Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
ObjectiveTo evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions.MethodsThe clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function.ResultsThe operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones (P<0.05).ConclusionThe treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.
ObjectiveTo evaluate the clinical efficiency of balloon occlusion of the lower abdominal aorta in blood loss control during resections of pelvic or sacral tumor. MethodsFrom April 2006 to April 2010, 24 patients diagnosed as pelvic or sacral tumor in this hospital were collected. Balloon occlusion of the lower abdominal aorta to control blood loss was used in these cases. Balloon catheters were placed via femoral artery to occlude the abdominal aorta before operation. Resections of pelvic or sacral tumors were performed after occlusion of abdominal aorta, duration no longer than 60 min per occlusion, if repeated occlusions needed, 10－15 min release in between. Results Average operative time was 153 min (range 40－245 min) and average blood loss was 310 ml (range 200－650 ml) in this series, and the procedure helped in clearly identifying the surgical margin, neurovascular structures, and adjacent organs. The blood pressure were stable in all the cases. No postoperative renal function impairment was found in all the cases, no side injuries to adjacent organs was identified. One case complicated with thrombosis in iliac artery at same puncture side was successfully treated with catheter thrombectomy. ConclusionIntraoperative abdominal aorta balloon occluding in pelvic and sacral tumor surgical operation could reduce blood loss, and improve the safety of operation.
Objective To summarize the advances of total femur replacement in recent years. Methods The literature related to total femur replacement was reviewed, and the indications, techniques, prosthesis design, complications, rehabilitation, and function were summarized. Results The indication of total femur replacement is a wide involvement of the femur, skip lesions and a huge bone defect in revision. Watson-Jone is the main incision in the proximal, and then the full length of the thigh to the patella. Vascular and nerve bundle, abduction muscles are well protected, and combined or costumed prosthesis are replaced. The prosthesis design progresses, showing a diversified prostheses. Complication is frequent and varied. Rehabilitation in early stage is physical therapy, weight training is evolutionary. The main function evaluation system is Musculoskeletal Tumor Society (MSTS) score. Conclusion Total femur replacement is effective in limb salvage. Large sample size and long-term follow-up study should be carried out to unify indications and functional exercise standards and reduce postoperative complications.
Objective To find an effective method of surgical treatment of fibrous dysplasia of bone involving the proximal femur. Methods From January 2001 to January 2006, 57 patients with fibrous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females, aging 8-50 years (mean 22 years). Thirty-five patients wereinvolved one bone and 22 patients were involved more than two bones. According to Guille’s classification, there were 34 cases of type A, 8 cases of type B, 8 cases of type C and 7 cases of type D. Fourteen cases compl icated by coax varus and the neck-shaft angle of femur was 78° on average (55-100°). The duration of the disease was 2.3 years on average (4 months to 10 years). The choice of the various operative procedures depended on the qual ity of the bone and the extent of the lesion. When the qual ity of the bone was good, then curettage and bone-grafting was performed. When the qual ity of the bone was poor, curettage and bone-grafting combined with internal fixation was performed. Medial displacement valgus or valgus osteotomies were used to treat fibrous dysplasia of bone involving the proximal part of the femur with coax varus. Results All patients were followed up for 6 months to 5 years with an average of 2.8 years. All bone graft were absorbed sl ightly at 3 months and markedly at 10 to 14 months postoperatively. The femoral mechanical al ignments were corrected completely radiologically in patients compl icated by coax varus; the average neck-shaft angle was corrected from 78° (55-100°) preoperatively to 122° (95-130°) postoperatively. The relative length of femur was increased 1.8-3.6 cm (mean 2.7 cm). After operation, 49 patients could walk without support, 5 with claudication, 3 ambulated with the aid of unilateral cane. Pain disappeared in 52 patients and pain was improved in 5 patients. No infections and recurrent fracture and progression of the deformity occurred in all patients. Conclusion Impactionallograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal fixation must be used when the qual ity of the bone is poor. Medial displacement valgus or varus osteotomies can correct varus deformity, improve function, as well as restore biomechanical axis of femur. It is also able to effectively eradicate lesions and prevent recurrence.
ObjectiveTo evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.MethodsThe clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.ResultsAll the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).ConclusionTaking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.
目的 通过对保留不同平面骶骨的新鲜人骨盆模型进行生物力学测试，分析骶骨切除平面与骨盆稳定性的关系，明确骶骨切除保留至何种程度时需行腰骶髂稳定性重建。 方法 选用6具正常成年男性新鲜尸体腰5-骨盆标本，采用200 N增量分级加载，以1.4 mm/min速率平稳加载直至1 000 N，依次测试保留完整骶骨及不同平面骶骨切除骨盆模型的最大主应力、剪切应力、位移及刚度变化，比较各组间的差异。最后测量1/2S1组骨盆环的极限载荷，记录骨折发生部位和骨折类型。 结果 随骶骨切除平面增高，最大主应力、剪切力及骶骨下沉位移在各测试点均有不同程度增大，骨盆的轴向刚度不断减小。当切除平面达骶1时，变化明显，尤其以经过骶1下1/4～下1/2时变化显著，与完整骶骨组比较，差异有统计学意义（P＜0.05）。骶1椎体下1/2平面切除后，骨盆的极限载荷是（2 375.97 ± 162.41）N，骨盆的破坏形态为经骶髂关节或骶椎的骨折。 结论 骶骨切除范围与骨盆环的稳定性密切相关，随着骶骨切除平面升高，残留骶髂关节各种应力急剧增高，骨盆的稳定性明显下降。当骶骨切除涉及骶1椎体时，极易发生骨折，需要进行腰骶髂局部重建以增强骶髂关节的稳定性。
ObjectiveTo investigate the procedure and effectiveness of total femoral replacement for treating femur malignant tumor.MethodsThe clinical data of 9 patients with femoral malignant tumors who underwent total femoral replacement between July 2013 and March 2017 were retrospectively analyzed. There were 5 males and 4 females, aged 16-75 years with an average of 44.8 years. The disease duration ranged from 2 to 6 months with an average of 3.5 months. There were 5 cases of osteosarcoma (3 cases were staged as Enneking ⅡB, 2 cases were staged as Enneking Ⅲ), 1 case of malignant fibrosarcoma (staged as Enneking ⅡB), 1 case of chondrosarcoma (staged as Enneking ⅠB), 2 cases of femoral muti-metastasis of lung cancer with pathological fracture. The visual analogue scale (VAS) score and the quality of life (QOL) score of the tumor patients were evaluated before operation and at 3 months after operation. The Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were evaluated at last follow-up.ResultsNine patients were followed up 11-58 months, with an average of 21 months. No complication such as wound infection, joint dislocation, and nerve injury occurred. One patient developed popliteal vein thrombosis, and 2 patients with osteosarcoma died of tumor progression. The VAS score and QOL score at 3 months after operation were 3.2±1.2 and 40.6±5.4 respectively, which were significantly improved when compared with preoperative ones (5.9±0.8 and 22.3±4.2 respectively) (t=11.314, P=0.000; t=–7.794, P=0.000). At last follow-up, the MSTS score was 15-29 with an average of 21.1, and the HHS score was 44-90 with an average of 66.5.ConclusionTotal femoral replacement is an effective limb salvage procedure for the treatment of femoral malignant tumors, which can effectively restore the weight-bearing and walking function, relieve pain, and improve the quality of life.
ObjectivesTo compare the role of problem-based learning (PBL) combined with team-based learning (TBL) methods with traditional lecture-based learning in the clinical probation teaching of bone tumor and explore which teaching method is more suitable for clinical probation teaching of bone tumor.MethodsThe 60 students of the 2013 grade five-year program medical students in West China Clinical College of Sichuan University who were undergoing clinical probation teaching in the orthopedic bone tumor subspecialty of West China Hospital of Sichuan University in April 2017 were randomly divided into 2 groups. The trial group adopted PBL combined with TBL teaching method, the control group adopted traditional teaching method. The general situation of the two groups of students were compared. After the end of the probation, the two groups of students’ knowledge mastery, comprehensive ability and satisfaction were compared.ResultsThere was no significant difference in the gender composition and the assessment scores of the last semester diagnostics course of the two groups of students (P>0.05). After the probation, in terms of knowledge mastery, the trial group’s theoretical test scores (89.13±3.47 vs. 87.03±2.99; t=2.511, P=0.015), teacher evaluation (88.33±4.48 vs. 85.90±3.96; t=2.231, P=0.030) and student evaluation (89.83±2.97 vs. 87.47±2.91; t=3.117, P=0.003) were better than those of the control group. In terms of comprehensive ability, the trial group’s ability in reasoning and induction, information management, goal completion, and communication (17.90±1.09, 18.00±0.91, 18.00±1.02, 17.90±1.13) were better than those of the control group (17.20±1.13, 17.13±1.20, 17.10±1.24, 16.83±1.29), the differences were statistically significant (P<0.05). There was no statistically significant difference in satisfaction between the two groups of students (P>0.05).ConclusionsPBL combined with TBL methods can improve the effect of clinical probation of bone tumors, deepen mastery of professional knowledge, improve comprehensive ability, and improve teaching quality.
Objective To explore the role and effectiveness of three-dimensional (3D) printing technology based on 3D multimodality imaging in surgical treatment of malignant bone tumors of limbs. Methods The clinical data of 15 patients with malignant bone tumors of the limbs who met the selection criteria between January 2016 and January 2019 were retrospectively analyzed. There were 6 males and 9 females, with a median age of 34 years (range, 17-73 years). There were 5 cases of osteosarcoma, 3 cases of chondrosarcoma, 2 cases of Ewing sarcoma, 1 case of hemangiosarcoma, 1 case of ameloblastoma, and 3 cases of metastatic carcinoma. The tumors were located in the humerus in 5 cases, ulna in 2 cases, femur in 3 cases, and tibia in 5 cases. The disease duration was 2-8 months (median, 4 months). Preoperative 3D multimodality imaging was administered first, based on which computer-assisted preoperative planning was performed, 3D printed personalized special instruments and prostheses were designed, and in vitro simulation of surgery was conducted, successively. Two cases underwent knee arthroplasty, 2 had semi-shoulder arthroplasty, 2 had proximal ulna arthroplasty, and 9 had joint-preserving surgery. Surgical margins, operation time, intraoperative blood loss, surgical complications, Musculoskeletal Tumor Society (MSTS) score, and oncological outcome were collected and analyzed. Results All 15 patients completed the operation according to the preoperative plan, and the surgical margins were all obtained wide resection margins. The operation time was 80-240 minutes, with a median of 150 minutes. The intraoperative blood loss was 100-400 mL, with a median of 200 mL. There was no significant limitation of limb function due to important blood vessels or nerves injury during operation. One case of superficial infection of the incision was cured after dressing change, and the incisions of the other patients healed by first intention. All patients were followed up 6-48 months, with a median of 24 months. Two of the patients died of lung metastasis at 6 and 24 months after operation, respectively. No local recurrence, prosthesis dislocation, or prosthesis loosening occurred during follow-up. At last follow-up, the MSTS score ranged from 23 to 30, with an average of 25. Conclusion3D printing tecnology, based on 3D multimodality imaging, facilitates precise resection and reconstruction for malignant bone tumors of limbs, resulting in improved oncological and functional outcome.