新辅助化疗下保肢治疗膝关节周围骨肉瘤患者的体会

目的探讨膝关节周围骨肉瘤患者施行保肢手术方案的优越性。方法 2001年1月~2009年12月我院收治并经病理活检确诊为膝关节周围骨肉瘤患者37例,其中24例行保肢治疗,13例截肢治疗,所有患者术前均行新辅助化疗2个疗程后行手术治疗,术后规律化疗6~12个疗程。随访患者术后生存率、局部复发、关节功能及并发症。结果 37例患者均获得随访,随访时间保肢组为16~163个月,截肢组为21~148个月。其中保肢组与截肢组5年生存率分别为58%和64%。术后局部复发保肢组为4例,占16.7%;截肢组为1例,占7.7%。保肢组的MSTS功能评分平均为81%（61%~88%）高于截肢组的72%（25%~91%）。术后并发症发生率两组相类似。结论膝关节周围骨肉瘤行保肢治疗的患者术后获得更好的肢体功能,术前、术后规律化疗和完整干净的肿瘤切除是获得较高生存率及较低局部复发的保证,术后并发症较常见。     

新辅助化疗结合保肢手术治疗骨肉瘤的临床疗效

目的:探讨骨肉瘤新辅助化疗结合保肢手术的临床疗效。方法:收集我院就诊或住院治疗的50例骨肉瘤患者,随机分为实验组和对照组,每组25例。对照组患者采用囊外彻底切除,对瘤体以及周围正常组织5 cm以上进行根治性切除术;实验组患者行保肢手术术前以及术后行新辅助化疗。治疗过程中对患者的不良反应进行及时治疗。治疗结束后,对患者肿瘤复发率、转移率、生存状况、肢体功能以及患者临床疗效进行评价。结果:与对照组相比,实验组患者术后的复发率、转移率较低(P0.05),3年生存率以及肢体功能的优良率较高(P0.05),临床治疗有效率较高(P0.05)。结论:新辅助化疗结合保肢手术能够降低骨肉瘤患者的术后复发率和转移率、改善患者的生存状况、肢体功能,临床疗效较好,对临床有指导意义。     

恩度联合新辅助化疗DIA方案治疗骨肉瘤的临床疗效分析

目的:观察恩度联合新辅助化疗DIA方案治疗骨肉瘤的临床效果和安全性.方法:对2011年1月至2012年8月期间在我院肿瘤骨科接受治疗的48例患者随机分成两组,治疗组接受恩度联合新辅助化疗DIA方案治疗,然后手术,对照组先手术后接收DIA方案治疗.结果:治疗组疾病的总缓解率为75％,对照组疾病总缓解率为50％,两组疾病总缓解率相互比较有统计学意义(P＜0.05);两组患者术后肿瘤复发率及生存率比较无明显差异(P＞0.05);治疗组患者肿瘤细胞的坏死率明显低于对照组,二者组间差异有统计学意义(P＜0.05);两组患者肝肾功能损害相互比较有统计学差异(P＜0.05);两组患者口腔黏膜炎、骨髓抑制、胃肠道反应相互比较差异均无统计学意义(P＞0.05).结论:恩度联合新辅助化疗DIA方案能提高骨肉瘤的治疗效果,减轻肝肾功能损害,值得在临床推广应用.     

重组人血管内皮抑素联合化疗治疗骨肉瘤的前瞻性对照非随机临床研究

目的:探讨重组人血管内皮抑素(恩度)联合新辅助化疗治疗II期经典型骨肉瘤的疗效。方法:2013年1月至2014年7月我院骨肿瘤科治疗72例II期经典型骨肉瘤患者,根据病人意愿将病人分为新辅助化疗联合恩度组和单纯化疗组。单纯化疗组化疗方案为:阿霉素30 mg/m2静滴,d1-d3,顺铂120 mg/m2静滴,d4;甲氨蝶呤10-12 g/m2静滴,d1;异环磷酰胺3 g/m2静滴,d1-d5。新辅助化疗联合恩度组在化疗基础上加用恩度,初期8个病例恩度15 mg/d,d1-d5,配合化疗每周期4次,术前术后各一个周期,总剂量40支;后期14个病例,恩度15 mg/d,d1-d10,配合化疗每周期4次,术前术后各一个周期,总剂量80支。化疗后根据化疗结果进行手术治疗,术后对手术标本进行组织学评估和免疫组化染色,测量化疗前后联合组和对照组肿瘤坏死率、血管内皮生长因子(vascular endothelial growth factor,VEGF)及微血管密度(microvessel density,MVD)。结果:72例患者入组,剔除资料不全5例,共纳入评价67例,其中联合组22例,对照组45例。术后进行随访,随访时间3-19个月,平均随访时间11.5个月。两组在肿瘤坏死率无明显差异,但术前术后比较,VEGF染色和MVD联合组较对照组有明显下降。结论:本研究显示恩度联合新辅助化疗并不能提高肿瘤坏死率,但恩度能有效抑制肿瘤新生血管生成。     

24例维吾尔族宫颈癌新辅助化疗临床疗效分析

目的:研究5-氟尿嘧啶、丝裂霉素加顺铂在局部晚期宫颈癌术前新辅助化疗中的作用.方法:应用5.氟尿嘧啶、丝裂霉素加铂类经股动脉插管,超选择性选择子宫动脉对局部晚期维族宫颈癌术前进行灌注化疗后栓塞,观察24例患者化疗前后局部肿瘤体积变化、手术切除率、盆腔淋巴结转移、脉管癌栓、病灶局部化疗反应.结果:作为术前新辅助化疗,肿瘤体积缩小总有效率87.5%,CR16.66%,手术切除率100%.结论:5-氟尿嘧啶、丝裂霉素加铂类方案联合化疗在局部晚期宫颈癌术前新辅助化疗方面疗效明显.     

骨肉瘤综合治疗的研究进展

骨肉瘤是一种以原始的成骨细胞为特征的恶性间质性肿瘤,特征为增殖的肿瘤细胞直接形成未成熟骨或骨样组织[1].典型骨肉瘤临床少见,其发病率约为十万分之三,多发于10～20岁的青少年,6岁以前及60岁以后少见,占骨恶性肿瘤的20%左右,发病部位一般为股骨远端和胫骨近端,其次为肱骨,其他部位少见,其血行转移发生早且发生率高,进展迅速,严重威胁患者的肢体甚至生命.近年来,随着新辅助化疗、保肢手术、免疫、基因、物理、分子靶向等治疗及其他方面的综合治疗的开展,骨肉瘤患者5年生存率从40年前的不足20%提高到现在的80%以上,大多数患者可以采用保肢的外科治疗方案,其重要因素归功于上述治疗的引入以及影像诊断及外科治疗水平等多方面的提升.本文对典型骨肉瘤的治疗作一综述如下.     

微波灭活与射频消融术中联合应用于治疗四肢骨肉瘤的疗效分析

目的:探讨微波灭活与射频消融技术联合应用治疗骨肉瘤的临床疗效。方法:回顾性分析我院自2007年至2012年间手术治疗的具有完整临床资料的骨肉瘤患者29例,其中发生于肱骨上端9例,股骨远端12例,胫骨上段5例,盆腔3例,并经TNM分期。术前采取动脉植入式化疗泵化疗2疗程,并于术中给以微波灭活与射频消融方法联合灭火肿瘤瘤体,刮除肿瘤后行骨水泥填充。术后随访8-60个月,平均50±2月。结果:29例患者中死亡1例,局部复发3例,远端转移2例。结论:微波灭活与射频消融术中联合应用于恶性骨肿瘤术中瘤体灭活,可以达到良好的肿瘤灭活效果,减少术中出血,大大提高患者生存率及降低复发率。     

局部晚期食管癌新辅助治疗的研究进展

食管癌是世界范围内恶性程度高、预后不良的肿瘤之一。手术治疗是局部晚期食管癌治疗的首选方式,但单纯手术治疗效果不佳,总体5年生存率较低。因此,局部晚期食管癌的治疗更倾向于手术联合多种模式的治疗。在局部晚期食管癌中,新辅助治疗展示出了明显的生存获益、良好的临床疗效以及可接受的毒性反应,成为局部晚期食管癌的标准治疗模式之一。新辅助治疗主要包括新辅助化疗、新辅助放化疗、新辅助免疫治疗。本文就局部晚期食管癌新辅助治疗的研究进展进行综述。     

紫杉醇联合洛铂治疗LACC患者的疗效评价

为了探讨紫杉醇联合洛铂在局部晚期宫颈癌(LACC)患者术前新辅助化疗中的效果以及对患者血清肿瘤标记物和预后的影响。本研究选取在我院实施新辅助化疗的58例LACC患者进行研究,其中29例患者采用紫杉醇联合洛铂新辅助化疗方案(A组)、29例患者采用紫杉醇联合顺铂治疗(B组),两组患者均实施根治性宫颈癌手术治疗,对比两组患者的近期疗效、血清肿瘤标记物、毒副反应发生率及远期预后。研究发现,A组患者的缓解率82.75%、总有效率100%,B组患者的缓解率68.97%、总有效率96.55%,两组间比较差异均不具有统计学意义(p0.05);化疗后,A组和B组患者的血清CYFRA21-1、SCCAg水平较化疗前均显著的降低(p0.05);化疗过程中,A组患者的恶心呕吐、腹泻发生率分别为17.24%、6.90%,B组患者的恶心呕吐、腹泻发生率分别为48.28%、62.07%,两组比较差异具有统计学意义(p0.05);36个月随访,A组总生存率为68.97%(20/29)、B组患者的总生存率为62.07%(18/29),两组比较差异无统计学意义(χ~2=0.305,p=0.5810.05);两组患者的生存函数曲线分析,生存时间比较差异无统计学意义(z=0.381,p=0.5370.05)。说明紫杉醇联合洛铂在LACC患者术前新辅助化疗中与紫杉醇联合顺铂的效果相当,但是紫杉醇联合洛铂相对毒副反应发生率更低,提高了患者的治疗依从性,可以成为目前LACC治疗的首选方案,但未来还需进一步研究来提高其治疗效果。     

贝伐单抗新辅助化疗对直肠癌患者微血管密度的影响

目的：对直肠癌患者进行联合贝伐单抗新辅助化疗的临床病理进行评估,研究贝伐单抗对肿瘤组织微血管的影响。方法：回 顾性分析在我院普外科治疗的47 例直肠癌患者进行联合或不联合贝伐单抗（Bev）的新辅助化疗（NAC）治疗,用最大肿瘤直径评 估肿瘤客观反应,用肿瘤消退分级评估肿瘤病理反应。结果：有31 例（66%）患者进行联合贝伐单抗（Bev）的新辅助化疗治疗（联合 Bev组）和其他16 例患者进行不联合Bev的新辅助化疗治疗（不联合Bev 组）。联合Bev组的肿瘤客观反应率明显高于不联合 Bev组（64.5 vs. 25.0 %,P=0.015）。联合Bev组(41.9 %)的病理反应率高于不联合Bev 组（41.9%vs. 12.5 %,p=0.052）,但并没有明 显差异。联合Bev 组的微血管密度（MVD）低于不联合Bev 组。结论：联合Bev的新辅助化疗治疗患者的靶向和病理反应好于不 联合Bev 新辅助化疗的患者。联合Bev治疗患者的肿瘤组织的(MVD)受到抑制。     

全膝关节置换术治疗类风湿性关节炎的临床效果分析

目的:探讨全膝关节置换术对类风湿性关节炎的临床疗效。方法:回顾性分析2012年10月至2014年1月在我院接受全膝关节置换术的80例风湿性关节炎患者的临床资料。采用HSS评分标准对膝关节疼痛情况进行评价,根据膝关节活动度(ROM)评价膝关节置换术的临床效果,观察患者术后并发症的发生情况,采用SF-36健康量表评估患者术后的生活质量。结果:患者术后膝关节疼痛评分低于术前(P0.05);患者术后膝关节活动度高于术前,且膝关节伸直和最大屈曲状态均优于术前(P0.05);术后膝关节冠状面和矢状面的畸形率均低于术前,差异具有统计学意义(P0.05);患者术后生存质量明显高于术前,差异具有统计学意义(P0.01)。术后发生感染2例,下肢深静脉血栓3例,膝前区疼痛2例,经对症治疗均获得缓解。结论:全膝关节置换术治疗类风湿性关节炎具有显著的临床效果,值得推广应用。     

全膝关节置换术对膝关节骨关节炎患者关节功能的影响

目的:探讨全膝关节置换术(TKA)对膝关节骨关节炎患者术后关节功能的影响。方法:回顾性分析2013年8月-2015年8月我院收治的76例膝关节骨关节炎患者的临床资料,所有患者均采用全膝关节置换术治疗。观察并比较患者手术前后膝关节HSS评分、膝关节疼痛目测类比评分(VAS)、膝关节屈曲活动度(ROM)的变化情况。结果:患者术后膝关节HSS评分、膝关节疼痛评分VAS及ROM均明显高于术前,差异具有统计学意义(P0.05);术前HSS评分、膝关节疼痛VAS评分、膝关节ROM、胫骨平台后倾角(PSA)以及股骨前髁偏距(ACO)与术后膝关节HSS评分呈正相关关系,而内翻畸形角度与术后膝关节HSS评分呈负相关关系,差异具有统计学意义(P0.05)。结论:全髋关节置换术能够改善骨关节炎患者的膝关节功能,并且术前膝关节HSS评分、膝关节疼痛VAS评分及PSA与术后患者髋关节功能恢复程度有关。     

全膝关节置换术与单髁置换术治疗老年膝关节骨关节炎的疗效比较

目的:探讨全膝关节置换术与单髁置换术对老年膝骨关节炎患者的临床疗效及术后恢复情况。方法:收集我院就诊的94例膝骨关节炎患者,随机分为UKA组和TKA组,每组各47例。UKA组采用单髁置换术治疗,TKA组采用全膝关节置换术治疗。观察并比较两组患者治疗前后膝关节功能评分(KSS)、疼痛视觉模拟评分(VAS)以及手术时间、术中出血量及术后并发症的发生情况等。结果:与治疗前相比,治疗后两组患者KSS评分均升高,VAS评分均下降,差异具有统计学意义(P0.05);与TKA组相比,UKA组VAS评分水平较低,KSS评分水平较高,差异具有统计学意义(P0.05);与TKA组相比,UKA组手术时间短,术中出血量少,差异具有统计学意义(P0.05);两组患者治疗后的并发症发生率差异无统计学意义(P0.05)。结论:在掌握适应证的前提下,与全膝关节置换术相比,单髁置换术创伤小、出血量少,关节功能恢复较好。     

Long-term results after combined modality treatment for non-metastatic osteosarcoma

Since the introduction of multimodality treatment, the prognosis of patients with high-grade non-metastatic osteosarcoma has significantly improved. A retrospective review was performed to assess the long-term results of this approach in a single centre setting, and to investigate the impact of potential clinical prognostic factors. Between 1985 and 1993, 35 patients with stage II-A and II-B osteosarcoma underwent preoperative chemotherapy (high-dose methotrexate), wide surgery, and adjuvant chemotherapy (cisplatin-doxorubicin/bleomycin-cyclophosphamide-dactinomycin) (modified T-10A protocol). There were 19 males and 16 females. Median patient age was 17 y (range 12–42). Primary tumour sites were the extremities (83%) and axial bones (17%). In spite of an unfavourable grade 3–4 histologic response rate to high-dose methotrexate of 12%, 31 (88%) patients were able to undergo limb-sparing surgery and 28 (80%) were rendered disease free after the planned therapy. Median follow-up was 8 y. The actuarial overall survival and disease-free survival rates were 64% and 49% at 5 y, and 59% and 49% at 10y, respectively. Tumour size and primary site were significant prognostic factors for survival in univariate analyses. In conclusion, long-term survival after combined modality treatment can be achieved in more than 60% of patients with localised osteosarcoma, including non-appendicular lesions. Limb-sparing surgery is a realistic goal for most cases. The prognostic value of tumour necrosis and the efficacy of neoadjuvant chemotherapy should be interpreted according to individual high-dose methotrexate scheduling.     

Predictors of use of pain medications for persistent knee pain after primary Total Knee Arthroplasty: a cohort study using an institutional joint registry

Introduction

To study the use of pain medications for persistent index knee pain and their predictors after primary Total Knee Arthroplasty (TKA).

Methods

The Mayo Total Joint Registry collects patient-reported data including pain medication use on all patients who undergo TKA. We used data from patients who underwent primary TKA from 1993-2005. We examined whether gender, age (reference, ≤60 yrs), body mass index (BMI; reference, <25 kg/m²), comorbidities measured by Deyo-Charlson index (5-point increase), anxiety and depression predicted use of pain medications (non-steroidal anti-inflammatory drugs (NSAIDs) and opioids) 2- and 5-years after primary TKA. Multivariable logistic regression additionally adjusted for operative diagnosis, American Society of Anesthesiologists (ASA) score, implant fixation and distance from the medical center.

Results

7,139 of the 10,957 eligible (65%) at 2-years and 4,234 of 7,404 eligible (57%) completed questionnaires. Significant predictors of NSAIDs use were (Odds ratio (95% confidence interval)): male gender at 2- and 5-years, 0.5 (0.4, 0.6) and 0.6 (0.5, 0.8); age >70-80 years, 0.7 (0.5, 0.9), 0.6 (0.4, 0.8); and depression, 1.4 (1.0, 1.8) and 1.7 (1.1, 2.5). BMI ≥40 was associated with NSAIDs use only at 2-years, 1.6 (1.1, 2.5). Significant predictors of opioid pain medication use at 2- and 5-years were: male gender, 0.5 (0.3, 0.9) and 0.4 (0.2, 0.8); age >70-80 years, 0.3 (0.1, 0.6), 0.3 (0.1, 0.8); and anxiety, 3.0 (1.6, 5.7) and 4.0 (1.7, 9.4).

Conclusions

Female gender and younger age were associated with higher risk of use of NSAIDs and opioids after primary TKA. Depression was associated with higher NSAID use and anxiety with higher opioid pain medication use after primary TKA.     

Results of the treatment of pediatric osteosarcoma in the Hungarian population

The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents with osteosarcoma. To evaluate the efficacy of surgery and multiagent chemotherapy for treating osteosarcoma, we reviewed 122 cases (65 males, 57 females, mean age 13.8 ± 3.6 years) treated at the Second Department of Pediatrics in Budapest between 1988 and 2006. Demographic parameters, tumor-related and treatment-related variables, response, overall survival (OS) and event-free survival (EFS) were analyzed. The 5-year OS and EFS were 68% and 61.5%, respectively. OS of patients without metastasis was 79%, while OS with early metastasis was 17%. Survival of patients with amputation (n=30) was not significantly different from that of patients with limb-salvage surgery (n=82), but all patients without radical surgery died. Gender and histological classification had no prognostic significance. Patients with localized tumors in extremities had increased survival compared to those with axial skeleton tumors (p=0.013). Poor histological response to neoadjuvant chemotherapy (rate of survivor tumor cells >10%) was associated with decreased survival (p=0.018). Patients under 14 years had better EFS than patients over 14 years (p=0.008). Our results demonstrate that younger patients with localized osteosarcoma of the extremities who receive limb-salvage surgery and chemotherapy have an excellent survival.     

全膝关节置换术后皮温与血清指标变化的相关性研究

目的:研究膝骨性关节炎(knee osteoarthritis,KOA)患者行单侧全膝关节置换术手术前后膝关节皮温、血清指标的变化规律以及与膝关节功能恢复之间相关性。方法:将2016年9月-2017年3月在我院行单侧全膝关节置换术且术后未发生假体周围感染的患者作为研究对象,测量并记录基本信息、术前及术后膝关节皮温、血清指标及膝关节功能评分,并进行统计学分析。结果:本研究共收集病例65例,随访时间为6个月。双膝皮温、双膝皮温差于术后第5天达到峰值,PCT、CRP、ESR均于术后第3天达到峰值,IL-6、WBC于术后第1天达到峰值,HGB下降至最低水平为术后5-7天。患者非手术侧膝关节皮温于术后30天恢复至术前水平,而手术侧膝关节皮温及双膝皮温差直至术后6个月仍未恢复至术前水平;PCT、IL-6、CRP于术后60天恢复至术前水平,ESR于术后90天恢复至术前水平,WBC于术后15天恢复至术前水平。结论:KOA患者TKA术后双膝皮温差直至术后6月仍高于术前水平,而研究中的各项血清指标均于术后3月内恢复至术前水平。     

经股内侧肌入路降低全膝关节置换术术后不良反应及促进膝关节功能康复

为评估髌骨旁内侧入路和经股内侧肌入路两种手术技术在全膝关节置换术(total knee arthroplasty,TKA)中的早期功能结果,本研究选取50例2013年3月至2017年3月期间在我院行全膝关节置换数的患者作为研究对象,随机分为两组。一组患者通过髌骨旁内侧入路进行TKA手术,另外一组患者通过经股内侧肌入路方法进行TKA手术。所有患者均只进行一次手术,两组均使用相同类型的植入物。使用视觉模拟评分法(visual analogue scale, VAS)记录疼痛评分,并在术后3周和6周时获得随访数据,包括股四头肌强度和本体感受。结果表明,TKA术后,经股内侧肌入路组患者在休息和运动时表现出明显较低的疼痛(VAS:平均2.13±1.87与2.84±1.76)和(VAS:平均3.11±2.16与3.21±2.02)。此外,经股内侧肌入路组患者在3周((41.2±17.8) Nm vs (27.3±14.1) Nm)和6周((47.4±19.5) Nm vs (35.6±16.2) Nm)显示出优异的等长股四头肌强度。另外,经股内侧肌入路组患者术后本体感觉良好,而两组患者的运动范围相似。研究初步表明,在早期康复期间,经股内侧肌入路方法比髌骨旁内侧入路更有优势。没有观察到与此方法相关的不良影响。因此,经股内侧肌入路应被认为是TKA中有价值的替代方法。     

A Prospective Evaluation of the Combined Helical Tomotherapy and Chemotherapy in Pediatric Patients with Unresectable Rhabdomyosarcoma of the Temporal Bone

We determined the efficacy of combined helical tomotherapy (HT) and chemotherapy in primary/recurrent unresectable rhabdomyosarcoma (RMS) of temporal bone. For this purpose, 9 patients (7 males/2 females), aged 4–9 (average: 6.89) years, with unresectable embryonal RMS of the temporal bone were treated at our hospital. The tumors had either invaded the carotid artery in the cavernous sinus (7/9) or both the cavernous sinus and the skull base foramen (2/9); 7 patients had primary and 2 had recurrent RMS. All patients underwent 2 cycles of induction chemotherapy with VIE (vincristine, ifosfamide, and etoposide), followed by concurrent HT (50–70 Gy) and chemotherapy with VE (vincristine and etoposide for 2 cycles), and 11 cycles of adjuvant chemotherapy with VIE. As a result, all patients achieved complete response, and the 2-year tumor-free survival rate was 100 %. During a follow-up of 3–51 months, all 9 patients were alive. We, therefore, conclude that the induction chemotherapy, adjuvant chemotherapy with VIE and concurrent HT and chemotherapy with VE regimen is effective in treating unresectable embryonal RMS of the temporal bone. The combined modality treatment may achieve the best chance of cure for these patients, thereby changing the therapeutic strategy from palliative to possibly curative.