| Objective: The treatment of malignant bone tumors such as osteosarcoma usually adopts the comprehensive treatment mode of preoperative chemotherapy,operation and postoperative chemotherapy.Limb salvage has gradually become the main stream way to treat malignant bone tumors of distal femur instead of amputation.However,the application of limb salvage with self-joint preservation in the treatment of malignant bone tumors of distal femur is still controversial and challenging.Patients with osteosarcoma are prone to nausea,vomiting and other clinical symptoms during the treatment of high-dose cisplatin chemotherapy,and most of the patients can not be completely relieved by western medicine alone.The purpose of this study is to evaluate the clinical efficacy of this operation through a retrospective study,to explore the effect of improved Mirels score system on the choice of internal fixation in limb salvage surgery with self-joint preservation of distal femur,and to provide guidance for clinical work combined with finite element analysis.To evaluate the clinical efficacy of auricular point pressing in the treatment of nausea and vomiting caused by high-dose cisplatin in postoperative patients with osteosarcoma,and to provide clinical basis for external treatment of traditional Chinese medicine to alleviate vomiting causing by postoperative chemotherapy in patients with osteosarcoma.Methods: 1.The clinical data of 30 patients with distal femoral malignant bone tumors treated by limb salvage surgery in 960 Hospital of Chinese PLA from January 2004 to December 2019 were analyzed retrospectively.The patients were divided into steel plate group(n = 14)and intramedullary needle group(n = 16).The musculoskeletal tumor association score system(MSTS)was used to evaluate the limb function of the two groups after operation,and the modified Mirels score system was used to evaluate the tumor bone strength of the two groups before operation,and statistical methods were used to compare the two groups.Through the finite element analysis,the segmental resection of the distal femur preserving its own joint was simulated and fixed with steel plate and intramedullary needle respectively,and the stress distribution and displacement of the two groups of models were compared.2.From September 2018 to December 2020,adopting the research method of self-cross-control test,patients with osteosarcoma who received cisplatin chemotherapy in the Department of Orthopaedics of 960 Hospital of Chinese PLA were divided into auricular point group and western medicine group.The data of nausea,vomiting,appetite,fatigue and white blood cell count before and after chemotherapy were collected,and the data of the two groups were compared by statistical methods.Results:1.The average follow-up time of 30 patients with malignant distal femoral bone tumor with self-joint preservation was 54.3 months.At the last follow-up,13 patients died of lung metastasis.The average postoperative MSTS score was 26.7,the postoperative local recurrence rate was 10%(3/30),the postoperative bone fracture rate was 10%(3/30),and the postoperative nonunion rate was 20%(6/30).2.There was no significant difference in sex,age,operation time,blood loss,postoperative complications(recurrence,fracture,nonunion)and survival rate between plate group and intramedullary needle group(P>0.05).3.The average postoperative MSTS scores of steel plate group and intramedullary needle group were 27.1 ±1.6 and 26.4 ±1.9respectively.There was no significant difference between the two groups(P=0.245).4.The average bone strength score of steel plate group and intramedullary needle group was 9.3±2.1 and 7.3±1.4 respectively,and there was significant difference between the two groups(P=0.006).5.The stress distribution results of the finite element analysis show that the stress concentration areas of the two internal fixation models are at the level near the proximal osteotomy,and the maximum stress of the intramedullary needle model is larger than that of the steel plate model,but the maximum stress of the two models does not reach the yield strength of titanium alloy.6.The results of finite element analysis show that the displacement of the femoral head of the intramedullary needle model is 2.81 mm,which is larger than the 1.7mm of the steel plate model.7.There was no significant difference in leukocyte count between the two groups of patients with osteosarcoma who received cisplatin chemotherapy before and after chemotherapy(P>0.05).8.On the 2nd and 3rd day after administration of cisplatin,the complete control rate of nausea and vomiting in the ear acupoint pressing group was better than that in the western medicine group,and there was significant difference between the two groups(P< 0.05).9.On the second day after administration of cisplatin,the normal appetite rate of the auricular point pressing bean group was better than that of the western medicine group,and there was significant difference between the two groups(P<0.05).10.Within 4 days after administration of cisplatin,there was no significant difference in fatigue between the two groups(P> 0.05).Conclusions:1.In the treatment of malignant bone tumors of the distal femur,limb salvage surgery with preservation of its own joint has better limb function in the long term.2.According to the results of finite element analysis,both intramedullary nail and steel plate can be used for limb salvage of distal femoral joint,but the plate has better stability.3.Using the improved Mirels scoring system,combined with the finite element analysis results of distal femur modeling,when limb salvage surgery with self-preservation of distal femur is performed,patients with bone strength score less than 8 can choose intramedullary nail fixation,while plate fixation is more suitable for patients with bone strength score?8.4.Auricular point pressing can reduce the nausea and vomiting reaction of postoperative patients with osteosarcoma treated with cisplatin chemotherapy,improve the appetite of patients,and help to improve the quality of life of patients during chemotherapy. |
PDF Full Text Request