RESUMEN

PURPOSE OF THE STUDY There are several treatment options for bone tumors at diaphyseal/metadiaphyseal sites of long bones (with joint preservation) including massive intercalary allografts, autografts (vascularized or non-vascularized fibular autograft, devitalised tumor bearing bone), endoprosthetic replacement (intercalary spacer), cementoplasty with ostheosynthesis and distraction osteogenesis. Reconstruction using massive intercalary bone allografts is for us the method of choice in case of curable primary bone tumors at the diaphyseal/metadiaphyseal region. The purpose of this study is to evaluate our results and complications. MATERIAL AND METHODS Our retrospective study reviewed 41 patients after intercalary allograft reconstruction following the resection of primary bone tumors in the years 2000 - 2014. The group consists of 27 men and 14 women with the mean age at the time of diagnosis 27 years and the mean follow-up (from primary surgery) was 7 years. The patients were diagnosed with the Ewing sarcoma (14), chondrosarcoma (9), osteosarcoma (8), adamantinoma (6), OFD-like adamantinoma (2) and aneurysmatic bone cyst (2). The site of tumor were tibia (18), femur (16), humerus (5), radius (1) and ulna (1). We retrospectively evaluated the results of this intercallary allograft reconstructions, the incidence of failures and complications as well as the role of risk factors. RESULTS 14 patients (34.1%) successfully healed without complications. In the same number of patients (14 patients, 34.1%) the allograft reconstruction failed. 7 of these patients underwent amputation (17.1%), 6 of whom for oncological complications (local recurrence) and only 1 for complications of the reconstruction (infection). Other 7 patients with an allograft-related failure were successfully treated with a limb salvage procedure and underwent a new reconstruction. The remaining 13 patients (31.7%) suffered from complications that did not result in a failure of the reconstruction. The major complications of the reconstruction were the non-union (53.7%), fractures and allograft resorption (14.6%) and infection (7.3%). By statistical evaluation of common risk factors a statistically significant relationship was found between uncomplicated healing and stable bridging osteosynthesis (p = 0.014), between allograft fractures/resorptions and non-bridging osteosynthesis (p = 0.018), and the lowest reoperation rate was connected with plate osteosynthesis (0.037). DISCUSSION AND CONCLUSIONS The intercalary allograft reconstruction is an important biological method in orthopaedic tumor surgery. Even though it is connected with a high rate of complications (non-union, fracture and resorption, infection), in the vast majority of cases they can be solved, while achieving limb-salvage and good function of extremity. The essential prerequisite for successful uncomplicated healing of reconstruction is the stable bridging osteosynthesis, preferably with a plate. In high risk patients with a combination of recognized important risk factors described in literature (adult patients, large resection (more than 15 cm), femoral location and aggressive oncological treatment) we nowadays try to reduce the complication rate with a primary combination of an allograft with vascularized fibular autograft. Key words:biological bone reconstruction, massive intercallary allograft, stable bridging osteosynthesis, primary bone tumors.

Asunto(s)

RESUMEN

BACKGROUND: The objective of this report was to estimate long-term outcome and prognostic factors in adult patients with high-grade osteosarcoma. The intended therapeutic strategy included preoperative and/or postoperative chemotherapy as well as surgery of all operable lesions. PATIENTS AND METHODS: We reviewed the clinical data of 36 newly diagnosed adult patients (aged 19-82, average 37.5, median 28.5 years) with high-grade osteosarcoma of the trunk or limbs evaluated by a multidisciplinary team and treated between 1999 and 2010 in Brno. Forty-five percent of patients were over thirty, more than 36% over forty. Thirty-one percent of patients had metastasis at the time of diagnosis. Demographic parameters, tumor-related and treatment-related variables included possible prognostic factors and their impact on response, overall survival (OS) and event-free survival (EFS) were analyzed. RESULTS: All the patients were followed up after treatment. Seventy-three percent of patients were poor responders to chemotherapy. Sixteen patients are alive, and twenty patients died. The survival time ranged from 2 to 177 months (average 45 months, median survival 23 months). The 5-year OS of all patients was 52.4%. OS of patients without metastasis was 68.12%, while 2-year OS with metastasis was 26% only. 5-year EFS was 38.7%. Univariate analysis revealed that the prognosis of adult osteosarcoma patients was significantly related to distant metastasis (p = 0.006), surgical stage (p = 0.00582), serum alkaline phosphatase (ALP) level (p = 0.00841) and serum lactatdehydrogenase (LD) level (p = 0.047). The other analyzed prognostic factors including age had no statistically significant influence on outcome of osteosarcoma in adult patients. CONCLUSION: The prognosis of osteosarcoma in adult patients was significantly correlated to surgical stage, distant metastasis, serum ALP and LD.

Asunto(s)

RESUMEN

The authors report the case of a 19-year-old girl with osteolytic bone lesions in whom primary hyperparathyreoidism caused by parathyroid gland adenoma was diagnosed. They emphasize necessity to be aware of a relationship of this rare condition to bone lesions that may be benign in appearance and may show ambiguous histological findings. The patient underwent excision of the adenoma and subsequent substitution therapy, which resulted in the healing of bone lesions.

Asunto(s)

RESUMEN

THE AIM OF THE STUDY: The authors evaluated the benefits of the arthroscopic debridement performed in the same session with the high tibial osteotomy in the management of the knee joint of osteoarthritis connected with varus or valgus deformity. MATERIAL AND METHODS: Arthroscopy was indicated in 52 patients from 96 patients with high tibial osteotomy in the years 1996-2001. RESULTS: Significant intraarticular disorders were found in all 52 patients. 34 patients were fully satisfied, 10 were partialy satisfied and 8 were not satisfied with the outcome. Twenty from 22 patients with meniscal tears had a marked improvement. 4 patients with loose bodies and 5 patients with chondral flaps causing blockages had no further blockages or irritation of the knee. The arthroscopic findings of chondral lesions were in 10 cases from 13 more significant than it was expected from weightbearing X-ray films. CONCLUSION: The arthroscopy performed before high tibial osteotomy in the same session helped to detect a significant intraarticular disorder and the arthroscopic debridement improved the end results after high tibial osteotomy. (Ref. 16.)

Asunto(s)

RESUMEN

Authors evaluated longterm results of the survival of patients with metastasis of adenocarcinoma in long bones and pelvis in 72 cases which were treated and followed at Ist Orthpaedic Clinic of the Faculty Hospital of St. Ann in Brno in the period of 1970-1995. Patients were divided into two groups. One group of patients was treated with intralesional operation and in the second group the metastasis was radically resected. The period of survival in the second group was longer. Authors also present a general survey of adjuvant therapy of metastasis of adenocarcinoma in bones. Key words: metastasis of adenocarcinoma in long bones and pelvis, method of treatment.