| Section 1 A retrospective analysis of limb salvage treatment for malignant tumor ofscapulaObjective To investigate functional and oncological results of different limb salvage strategies for scapular malignant tumor.Methods A retrospective analysis of 19 patients received limb salvage surgery with malignant tumor of the scapula from May 2001 to May 2012 was performed. There were 12 males and 7 females and the mean age was 35.7 years(range: 6-60 years). Tumors include 4 metastatic tumors and 15 primary malignant tumors. According to Enneking surgical staging: stage ?B 15 cases, stage ? 4 cases. In 4 metastatic cases of limb salvage, 2 cases received partial resection of the scapula and scapulohumeral joint was preserved, 1 cases received humeral head suspension after complete scapula resection, 1 case received constrained shoulder prosthesis after complete scapula resection. In 14 primary malignant tumor cases of scapula limb salvage, 7 cases received partial resection of the scapula and the glenoid and scapulohumeral joint wsa preserved, 1 case received scapula allogeneic transplantation, 1 case received intralesional curettage and bone cement filling, 1 case received inactivated autologous scapula replantation, 3 cases received humeral head suspension after complete scapula resection, 2 cases received constrained shoulder prosthesis after complete scapula resection. Function was documented according to MSTS(1993) functional scoring system.Results 19 cases were followed up with the mean period of 36 months(range: 6-60 months). In 6 dead cases, 2 cases of scapula metastases from liver cancer and 1 case of scapula metastases from angiosarcoma died of primary tumors metastases and organ failure, 1 case with osteosarcoma died of lung metastasis, 1 case with scapula synovial sarcoma died of local recurrence with concurrent lung metastases, 1 case with scapula myeloma died of non-primary disease. The score of MSTS(1993): 1 case of allogeneic scapula got 18 points, 1 case of inactivated autologous replantation got 26 points, 10 cases of scapula partial resection and glenoid preservation got 24.2 points on average, 4 cases of scapula total removal and the humeral head suspension got 21 points on average, 3 cases of constrained shoulder prosthesis after complete scapula resection got 24.7 points on average.Conclusions Both partial scapulectomy with the preservation of glenoid, and total scapulectomy with constrained scapular prosthesis could maximally preserve the shoulder functions. Inactivated autologous replantation can be regarded as an alternative for children with scapula malignant tumors. Prosthesis, autologous or allogeneic scapula can restore the shoulder stability and functions, and also improve the cosmetic appearance. Section 2 A retrospective analysis of limb salvage for malignant bone tumors aroundthe kneeObjective To investigate the functional and oncological results of different limb salvage strategies for malignant bone tumors around the knee.Methods We retrospectively reviewed 85 patients who underwent limb salvage in our department from January 2010 to December 2015. The preoperative diagnoses were osteosarcoma in 78 patients, Ewing's sarcoma in 5, chondrosarcoma in 1 and synoviosarcoma in 1. There were 52 males and 33 females and the mean age was 18.4(range: 8 ~65). According to Enneking surgical staging: stage?B 1 case,stage?A 3 case, stage ?B 79 cases, stage ? 2 cases. The tumors were located in 49 distal femurs and 36 proximal tibias. 54 patients received reconstruction with prosthesis; 10 patients received reconstruction with allograft and vascularized fibular flap; 7 patients received reconstruction with devitalized bone stump and vascularized fibular flap; 6 patients received reconstruction with allografts; 8 patients received reconstruction with APC. Function was documented according to MSTS(1993) functional scoring system.Results The median follow-up was 24 months(range, 8–76 months). At the last follow-up, 23 patients died of tumor-related causes without reconstruction failure. 34(41%) patients developed pulmonary metastasis or multiple bone metastases.17(20%) patients developed local recurrence, 5 underwent surgery to treat recurrence in soft tissue, 5 ultimately received amputation, 8 patients developed local recurrence and pulmonary metastasis. The 3-year survival rate was 67.2% and the 5-year survival rate was 51%. The average MSTS functional score at last follow-up was 24.5 points.Conclusion Limb salvage has become the main treatment way for malignant tumors around the knee joint. On the premise of safe margin, it can maximally recover the knee joint function. The long term results of the reconstruction with composite consisting of devitalized bone stump and vascularized fibular flap need to be remains to be further studied. The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children has shown the patient's satisfactory results. However, to the surgical indications are strictly chosen. Section 3 A preliminary study of evaluating response to neoadjuvant chemotherapyin osteosarcoma based on dynamic contrast-enhanced MRIObjective To investigate the analysis system to evaluate response to neoadjuvant chemotherapy in osteosarcoma based on dynamic contrast-enhanced(DCE) MRI.Methods From March 2014 to July 2015 15 patients with diagnosis of osteosarcomas in long bones were included in current study, there were 8 males and 7 females. The mean age was 15.8 years old(range: 7-23 years). The tumors were located in the 9 distal femurs and 6 distal tibias. DCE MRI examinations were performed in all patients after neoadjuvant chemotherapy was completed. All original MRI files(DICOM) were collected. According to the time-enhancement curve of DCE image, the total tumor area, tumor tissue, necrotic tumor tissue and the tissue with the viability between liveness and necrosis were respectively segmented. Three-dimensional reconstruction was performed and the tumor volume and necrosis rate of various parts were calculated. All patients underwent radical surgical resection of the tumor. Six sections with the most complex signals were selected for analysis. The rate of tumor necrosis was calculated by assessing the medical image data and histology staining, respectively.Result There was a significant difference between necrosis rate from imaging data(0.55±0.11) and histopathological data(0.81±0.12) in 69 sections(P<0.01). The imaging necrosis rate and histological necrosis rate was positively correlated.(r=0.69,P<0.01).Conclusion Automated analysis system evaluating response to neoadjuvant chemotherapy in osteosarcoma based on DCE MRI can identify residual viable tumor tissue and necrotic tumor tissue. It can estimate the rate of tumor necrosis. But its accuracy remains to be a large sample of further research. |
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