Objective To explore better approach of resecting tumoraround the anterior skull base and reconstructing the anterior skull base.Methods In November 2004, a 49-years-old male patient with intracranial recrudescent adenoid cystic carcinoma in the anterior cranial fossa was treated using modified transcranial approach. Neurosurgeon and rhinolaryngologist cooperated to excise the tumour completely, and to reconstruct anterior skull base using the pedicle periosteum temproal musculofascial flap(15 cm×10 cm) andthe pedicle flap of aponeurosis of occipitofron talis muscle and muscular fasciae（10 cm×6 cm）.Results After operation, the wound healed by first intention. Complication, such as infection and cerebrospinal rhinorrhea, did not occur. The patient was discharged 10 days after operation, and was followed up for 8 months, no local recurrence were investigated and no scar formed over the face.Conclusion The modified transcranial approachis a relatively novel exposure that enables the skilled cranial base surgeon tosafely resect many malignant lesions previously and to reconstruct the defect of anterior skull base together.
Objective To evaluate the effect of reconstruction withautograft implantation in total hip arthroplasty(THA) with regional acetabular deficiency. Methods From 1991 to 2000, 39 cases of THA with acetabular deficiency were conducted. Autogenous bone implantation was used to reconstruct the deficient acetabulum. Of the 39 patients, 25 were males and 14 were females. The age ranged from 34 to 62(45.2 on average). There were21 cases of developmental dysplasia resulted deficiency, 14 cases of fracture of femoral neck complicated with head necrosis(10 hips) and fracture of acetabulum(4 hips). The resected femoral heads or autologous ilium were made the wedgeshaped graft and implanted into the deficient acetabulum, which included 12 cases with cement THA and 27 with cementless THA.Of all the cases, 24 were followed up 2 to 10 years(6.7 years on average). Harris scores before operation were 18 to 50(38.1 on average). Results The limbs were lengthened by 2.4 cm on average. No serious complications were observed in these patients. Comparedwith the scores before the operation, the average Harris scores after the operation were 92.1(Plt;0.01)and 86.3(Plt;0.05) in the one-year and the latest follow-up respectively. The rates for the good were 91.7% and 83.3% in the one-year and the latest follow-up respectively.Conclusion The acetabular reconstruction with autograft in THA will bring better stability in those patients with acetabular deficiency. It is of significance in maintaining a long-term function in the replaced hip.
Objective To evaluate the results of chest wallreconstruction (CWR) in patients who underwent chest wall tumor resection accompanying huge chest wall defect. Methods From Jan. 1998 to Mar. 2003, 31 patients underwent CWR. Among them, 20 were male and 11 female. The age ranged from 8 to 72 years.The indications for resection were primary chest wall tumor in 21 patients, lung cancer with invasion of chest wall 6, recurrence of breast cancer 2, radiationnecrosis 1 and skin cancer 1. The number of rib resected was 2~7 ribs (3.6 in average). The defect was 20~220 cm2 (97.1 cm2 in average). Concomitant resectionwas done in 13 patients, including lobectomy or wedge resection of lung 10, partial resection of diaphragm 2, and partial sternectomy 1. Seven patients underwent soft tissue reconstruction alone(latissimus dorsi+greater omentum, latissimusdorsi myocutaneous flap, latissimus dorsi muscle flap), 5 patients bony reconstruction alone(Prolen web), and simultaneous BR and STR were performed in 19 patients(latissimus dorsi, pectorails major, latissimus dorsi+fascia lata, and Prolene web). Results Three patients (9.7%) developed postoperative complications. Postoperative survival period was 6~57 months with a median of 22 months. Conclusion A favorable clinical outcome can be achieved by CWR for the patients with hugechest wall defects that result from resection of chest wall tumors.
目的:探討脊柱轉移瘤患者的手術切除與脊柱穩定性重建的適應證與效果。方法：2003年4月至2008年4月，收治了脊柱轉移癌患者32例。腫瘤轉移部位:胸椎轉移22例，腰椎轉移7例，頸椎轉移3例。男性13例，女性19例。出現神經系統受損者27例，其中完全癱瘓者7例，不完全癱瘓者20例。全組患者均做了椎體切除、內固定術或后路椎板切除、椎管減壓內固定術或前后路聯合行360°脊椎切除固定一期重建脊柱穩定性。觀察術后局部疼痛緩解，神經功能恢復及脊柱穩定性情況。結果：隨訪時間為6～60個月，32例患者中，30例術后痛疼得到緩解。27例有神經功能損害的患者中，25例術后麻痹癥狀改善。3例完全癱瘓的患者中，2例在減壓術后ASIA分級提高了1~2個等級。術后影像學提示脊柱序列和椎間高度恢復。術后存活1年以上的患者22例，約占患者總數的69%。結論：外科切除與重建治療轉移癌所致椎體塌陷或不穩定造成嚴重的神經損害或機械性脊柱痛疼的外科療效肯定，能夠增加脊椎穩定性，提高生存質量。
目的:研究距骨骨折螺旋CT軸掃、多平面(MPR)和三維(3D)重建圖像的特點及其臨床意義。方法:收集距骨骨折患者術前螺旋CT資料12例,同時進行了MPR和3D重建圖像。著重分析距骨骨折線的走行、與關節面的關系、關節面塌陷程度等,并評價軸掃、MPR和3D重建圖像的優勢。結果:在12例距骨骨折者骨踝關節受累7例。MPR和3D重建圖像可直觀顯示骨折詳細情況。結論:螺旋CT軸掃、多平面和三維重建圖像相結合,可更好顯示距骨骨折的情況,能為臨床術前診斷和治療提供有價值的影像信息。
目的:介紹以骨間前動脈背側支為蒂的頭狀骨移位治療晚期月骨無菌性壞死。方法:對7例Lichtman分Ⅲ、Ⅳ期月骨無菌性壞死患者采用壞死月骨摘除,以骨間前動脈背側支為蒂的頭狀骨移位替代壞死月骨。結果:術后隨訪1～5年,平均32個月,移位頭狀骨有可靠血運,6例腕痛消失,1例仍有輕度腕痛,優良率100%。結論:應用該法替代月骨支撐腕關節,符合腕關節功能解剖,是治療Ⅲ、Ⅳ期月骨無菌性壞死的有效方法。
Objective To discuss the definition of complicated giant cell tumor of the bone and retrospectively analyze the treatment protocols and their therapeutic results so as to provide a clinical basis for reducing the postoperative recurrence of this kind of tumor. Methods From April 2001 to April 2005, 22patients (11 males and 11 females, aged 15-66 years) with complicated giant cell tumor of the bone were treated by the marginal or wide excision. The tumor was located in the distal femur in 10 patients, the proximal tibia in 5, theproximal femur in 2, the proximal humerus in 2, the hip bone in 2, and the distal radius in 1. The Campanicci′s grading system was used and the patients were grouped as follows: Grade Ⅱ in 4 patients, and Grade Ⅲ in 18. The functional results of the patients were assessed by the clinical examination. The reconstruction methods were used in the forms of osteoarticular allografting (14 patients) and total arthroplasty (8 patients). Results The analysis on the follow-up (6-48 months, averaged 23 months) of the 22 patients revealedthat the complicated factors were as follows: the tumor breaking through the cortex with an extraosseous mass; the tumor having pathologic fracture; the tumor representing more biologically-aggressive lesions; and the tumor having one or more local recurrences. Two patients (9%) had a local recurrence respectively 8 and 11 months after operation, but improved respectively by limb amputation and radiotherapy. Total arthroplasty achieved a better articular function than osteoarticular allografting. All the patients with osteoarticular allografts showed various degrees of the bone union of the allograft with the host bone. Conclusion The marginal or wide excision of this kind of complicated giant cell tumor of the bone combined withosteoarticular allograft or total arthroplasty can reduce the local recurrence of the tumor and achieve a certain degree of the articular motion function.