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Long-term outcome of iliosacral resection without reconstruction for primary bone tumours.

原发性骨肿瘤不重建髂骶部切除术的远期疗效。

  • 影响因子:3.58
  • DOI:10.1302/0301-620X.102B6.BJJ-2020-0004
  • 作者列表:"Gupta S","Griffin AM","Gundle K","Kafchinski L","Zarnett O","Ferguson PC","Wunder J
  • 发表时间:2020-06-01
Abstract

AIMS:Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction. METHODS:Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS). RESULTS:At a mean follow-up of 159 months (1 to 207), 23 patients were alive without disease, one was alive with lung metastases, one was alive following local recurrence, four were dead of disease, and three had died from other causes. The overall ten-year survival was 77%. There was only one (3%) local recurrence, which occurred at 26 months. There were 18 complications in 17 patients; 13 wound healing complications/infections, three fractures, one pulmonary embolism, and one dislocation of the hip. Most complications occurred early. The mean functional scores were 21.1 (SD 8.1) for MSTS-87, 67.3 (SD 23.9) for MSTS-93 and 76.2 (SD 20.6) for TESS. CONCLUSION:Patients requiring Type I or Type I/IV pelvic resections can expect a good oncological outcome and a high rate of local control. Complications are generally acute in nature and are easily manageable. These patients achieved a good functional outcome without the need for bony reconstruction. Cite this article: Bone Joint J 2020;102-B(6):779-787.

摘要

目的: 原发性骨肿瘤的髂骨 (I型) 和髂骨骶部 (I/IV型) 骨盆切除术在骨盆环产生大的节段性缺损。这种缺损的处理是有争议的,因为外科医生可能会选择重建它或不重建它。当不进行重建时,残余髂骨塌陷回剩余的骶骨上,形成髂骶假关节。本研究的目的是评估不重建盆腔切除术后的长期肿瘤学结果、并发症和功能结局。 方法: 在 1989-2015 之间,32 例原发性骨肿瘤患者接受了I型或I/IV型骨盆切除术,但没有重建。男性 21 例,女性 11 例,平均年龄 35 岁 (15 ~ 85 岁)。最常见的诊断是软骨肉瘤 (50%,n = 16)。使用Kaplan-Meier方法评估无局部复发、无转移和总生存期。采用肌肉骨骼肿瘤协会 (MSTS) 和多伦多肢体挽救评分 (TESS) 评价患者功能。 结果: 平均随访 159 个月 (1 ~ 207),23 例患者无病存活,1 例肺转移存活,1 例局部复发后存活,四人死于疾病,三人死于其他原因。总的十年生存率为 77%。仅 1 例 (3%) 局部复发,发生于 26 个月。17 例患者有 18 例并发症; 13 例伤口愈合并发症/感染,3 例骨折,1 例肺栓塞,1 例髋关节脱位。大多数并发症发生较早。平均功能评分MSTS-87 为 21.1 (SD 8.1),MSTS-93 为 67.3 (SD 23.9),TESS为 76.2 (SD 20.6)。 结论: 需要I型或I/IV型盆腔切除术的患者可以预期良好的肿瘤学结局和高局部控制率。并发症通常是急性的,易于控制。这些患者获得了良好的功能结果,无需骨性重建。引用本文: 骨关节J 2020;102-B(6):779-787。

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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