Nanozymes are nanomaterials with enzyme-like catalytic activities that have rapidly advanced in the biomedical field in recent years due to their high stability, low cost, and catalytic versatility. As promising alternatives to natural enzymes, nanozymes have demonstrated unique advantages in infection control, cancer therapy, and tissue regeneration. This review systematically summarizes key advances in recent years in nanozyme-based catalytic therapeutics. We focus on their mechanisms and applications in combating bacterial, viral, and fungal infections via membrane lipid peroxidation, protein/genome damage, and biofilm disruption; in cancer treatment through chemodynamic therapy (CDT), tumor microenvironment modulation, and multimodal synergistic strategies; and in bone regeneration through antioxidant, anti-inflammatory, and osteoinductive functions. Moreover, we highlight the integration of nanozymes with hydrogels, scaffolds, and microrobotic systems to enhance therapeutic outcomes. Finally, current challenges such as targeting specificity, in vivo catalytic control, biosafety, and clinical translation are discussed to provide a comprehensive roadmap for future research and clinical development in catalytic nanomedicine.

11526 Background: Clinical studies show overexpression of multiple tyrosine kinase receptors in osteosarcoma, supporting targeted therapy as a promising direction. Anlotinib, a multi-targeted tyrosine kinase inhibitor, exerts anti-tumor angiogenesis effects. Combining anti-angiogenic agents with chemotherapy may yield synergistic tumor control, particularly as perioperative therapy. We present updated long-term efficacy and safety data, including key secondary endpoints, to validate this regimen’s clinical value. Methods: This was an open-label, single-arm, multicenter phase II trial. Eligible patients (12-40 years) had histologically confirmed primary localized stage IIB classic extremity osteosarcoma and were operable. Patients received anlotinib (10mg, po, d1-14, q3w), doxorubicin (A, 20-25 mg/m², iv, d1-3, q3w) and cisplatin (P, 70-90 mg/m², iv, d1, q3w) for 9 weeks. Radical surgery was performed at week 10 (no contraindications). Postoperatively, A+P was given at weeks 12-14, followed by anlotinib+A+P (same doses) at weeks 15-20. From week 21, anlotinib monotherapy (12mg, po, d1-14, q3w) continued until week 104 or an event-free survival (EFS) event. Primary endpoint: 24-month EFS rate. Secondary endpoints: 36-month EFS rate, local recurrence rate, lung metastasis rate, 3-year overall survival (OS) rate, and safety. Results: From May 2020 to April 2022, 52 patients were enrolled, treated, and included in full analysis set (FAS) and safety set (SS). Of these, 84.6% (44/52) were Han and 55.8% (29/52) male. Median follow-up was 42.7 months (IQR 30.4-52.7). The 24-month and 36-month EFS rates were 73.7% (95% CI 59.0-83.9) and 46.6% (95% CI 27.4-63.7), respectively. Median OS was not reached; 36-month and post-hoc 60-month OS rates were 74.6% (95% CI 59.6-84.7) and 71.4% (95% CI 55.5-82.4). Twenty-five percent (13/52) of patients died, mostly due to lung metastasis (13%). Among 51 surgical patients, local recurrence, lung metastasis, and other-site metastasis occurred in 23.5%, 17.6%, and 9.8%, respectively. Median recurrence-free survival (RFS) was 32.4 months (95% CI 25.7-not estimable). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 84.6% (44/52) of patients, with neutropenia most common (28/52 [53.8%]). No grade 5 TRAEs were observed. Serious TRAEs occurred in 40.4% (21/52), mainly myelosuppression (14/52 [26.9%]). None of the 13 on-study deaths were TRAE-related. Conclusions: Perioperative anlotinib plus cisplatin and doxorubicin shows promising efficacy in treatment-naïve stage IIB classic extremity osteosarcoma, with manageable safety. It achieves favorable long-term OS, and clinically acceptable local recurrence and lung metastasis rates, serving as a potential new perioperative option for this population. Clinical trial information: ChiCTR 2000033298.

Bioactive titanium metals with titania/titanate surface were prepared with anodic oxidation, alkali heat, or acid-base treatment methods. It was found that the bioactive Ti could be initiated with a photodynamic effect by X-ray used for bone tumor treatment, which could produce a large amount of reactive oxygen species (ROS). This effect could affect the ROS balance of bone tumor cells, cause oxidative stress in the bone tumor cells, and promote apoptosis of bone tumor cells. In the animal test, it was found that the photodynamic therapy (PDT) of the bioactive Ti metal could inhibit bone tumor growth, which implies that the bioactive Ti metal could be endowed with anti-tumor properties during the X-ray therapeutic process. It is hopeful to get Ti metal with synergistic bio-functions with both bioactivity and anti-tumor properties by surface modification.

Rationale:The healing of severe infected burn wounds is impeded by a vicious cycle of bacterial biofilms, oxidative stress, immune dysregulation, and hypoxia. Existing microneedle (MN) platforms often fail to address these multifactorial barriers due to insufficient mechanical robustness, lengthy fabrication times, and limited therapeutic scope. Our goal was to develop a multifunctional, on-demand MN platform that can simultaneously overcome these challenges by systematically dismantling pathological barriers and activating endogenous regenerative pathways. Methods:We developed a multifunctional MN platform based on a semi-Interpenetrating Polymer Network (sIPN) of hyaluronic acid methacrylate (HAMA) and ethoxylated trimethylolpropane triacrylate (ETPTA). This platform was co-encapsulated with a triad of therapeutic agents: a biofilm-dismantling antisense oligonucleotide (ASO) targeting the bacterial gene yycF, nanoceria (CeO₂) for reactive oxygen species (ROS) scavenging and in-situ oxygen generation, and anthocyanin (An) as an antioxidant and anti-inflammatory agent. The therapeutic efficacy of the MN platform was evaluated in a rat model of MRSA-infected full-thickness burns. Healing was assessed through macroscopic observation, histological analysis, and immunofluorescence staining. The underlying molecular mechanisms were investigated using transcriptomic and protein analyses of wound tissues. Results:The fabricated sIPN MNs exhibited exceptional mechanical strength, rapid fabrication time, and strong tissue adhesion. In the rat model, the MNs effectively dismantled biofilms, reduced oxidative stress, alleviated hypoxia, and shifted the immune balance towards M2 macrophage polarization. This comprehensive microenvironment remodeling led to accelerated wound closure, promoted angiogenesis, and encouraged ordered collagen deposition, resulting in higher-quality tissue regeneration compared to control groups. Transcriptomic and protein analyses revealed that this enhanced healing was driven by the significant activation of the epidermal Wnt/KLF5 signaling axis. Conclusions:Our study presents a mechanistically elucidated, multimodal sIPN MN platform that effectively promotes the healing of infected burn wounds. By remodeling the pathological microenvironment and activating the Wnt/KLF5 regenerative axis, this on-demand platform demonstrates significant potential for clinical translation in the management of complex wounds.

BackgroundMetastatic castration-resistant prostate cancer (mCRPC) frequently involves the skeleton. While Radium-223 (Ra-223) alleviates symptomatic bone lesions, its effect on overall survival (OS) and fracture risk is debated. Bone-protective agents (BPAs) may play a critical modulatory role. This study systematically examined how Ra-223 influences OS and fracture risk and the effect of concomitant BPA use.MethodsAs per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, the Cochrane Library, and Web of Science were retrieved for randomized controlled trials (RCTs) and cohort studies through July 14, 2025. The primary outcomes were OS and fracture incidence in this PROSPERO-registered review (Registration No.: CRD420251102769). Hazard ratios (HRs) with 95% confidence intervals (CIs) were preferentially extracted; relative risks (RRs) were used when necessary. Heterogeneity was assessed using the I² statistic to guide the choice of random-effects versus random-effects models. Leave-one-out sensitivity analyses were conducted, and study quality was appraised using the NIH tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies.ResultsNine studies were included, including six RCTs and three cohort studies. The pooled OS analysis (five studies, n=3,671) showed no significant benefit (HR = 0.82, 95% CI: 0.60-1.11; I²=79.8%). Excluding one study on an abiraterone background revealed a survival advantage (HR = 0.71, 95% CI: 0.61-0.81; I²=43.5%). For fracture risk, pooled analysis (five studies, n=3,671) showed no significant increase (HR = 1.32, 95% CI: 0.68-2.58; I²=89.1%). Concomitant BPA use (3 studies, n=279) was associated with a substantial fracture risk reduction (RR = 0.23, 95% CI: 0.11-0.45; I²=0.0%).ConclusionsCurrent evidence suggests that Ra-223 administered alongside standard therapy is not associated with statistically significant differences in OS or fracture risk among patients with mCRPC. Concomitant BPA therapy significantly reduces fracture incidence. Therapeutic context, including concurrent therapies and sequencing, may influence survival. Routine evaluation and consideration of BPA use during Ra-223-based regimens, together with strengthened bone health monitoring protocols, are advisable. Given the limited number of eligible studies and substantial heterogeneity, additional high-quality RCTs and individual patient data meta-analyses are needed to clarify these associations.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251102769.

To engineer a porous nanohydroxyapatite/polyphosphoester-amino acid composite bone graft substitute (nHA/PPE-AA) in granular form and evaluate its reparative efficacy and in vivo safety in a rabbit femoral condyle critical-sized defect (CSD) model. Porous nHA/PPE-AA granules were fabricated using polyphosphoester-amino acid copolymer (PPE-AA) as the organic matrix and nanohydroxyapatite (nHA) as the inorganic phase. Material characteristics were examined by scanning electron microscopy, X-ray diffraction, and Fourier-transform infrared spectroscopy. A rabbit femoral condyle CSD model (10 × 10 × 10 mm3) was randomly assigned to nHA/PPE-AA, positive control (calcium sulfate), and blank groups. Bone repair was assessed by gross inspection, serum bone turnover markers, digital radiography (G/N ratio), micro-computed tomography, sequential fluorochrome labeling, histology, interfacial SEM, and BMP-2 mRNA expression. Safety was evaluated by ESR, WBC, CRP, and histology of major organs and peri-implant tissues. The nHA/PPE-AA composite exhibited an interconnected porous granular structure (35%-55% porosity, 3-7 MPa compressive strength). XRD and FTIR confirmed stable coexistence of nHA and PPE-AA. Gross and imaging analyses demonstrated progressive defect repair, with higher G/N ratios and more trabecular regeneration in the nHA/PPE-AA group. Fluorochrome labeling and histomorphometry indicated accelerated mineralization and shorter lag time. Histology and SEM confirmed mature neobone formation and superior bone-material integration. RT-qPCR showed sustained BMP-2 upregulation from 1 to 3 months, peaking at 3 months. Safety assessments revealed only transient changes in ESR, WBC, and CRP, with no significant organ pathology. Porous nHA/PPE-AA granules provide interconnected porous structure, moderate mechanical support, osteogenic activity, and good in vivo biocompatibility. In a rabbit femoral condyle CSD model, they promoted new bone formation, accelerated mineralization, and improved bone-material interface, highlighting their potential as a translationally relevant bone void filler.

This study aimed to analyse postoperative gait characteristics in patients with fibrous dysplasia (FD) of the proximal femur with varus deformity and to comprehensively assess limb function. We retrospectively reviewed patients who underwent surgical correction between January 2013 and October 2017. Limb length discrepancy and mechanical axis alignment were evaluated at follow-up. Gait parameters of both lower limbs were assessed using a three-dimensional (3D) gait analysis system, and the affected side was compared with the contralateral limb. Limb alignment and length were largely restored, with residual discrepancies of ≤ 2 cm in most patients. Functional outcomes were excellent, with high Musculoskeletal Tumour Society (MSTS) and Harris Hip Score results. However, gait asymmetries persisted postoperatively. Compared with the contralateral limb, the affected limb demonstrated significantly lower gait speed (0.98 ± 0.13 vs. 1.15 ± 0.15 m/s) and cadence (99.07 ± 5.97 vs. 110.32 ± 7.21 steps/min). Single-limb support time was shorter (33.47 ± 2.63 vs. 39.59 ± 3.69

To investigate the predominant factors predicting trend of post-traumatic growth for patients after bone tumour surgery. We conducted a longitudinal observational study with convenience sampling. Follow-up examinations were conducted every two weeks over a total follow-up period of one month. Post-traumatic growth (PTG) levels were measured using the Chinese version of the Post-Traumatic Growth Inventory (PTGI-C). Latent Category Growth Model (LCGM) was applied to explore the latent trajectory categories of PTG. Univariate and multivariate analyses were conducted to explore the predictors and influencing factors for patients with different trajectories. A total of 153 patients were included in the study, and 141 patients completed the follow-up. The means of PTGI-C at different monitoring time were 41.24 ± 21.94, 44.56 ± 23.33, and 40.69 ± 22.63, respectively. Repeated measures analysis of variance with univariate revealed statistically significant differences in PTGI-C across different time (F = 3.372, P = 0.02). Patients were categorized into two latent subgroups: an increasing trend group (intercept = 44.276, slope = 5.152, P < 0.001) and a decreasing trend group (intercept = 35.164, slope = − 4.718, P < 0.001) based on two-category LCGM model. Low levels of post traumatic stress (vs. high levels) were associated with increased odds of decreasing PTG trajectory (OR 2.67, P = 0.015), indicating a risk factor. Unmarried status (vs. married) and giant cell tumour (OR = 0.223, P = 0.047), fibrogenic tumours (OR = 0.127, P = 0.007), cartilaginous origin tumour (OR = 0.194, P = 0.034), and other tumours (OR = 0.169, P = 0.023, vs. osteosarcoma) were protective factors. The classification of PTG change trajectory suggested different positive psychological processes in patients with bone tumours. Identifying the influencing factors of patients in the PTG decline trend group can guide nurses to provide effective intervention in time. ChiCTR2300074170 (Registration Date: 1st August 2023).

Primary bone malignancies such as osteosarcoma are exceedingly rare in HIV-positive individuals, presenting unique surgical and long-term management challenges. The aim of this case report is to evaluate the 15-year clinical and functional durability of limb-salvage surgery in an immunocompromised patient. A 29-year-old HIV-infected female presented with a proximal tibial mesenchymal tumor. She underwent surgical resection followed by endoprosthetic reconstruction. During the follow-up period, the patient received regular antiretroviral therapy to manage her HIV infection. At 15 years post-surgery, radiographic assessment confirmed sustained implant stability, with no evidence of aseptic loosening, infection, or structural failure. Clinical evaluation demonstrated excellent functional recovery, with a symmetric gait and no need for additional surgical interventions. Notably, HIV markers were undetectable, further highlighting the successful management of both the tumor and the patient's HIV infection over the long term. This case demonstrates the long-term feasibility of successful limb-salvage surgery in HIV-positive patients, emphasizing the importance of multidisciplinary care and effective HIV management for sustained functional outcomes.

Aim To investigate the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery. Methods We conducted a longitudinal observational study with convenience sampling. Follow-up examinations were conducted every two weeks over a total follow-up period of one month. PTG levels were measured using the Chinese version of the Post Traumatic Growth Inventory (PTGI-C). Latent Category Growth Model (LCGM) was applied to explore the latent trajectory categories of PTG. Univariate and multivariate analyses were conducted to explore the predictors and influencing factors for patients with different trajectories. Clinical trial number: ChiCTR2300074170 (Registration Date: 1st August 2023) Results A total of 153 patients were included in the study, and 141 patients completed the follow-up. The means of PTGI-C at different monitoring time were 41.24 ± 21.94, 44.56 ± 23.33, and 40.69 ± 22.63, respectively. Repeated measures analysis of variance with Univariate revealed statistically significant differences in PTGI-C across different time (F = 3.372, P = 0.02). Patients were categorized into two latent subgroups: an increasing group (intercept = 44.276, slope = 5.152, P < 0.001) and a decreasing group (intercept = 35.164, slope = − 4.718, P < 0.001) based on two-category LCGM model. Logistic regression analysis results indicated that being unmarried (OR = 0.381, P = 0.019), low level of post-traumatic symptoms (OR = 2.666, P = 0.015) which was the most influential, giant cell tumour (OR = 0.223, P = 0.047), fibrogenic tumours (OR = 0.127, P = 0.007), cartilaginous origin tumour (OR = 0.194, P = 0.034), and other tumours (OR = 0.169, P = 0.023) were predictive factors for the PTG trajectory. Conclusion The classification of PTG change trajectory suggested different positive psychological processes in patients with bone tumours. Identifying the influencing factors of patients in the PTG decline trend group can guide nurses to provide effective intervention in time.

Given the limited blood supply that results in the poor self-healing ability of the meniscus, use of meniscal tissue engineering (MTE) scaffolds has emerged as an effective strategy for the treatment of meniscal injuries. However, the efficacy of mesenchymal stem cells (MSCs) is limited in the inflammatory state caused by chronic injuries, making it challenging for existing meniscal implants to promote meniscal regeneration and delay articular cartilage degeneration in an inflammatory environment. This study introduces a method to incorporate phosphoester (PE) units into the main chain of poly(amino acids) (PAAs) through ring-opening copolymerization, subsequently creating a copolymer with graphene oxide (GO) to yield phosphoester-modified poly(amino acid)-graphene oxide (P-P-GO). PCL/P-P-GO scaffolds were fabricated by blending P-P-GO with polycaprolactone (PCL) and employing 3D printing technology. The PAAs of P-P-GO scaffolds provide a nutritious environment essential for MSC proliferation, migration, and differentiation, while the PE enhances the cell adhesion properties, with further improvements by GO. In vitro experiments have shown that the PCL/P-P-GO scaffolds upregulate the expression of chondrogenic-specific genes and increase the production of collagen and glycosaminoglycans. Additionally, γ-aminobutyric acid of the scaffolds can suppress the secretion of inflammatory factors, induce M2 polarization of macrophages, and promote angiogenesis. In vivo studies using a rabbit meniscectomy model have demonstrated that PCL/P-P-GO scaffolds can promote meniscal tissue regeneration and delay cartilage degeneration. After six months of implantation, the regenerated meniscus exhibited a structure and composition resembling natural meniscus, and the progression of osteoarthritis was significantly slowed. Compared to the traditional cell-loaded scaffold, PCL/P-P-GO scaffolds are easy to produce and cost-effective and hold broad translational potential for the clinical treatment of meniscal injuries.

Osteosarcoma (OS), the most prevalent primary malignant bone tumor in adolescents, exhibits a high metastatic potential and resistance to therapy. This characteristic results in a dismal prognosis in advanced cases even following multimodal therapies. This review synthesizes the dual roles of stem cells in OS pathogenesis and therapeutic innovation. Cancer stem cells (CSCs) drive tumor initiation, progression, and chemoresistance through dysregulated molecular pathways that include Wnt/β-catenin, Notch, and Hedgehog signaling, with key markers such as CD133 and CXCR4 contributing to stemness maintenance and metastasis. Concurrently, mesenchymal stem cells (MSCs) paradoxically influence OS progression. Although their tumor-homing capacity enables targeted drug delivery (e.g., IDD-1040-paclitaxel complexes) and immunomodulation, MSC-derived factors like TGF-β can promote cancer-associated fibroblast differentiation and immune evasion. The immunosuppressive tumor microenvironment (TME), characterized by hypoxia-induced HIF-1α activation, metabolic reprogramming, and M2 macrophage polarization, further facilitates CSC resilience and therapy resistance. Emerging strategies—including CSCs-targeted agents (AZD1080, DNMTi/HDACi), CRISPR/Cas9-engineered CD133-directed CAR-T cells, and MSC-mediated delivery of oncolytic viruses—show preclinical promise in overcoming these barriers. However, critical challenges persist: intratumoral CSC heterogeneity limits targeted therapy efficacy; MSC functional plasticity risks tumor promotion via fusion or batch variations; and inefficient cell homing due to pulmonary entrapment reduces therapeutic delivery. Future directions necessitate biomarker-guided combinatorial approaches, optimized MSC administration routes (e.g., intra-arterial injection), and integrated multi-omics profiling to address translational bottlenecks. Resolving these issues will advance personalized stem cell-focused therapies for OS.

Osteosarcoma, a primary malignant bone tumor originating from mesenchymal cells, is the most prevalent bone malignancy in children and adolescents. Current standard treatment involves aggressive surgical resection aimed at maximal tumor removal; however, this inevitably creates extensive bone defects that substantially impair patients’ quality of life. Furthermore, the risks of postoperative tumor recurrence and metastasis critically influence therapeutic outcomes. With the continuous advancement of biomaterials, their applications in postsurgical osteosarcoma management have increased substantially. Biomaterial-based strategies are enabling diverse antineoplastic function and bone regeneration strategies. However, previous biomaterial strategies have typically focused on osteogenic or antitumor functions in isolation. The current research frontier is shifting toward developing integrated strategies that simultaneously achieve both effective tumor suppression and functional bone regeneration. This review strategically categorizes these emerging strategies into 3 distinct approaches: (a) Traditional bifunctional strategies: Integrating coloaded osteogenic and antitumor agents within a carrier. (b) Enhanced antitumor bifunctional strategies: Incorporating components or designs that actively boost the potency of the antitumor modality beyond simple codelivery. (c) Temporally controlled sequential strategies: Engineered to perform antitumor and pro-regeneration functions in a defined, sequential order. By critically analyzing the cutting-edge biomaterials employed in these strategies, we assessed their potential for clinical translation, emphasized the ongoing technical barriers, and outlined the challenges for future development.

PurposeLimb salvage surgery and amputation are two commonly performed procedures for lower extremity tumors. When comparing these procedures in tumor patients, it is important to consider their impact on quality of life (QOL) and functional mobility. These patients often experience physical, emotional, and psychological challenges, making these factors crucial in determining the most suitable treatment approach.MethodThe outcomes of lower extremity tumors patients for QOL were collected from PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar until 28 February 2023. The physical function, mental health, role function, social function, emotional function, Toronto Extremity Salvage Score, and Musculoskeletal Tumor Society Score outcomes were analyzed to determine the differences between the two procedures.ResultsFive articles were included according to the selection criteria with a total of 245 patients. The standard mean difference (SMD) values of each parameter were slightly higher in limb salvage surgery patients but not higher enough to produce statistically significant results; the SMD values for physical function and mental health were 0.72 and 0.04, respectively. This study did not report any heterogeneity or publication bias.ConclusionsQOL is a large and enhanced term, which carries its importance and is challenging to compare between any procedures. The minimal rise in SMD of different QOL parameters highlighted only a slight advantage of limb salvage surgery over amputation. Therefore, further research is required to explore the impact of this crucial topic.

Background: Desmoid fibromatosis (DF) is a pathological intermediate fibroblastoma that is difficult to control locally due to its invasive nature, especially in the extremities. Although anlotinib demonstrated efficacy in treating DF with tolerable safety, the impact of surgical intervention in conjunction with anlotinib administration on local control in patients with extremity DF remains undetermined.Methods: We conducted a retrospective examination of the clinical medical documentation belonging to patients with resectable DF of the extremities who were treated with surgery between January 2010 and June 2022. The patients were divided into two cohorts: surgery alone cohort and surgery combined with anlotinib group (surgery plus anlotinib cohort), crossover to surgery plus anlotinib cohort was admissible for patients in the surgery alone cohort who experienced disease recurrence postoperatively. Clinical data such as basic information, tumor location, anlotinib toxicity, time to recurrence, surgical complications, follow-up time, visual analogue scale (VAS) score and Musculoskeletal Tumor Society (MSTS) score at the last follow-up were collected.Results: In total, 48 consecutive patients (19 males and 29 females) with resectable DF of the extremities, including 25 patients in the surgery alone cohort, 23 patients in the surgery plus anlotinib cohort, and 10 patients who were transferred from the surgery alone cohort to the surgery plus anlotinib cohort. The VAS score at the last follow-up was 5 (IQR, 3–6) in the surgery alone cohort and 2 (IQR, 1–3) in the surgery plus anlotinib cohort, respectively; the MSTS score at the last follow-up was 19 (IQR, 16.5–24) in the surgery alone cohort and 27 (IQR, 25–28) in the surgery plus anlotinib cohort, respectively; these characteristics were statistically different between the two cohorts. The 3-year recurrence-free survival (RFS) of the surgery alone cohort and the surgery plus anlotinib cohort were 37.7% and 72.6%, respectively, and the difference was statistically significant (p = 0.022).Conclusion: Surgery combined with anlotinib appears to be effective in controlling local recurrence in patients with resectable DF of the extremities, and the side effects were acceptable.

ObjectivesThere is still controversy over the choice of treatment for end‐stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures.MethodsThis retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression‐free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan–Meier method with a log‐rank test for group comparisons. Paired t‐tests and the Mann–Whitney U test were applied to metric and non‐normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ2 test.ResultsAll patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow‐up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1‐ and 3‐month follow‐ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression‐free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77).ConclusionCompared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression‐free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice.

目的 探讨 CT 引导下经皮微波消融术(microwave ablation,WMA)治疗肢体骨样骨瘤的可行性及优缺点.方法 2019 年 7 月至 2021 年 4 月四川省第四人民医院共收治了 23 例运用经皮 WMA 治疗的四肢骨样骨瘤患者.回顾性分析了这 23 例骨样骨瘤患者的临床资料.通过术前与术后疼痛视觉模拟评分(visual analogue scale,VAS)评估临床疗效.结果 23 例疼痛症状均明显改善,术前所有患者的 VAS 评分为(7.21±1.35)分,术后 1 个月、3 个月、6 个月、12 个月随访时,患者的 VAS 评分分别为(1.82±0.97)分、(0.81±0.43)分、(0.77±0.34)分、(0.60±0.41)分.除 1 例出现局部脓肿外,其余患者未见其它严重并发症.结论 利用 CT 引导下 WMA 治疗骨样骨瘤是一种安全可靠的治疗手段,但因为目前的仪器设备尚不统一,且各种骨组织本身及周围神经血管分布情况不一致,其消融的频率和时间需要严格把控,需要更多的病例治疗积累数据.

Objective:To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection. Methods:Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded. Results:All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients. Conclusion:Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.

Background:Current research is focused on the factors that influence the maintenance of limb function after total femoral replacement. This retrospective study investigated the difference in functional outcomes in patients with invasion of the rectus femoris vs. an intact rectus femoris that underwent total femoral replacement with a modular total femur prosthesis.Methods:The medical records of patients who underwent total femoral replacement with a modular total femur prosthesis between July 2010 and March 2017 at our institute were retrospectively reviewed. The patients were divided into two groups: group A had invasion of the rectus femoris and group B had an intact rectus femoris. Functional status was assessed using the Musculoskeletal Tumor Society Rating Scale (MSTS) and the Harris Hip Score (HHS). Complications were assessed using the International Society of Limb Salvage classification that was published in 2011 and modified in 2014.Results:The mean total MSTS score (23.0 ± 4.8 vs. 17.6 ± 3.1; P = 0.02) and the mean total HHS score (80.17 ± 6.24 vs. 55.38 ± 13.30; P = 0.001) were significantly higher in patients with intact rectus femoris compared with patients with invasion of the rectus femoris. Patients with an intact rectus femoris achieved significantly better limb function (support and gait) and active range of motion (P < 0.05). The overall complication rate was 35.7%.Conclusions:Functional outcomes after total femoral replacement were significantly better in patients with an intact rectus femoris compared with patients with invasion of the rectus femoris, possibly because more muscle mass can be preserved around the femur in patients with an intact rectus femoris.

目的 比较椎弓根螺钉内固定术、单纯椎板减压与联合运用病灶微波消融术在胸腰椎转移性肿瘤中的临床疗效.方法 回顾性分析2017年1月至2021年5月就诊于四川省第四人民医院收治的45例胸腰椎转移瘤伴病理性骨折的临床资料.按照手术方式分为A组25例采用椎弓根螺钉内固定联合椎板减压术,B组20例在A组的基础上联合运用了病灶微波消融灭活.患者术前均行Tokuhashi评分、Tomita评分.并通过脊柱肿瘤不稳定评分系统(SINS)评估其脊柱稳定性,并运用硬脊膜外脊柱压迫(ESCC)评分系统对脊柱压迫程度进行评价.详细记录了患者术前神经功能障碍的时间、手术持续时间、术中出血量等.并于术前及术后记录所有患者的疼痛VAS评分和SF-36生活质量评分.通过Kaplan-Meier评价系统评估患者的总体生存期.结果 45例患者均获得随访,随访时间为5～41个月,中位时间分别为19个月和21个月.术前两组患者Tomita评分、改良Tokuhashi评分、SINS评分、ESCC评分和Frankle分级差异均无统计学意义(P＞0.05),两组患者的手术持续时间差异也无统计学意义(P＞0.05).A组患者术中出血量(675.37±87.25)ml高于B组的(549.36±128.14)ml(P＜0.05).两组患者在SF-36生活质量评分和VAS评分方面在术后随访时均较术前明显改善.术后3个月SF-36评分A组(66.39±7.18)分高于B组(75.38±5.95)分,差异有统计学意义(P=0.01).A组术后1个月和3个月VAS评分分别为(2.80±1.29)分和(2.35±1.04)分,均高于同时刻的B组,差异均有统计学意义(P＜0.05).两组患者术后的脊髓功能均有所改善,但差异无统计学意义(P＞0.05).两组患者的总体生存期差异无统计学意义(P＞0.05).结论 在治疗胸腰椎转移性肿瘤时,与传统的单用椎弓根螺钉及椎板减压术相比,加用微波消融灭活后,不会增加手术风险和创伤,在缓解痛处和改善生活治疗方面,具有一定优势.