朗格汉斯细胞组织细胞增生症(LCH)是局部或全身的朗格汉斯系统的组织细胞异常增生和嗜酸性粒细胞浸润所形成的一种原因不明的肿瘤性病变[1].此病少见,原发于锁骨的更是罕见.

Objective To systematically evaluate the efficacy and safety of intra-articular injection of tranexamic acid(TXA)in patients undergoing total knee arthroplasty(TKA). Methods We electronically searched Pub Med, Cochrane Library,EMBASE, CNKI, CBM and Wanfang Data from inception to May 2014 and manually searched journal of library collection to identify randomized controlled trial(RCT) and Quasi-randomized controlled trial(q RCT) about intra-articular injection of tranexamic acid in patients undergoing TKA. The methodological quality of the included trials was assessed and the data were extracted according to the Cochrane Handbook 5.1.0. Meta-analysis. Data were analysed using Rev Man 5.2 software. Results A total of nine RCTs and one q RCT involving 846 patients were included. The results of meta-analyses showed that: 1Efficacy: Compared with the control group, the use of tranexamic acid reduced postoperative hemoglobin loss[SMD=-0.63,95%CI(-0.81,-0.45),P 0.000 01] and the rate of blood transfusion use[RR =0.28,95%CI(0.20,0.38),P 0.000 01]. 2Safety:Compared with the control group, the use of tranexamic acid did not increase the incidence of deep vein thrombosis [ RR =0.66,95%CI(0.24,1.84),P =0.43]. Conclusion The current evidence indicated that intra-articular tranexamic acid injection during total knee arthroplasty can effectively reduce postoperative hemoglobin loss and rate of blood transfusion use, without increase of the incidence of DVT. So intra-articular tranexamic acid injection has good clinical application value.

Chordoma is a rare low and moderate-grade malignant tumor originated in the embryonic period residual notochord tissue.Due to its critical location, local aggressive nature, and high recurrence, chordoma is not sensitive to radiotherapy and chemo-therapy with poor prognosis .Surgery is the main treatment method .Here we present a review focusing on basic and clinical research progress of chordoma .

OBJECTIVE:To systematically evaluate the efficacy and safety of preoperative administration of cyclooxygenase-2 (COX-2) inhibitor on pain occurring with total knee arthroplasty (TKA).METHODS:We electronically searched PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang data from inception to March 15, 2014 and manual searched journal of library collection to identify randomized controlled trials (RCTs) about preoperative administration of COX-2 inhibitor on pain occurring with TKA. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.1.0. Meta-analysis was performed by using RevMan 5.2 software.RESULTS:A total of 6 RCTs involving 228 patients were included. The results of meta-analyses showed that: (1) Efficacy: The visual analog scale (VAS) of post-operation at 12-hour (WMD = -0.60, 95% CI -0.83 to -0.37, P < 0.000 01) and 24-hour (WMD = -0.74, 95% CI -1.29 to - 0.19, P = 0.008) was decreased when COX-2 inhibitor was used before operation. And compared with control group, experimental group decreased the modified numerical pain rating scale (MNPRS) at 24-hour (WMD = -0.50, 95% CI -0.70 to -0.30, P < 0.000 01), 48-hour (WMD = -0.55,95% CI -0.65 to -0.45,P < 0.000 01) under quiescent conditions, and the same result at 24-hour (WMD = -0.82, 95% CI -1.26 to -0.38, P <0.000 01), 48-hour (WMD = -0.71, 95% CI -0.82 to -0.60, P < 0.000 01) under active conditions. The morphine consumption postoperatively were fewer in experimental group at the first day (WMD = - 1.35, 95% CI -1.92 to -0.79, P < 0.000 01) and the second day (WMD = -1.60, 95% CI -2.68 to -0.52, P = 0.004). (2) Safety: COX-2 inhibitor could lessen the incidence of postoperative pruritus (RR = 0.35, 95% CI 0.15 to 0.84, P = 0.02), but not statistically decrease of nausea and vomiting (RR = 0.83, 95% CI 0.54 to 1.28, P = 0.40) and exhaustion (RR = 0.63, 95% CI 0.05 to 7.67, P = 0.72).CONCLUSION:The current evidence indicated that preoperative administration of COX-2inhibitor can effectively improve the effect of postoperative analgesia, reduce the consumption of morphine and lessen the incidence of pruritus. Due to the limited quantity of the included studies and the evidence with limited strength,further high-quality RCTs are needed to verify the aforementioned conclusion.

Objective The periacetabular tumor has a low rate of incidence,but its special location poses a challenge to clinical treatment. The aim of this study was to discuss the methods,effects,and complications of surgical treatment of periacetabular tumors. Methods We retrospectively analyzed the clinical data of 36 cases of periacetabular tumor surgically treated in our department,including 21 males and 15 females,aged 15 to 64( 45. 2 ± 6. 3) years. Among them,there were 8 cases of benign tumor( 4 cases of simple bone cyst,1 case of desmoplastic fibromas,1 case of osteofibrous dysplasia,and 2 cases of hemangioma) and 28 cases of malignant tumor( 5 cases of osteosarcomas,12 cases of chondrosarcomas,2 cases of giant cell tumor of the bone,1 case of malignant chondroblastoma,2 cases of malignant fibrohistiocytoma,and 5 cases of metastatic tumor of the bone). The benign cases received simple tumor resection plus bone graft and steel plate system internal fixation,while malignant cases underwent reconstruction by combined pedicle screw fixation system with bone cement. Results No patients died perioperatively and controllable complications occurred in5 cases after operation. All the patients were followed up for 5 to 96 months except for 1 case of benign tumor. None of the benign cases experienced recurrence,and all of them achieved normal hip function. Lung metastases occurred in 10 malignant cases( 4 cases of osteosarcomas and 6 cases of chondrosarcomas),who died of respiratory failure,and the other 18 remained tumor-free after surgery. Of the 2 patients with malignant fibrohistiocytoma,1 died 2 years postoperatively and the other survived with tumor. Neither local recurrence nor lung metastasis was found in the patients with chordoma and malignant chondroblastoma till the end of follow-up. The 5 patients with metastases died within 3 years after operation. At 3 months after surgery,the Harris scores after total hip replacement were 90 in the 7 benign cases,70-79 in 9 malignant cases,and 70 in the other 19 malignant cases. Conclusion For the treatment of malignant tumors,reconstruction by combined pedicle screw fixation system with bone cement does not affect the general daily activities of the patients. Preoperative embolization of the internal iliac artery can reduce bleeding and improve operation safety,and measures should be taken to minimize postoperative complications.

Objective The incidence rate of sacrococcygeal tumor is low , however , due to its special position , clinical symptoms are inclined to be more severe .The aim of the article was to explore the methods and therapeutic effects of operative treat-ment for sacrococcygeal tumors . Methods A retrospective analysis was made on 44 cases of sacrococcygeal tumors treated in our hospital from January 2008 to December2012 .Of all the cases , there were 11 chordomas , 9 neurinoma , 4 malignant fibrous histioto-ma, 4 giant cell tumor, 7 metastases tumors and 9 others.All the patients had definite pathological diagnosis after operation .Operative treatments involved simple resection of rumors , simple resection of lesions and resection of lesions plus screw-rod system internal fixa-tion. Res ults No patients died in perioperative period .Follow-up was made in all patients for the average time of 3.3 years(4 months to 59 months).Except for 4 patients'delayed healing of incision operation and 1 patient′s healing of operation incision after de-bridement , all the other patients healed after enhancing the wound dressing , among which there are 3 cases of chordoma recurrence , 1 case of giant cell tumor recurrence , 3 death cases of malignant fibrous histiotoma in 2 years and 1 case alive with tumor .All patients with metastases tumor died in 3 years.Except 1 patients with osteosarcoma alive with tumor , all patients′symptoms had been alleviated after operation. Conclusion Chordoma and giant cell tumor still have a high recurrence rate after operation . The extent of rumor resection and nerve preservation are determined by the range of tumors.Preoperative embolization of the internal iliac artery can clearly reduce bleeding and improve the operation safety .