region are significantly enriched in immune- and inflammation-related pathways such as the PI3K–Akt signaling pathway, cytokine–receptor interaction, and ECM–receptor interaction. [Conclusion] Differentially expressed genes in various sites of osteosarcoma and blood samples are significantly enriched in immune regulation and inflammation-related signaling pathways, suggesting that these pathways may play important roles in the pathogenesis and progression of osteosarcoma.
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LIU peng, YU Yong-zhi, ZHAN Chun-rui, AN Yi-xian, LI Bo, WANG Xing-bo
2025,33(14):1310-1314, DOI: 10.20184/j.cnki.Issn1005-8478.120188
Abstract:
[Objective] To research the setting time and the sustained-release characteristics of epirubicin composed with calcium sulfate bone cement in different doses to provide the theoretical basis for the clinical application of anti-tumor drug calcium sulfate bone cement. [Method] The epirubicin was mixed with calcium sulfate bone cement in different mass ratios, including the blank control group, 0.2% group, 0.5% group and 1% group to prepare the test specimens of epirubicin composited with calcium sulfate bone cement. The final setting time of their preparation was recorded. The specimens of calcium sulfate bone cement containing the anti-tumor drug in each group were placed in the simulated body fluid extraction. The extract solutions at each time point, including 1, 3, 5, 7, 10, 20 and 30 days were retained and the concentration of epirubicin in the extract was mesearued by high performance liquid chromatography. The percentage of drug release at each time point to the total was calculated, and the corresponding curve was plotted. [Result] The final setting time of calcium sulfate bone cement showed no significant difference between the blank control group and the 0.2% group and the 0.5% group [(986.0±5.3) s vs (982.0±6.1) s vs (988.0±11.1) s, P＞0.05], while the setting time of the 1% group was significantly shortened compared with the the blank control group [(986.0±5.3) s vs (767.3±16.2) s, P＜0.001]. The daily released amount of each group reached the peak on the third day of the in vitro release test, then gradually decreased. After the 10th day, it was released slowly at a relatively stable concentration. By the 30th day, there was still release. [Conclusion] Epirubicin can be released from the calcium sulfate bone cement complex, reaching its peak on 3 days, and eventually releasing slowly and persistently at a stable drug concentration. The addition of epirubicin to calcium sulfate does affect the setting time of calcium sulfate bone cement.
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LIU Jin-wei, GUO Ch? uan-hao, ZHANG Jing-yu, LIU Yan-cheng, LUN Deng-xing, XU Wei-guo, HU Yong-cheng
2025,33(14):1315-1320, DOI: 10.20184/j.cnki.Issn1005-8478.120265
Abstract:
[Objective] To introduce the surgical technique and its preliminary clinical outcomes of the sandwich bone grafting for bone defect secondary to curettage of the distal femoral giant cell tumor. [Methods] From January 2016 to December 2024, a total of 25 patients received this surgical treatment for bone giant cell tumor of the distal femur. After the patients were anesthetized, they were placed in a 30° supine position on the affected side. The surgical exposure was carried out along the lateral intermuscular space to the bone surface of the femur. A bone fenestration was made with an electric drill, and the entire lesion was exposed as much as possible within the visual field. The tumor was thoroughly removed with curettes in sequence. The tumor wall was cauterized at a high temperature by electrocoagulation, and then was polished with a high-speed burr with the articular cartilage and the outer subchondral bone preserved intact. A suitable femoral plate was pre-placed and fixed on one side with a screw, while the remaining screws measured in length. The artificial bone material was evenly placed on the the articular side in a layer with thickness of 10~15 mm, then, gelatin sponge was placed, and finally bone cement was poured into the remaining tumor cavity. The inactivated bone fragments harvested from fenestration were replanted, the preplaced plate was positioned correctly, and the screws were sequentially tightened for fixation before the bone cement solidified. The knee joint was flexed and extended to exclude the overflow of bone cement into the joint cavity. [Results] All patients had the surgical procedures performed successfully, and were followed up ranging from 6 to 84 months. The average distance between the distal end of the plate and the articular surface of the femur on the postoperative X-ray in the anteroposterior position was ranged from 0 mm to 56mm with a mean of (13.0± 2.5) mm, with the average healing time of bone graft ranged from 13 weeks to 22 weeks in a mean of (17.6±4.2) weeks. At the latest followup, the Musculoskeletal Tumor Society (MSTS) was of (26.0±3.2) (ranging from 21 to 30 points). Regarding adverse events, 4 cases were of local recurrence, 1 case of severe lameness, and 2 cases of local rejection after the operation, however, no infection, deep vein thrombosis of the lower limb and other complication were noted in anyone of them. [Conclusion] The sandwich bone grafting for the distal femoral bone giant cell tumor is technically feasible, provides immediate stability and increases the success rate of joint preservation, and achieves satisfactory preliminary clinical consequence.
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ZHANG Qi-dong, LI Tong, WANG Wei-guo, CHENG Liming, HUANG Cheng, DING Ran, LIU Zhao-hui, GUO Wan-shou
2025,33(14):1321-1325, DOI: 10.20184/j.cnki.Issn1005-8478.120012
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical outcomes of 3D printed partial femoral head replacement for osteonecrosis of the femoral head. [Methods] From November 2022 to January 2024, a total of 14 patients, aged of (45.6± 10.1) years in an average, underwent partial femoral head replacement for osteonecrosis of femoral head. The individualized partial femoral head replacement prosthesis and patient-specific instruments (PSI) were made by 3D printing technique before operation. After the femoral head was completely exposed with protecting its blood supply, all necrotic tissues in the femoral head, including the sclerotic bone affecting the molding, were completely removed by curetting and grinding until the healthy cancellous bone with bleeding exposed. The excised bone surface of the femoral head was trimmed to a concave shape to match undersurface of the prosthetic component precisely by PSI. Two fixation column holes were drilled using the PSI guide, and a test mold was installed for testing to ensure proper articular matching of the joint. After irrigation to remove all bone debris and soft tissue residue, the customized femoral head partial prosthesis was installed to reconstruct a smooth articular surface of the femoral head. Finally, the hip was reduced to ensure perfect matching between the femoral head and acetabulum without limited range of motion, subsequently, the wound was irrigated, and the joint capsule and incision were sutured. Periopera- tive management was conducted based on the concept of enhanced recovery after surgery (ERAS). [Results] All the 14 patients had partial femoral head replacement performed successfully, with operation time of 1.5~3 hours, intraoperative blood loss of 200~500 mL. Compared with those preoperatively, the VAS score [(7.1±0.7), (2.2±1.3), P＜0.001], hip flexion-extension range of motion (ROM) [(100.7±17.7)°, (113.6±10.6)°, P=0.011] and Harris score [(50.8±7.5), (86.8±4.7), P＜0.001] were significantly improved at the latest follow-up lasted for a mean of (12.4±6.4) months. [Conclusion] This partial femoral head replacement does achieve satisfactory short-term clinical outcome for osteonecrosis of the femoral head by removing the lesion and implanting an individualized partial femoral head prosthesis for local replace-ment, with advantages of preserving normal bone, rapidly restoring the stability of femoral head and restoring the smooth articular surface.
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LIU Yang, LIU Hao, ZHANG Yuan-jian, CUI Lu-kuan, GE Wen-long, ZHOU Shi-meng, HU Yong-cheng
2025,33(14):1326-1331, DOI: 10.20184/j.cnki.Issn1005-8478.120400
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical outcome of periosteum preserved fenestration through Watson-Jones approach for curettage of benign tumors in the proximal femur. [Methods] From January 2022 to September 2024, 14 patients received periosteum preserved fenestration through Watson-Jones approach for curettage of benign tumors in the proximal femur. After general anesthesia or subarachnoid anesthesia, the patient was placed in the supine position or the semi-lateral position. The incision started approximately 3~4 cm below the outer side of the anterior superior iliac spine, passing the the femoral greater trochanter, and extended no the lateral side of the femur. Retracting tensor fascia forward and the gluteus medius backward, detach the vastus lateralis from the greater trochanter and reflect it distally with the periosteum intact. The fenestration range was determined according to the size of the lesion, usually the site in front of the proximal femur. The periosteum was sharply incised at the proximal, distal and lateral borders of the predetermined fenestration. After drilling through the cortical bone, the cortical fragment was cut on the three sides with an osteotome, while preserve the integrity of the medial periosteum flap. At the medial edge of the fenestration, the bone cortex was pried open after drilling through the periosteum to form a cortical bone flap with pedicle of the medial periosteum for exposure of the lesion. Curetting the lesion sequentially, if it was an active tumor, a high-speed burr could be used to further grind off the irregular bone cortex and bone ridge on the inner wall of the tumor cavity, or other means, such as electrocautery and distilled water irrigation used to inactivate the possible remaining tumor cells. After the tumor was scraped off, the incision was rinsed with a large amount of normal saline. After that, internal fixation of the proximal femur with plate or intramedullary nail was performed, and then, bone grafts put into out in the tumor cavity. After confirming sufficient bone grafting, the opened bone fragment was reset, a drainage tube placed, and the incision closed in layers. [Results] All patients had the operation performed successfully with operation time of 120~270 min and intraoperative blood loss of 30~1 000 mL. All patients were followed up for 12 to 36 months. Except one case where the plate fracture occurred, all patients had the lesions healed smoothly without any complications. Compared with those preoperatively, the VAS score [(3.1±1.8), (0.1±0.4), P＜0.001] and Harris score [(80.2±24.5), (98.9±2.2), P=0.014] were significantly improved at the last follow-up. [Conclusion] The Watson-Jones approach can safely and conveniently expose benign intramedullary tumors in the proximal femur, with advantages of less injury and less bleeding. In addition, this cortical fenestration technique with periosteum preservation is conducive to bone healing at the fenestration site and improves the therapeutic consequence.
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ZHU Kai, LI Shuang, ZHANG Hong-liang, LIU Jin-wei, ZHANG Jing-yu, HU Yong-cheng, LIU Yan-cheng
2025,33(14):1332-1335, DOI: 10.20184/j.cnki.Issn1005-8478.120333
Abstract:
[Objective] To explore the clinical efficacy and safety of endoscopic curettage and bone grafting in the treatment of benign or borderline bone tumors of the extremities. [Methods] A total of 38 patients with benign/borderline bone tumors of the extremities with a maximum diameter of ≤5 cm from May 2023 to September 2024 were included into this study. The lesion was removed and the tumor cavity treated with bone grafting or drug injection under endoscope. The surgical conditions and complications were recorded with using the pain NRS score and MSTS functional score after the operation. The imaging manifestations were evaluated using the modified Neer classification, and the recurrence was observed. [Results] All patients had operations performed successfully with operation time of (95.8±28.9) min and the blood loss of (16.3±18.6) mL. Of them, 3 patients developed lower extremity venous thrombosis after the operation, but without serious adverse consequences. During the followup process, there was no pathological fracture or tumor recurrence. With time elapsed 1 month, 3 months, 6 months and 1 year postoperatively, the NRS score [(1.9±0.6), (0.9±0.4), (0.0±0.0), (0.0±0.0), P＜0.001] and MSTS score [(77.7±10.0), (86.1±8.1), (93.2±4.8), (100.0±0.0), P＜0.001] were significantly improved. As for imaging, the modified Neer's grade for lesion healing was improved significantly over time [A/B/C/D, (0/38/0/0), (32/6/0/0), (31/5/0/0),(18/3/0/0), P＜0.001]. At the last follow-up, all patients achieved complete lesion healing without recurrence. [Conclusion] Endoscopic debridement and bone grafting for the treatment of benign or borderline bone tumors of the extremities is safe and effective, with advantages of less trauma and faster functional recovery.
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LIU Xiao-feng, HE Xu, LIN Wen-ping
2025,33(14):1336-1338, DOI: 10.20184/j.cnki.Issn1005-8478.110628
Abstract:
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ZHOU Shi-meng, LIU Yang, ZHANG Tong-yu, HU Yong- cheng
2025,33(14):1339-1341, DOI: 10.20184/j.cnki.Issn1005-8478.120248
Abstract:
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LIU Fu-zea, BAI Zhuo-songa, WANG Haia, MA Guo-taob
2025,33(14):1342-1344, DOI: 10.20184/j.cnki.Issn1005-8478.110249
Abstract:
