Objective:To investigate the feasibility and early clinical efficacy of spherical motion axis hinge knee prosthesis to reconstruct distal femoral bone defects.Methods:A retrospective analysis was performed on 16 patients admitted to PLA 960th Hospital and Tianjin Hospital from October 2019 to November 2021, including 8 males and 8 females, with an average age of 43.3±17.8 years (range, 15-71 years). There were 13 patients of primary tumors of the distal femur and 3 patients of postoperative revision of knee joint prostheses. Among the 13 patients with distal femur tumors, there were 6 cases of osteosarcoma, 5 cases of giant cell tumor of bone, 1 case of leiomyosarcoma and 1 case of chondrosarcoma. The reasons for revision after prosthesis replacement in 3 cases were: 2 cases of aseptic loosening after tumor-type prosthesis and 1 case of periphery fracture of surface artificial knee prosthesis. A spherical shaft rotary hinged knee prosthesis was designed and fabricated to reconstruct postoperative femoral defects in 16 patients. Follow up regularly after the operation, recheck the X-ray film to evaluate the lower limb force line, evaluate the quality of life after the operation with the Chinese version of 36-item short-form (SF-36), and evaluate the postoperative limb function with the Musculoskeletal Tumor Society (MSTS) 93 evaluation system.Results:All 16 patients were successfully placed with prostheses, and except for 2 patients undergoing total femoral replacement, the length of bone defects was 18.2±11.7 cm (range, 8.6-47.1 cm) in other 14 patients, and the operation time was 138±19 min (range, 110-170 min), the intraoperative blood loss was 211±118 ml (range, 100-500 ml). The postoperative full length orthostatic X-ray film of the lower limbs showed that the distance between the mechanical axis of the lower limb and the center of the knee joint was 0.1 (0, 0.7) cm in 16 patients, and the hip-knee ankle angle was 179.0°±2.3°(range, 173.3°-182.2°). The patients were followed up for 12-36 months. No prosthesis complications were found in 16 patients. The SF-36 score was 56.7±7.0 (range, 42.7-67.4) for physiological function and 54.1±7.6 (range, 40.5-66.3) for psychological function. The maximum knee flexion angle was 120.0°±15.6° (range, 95°-130°). The MSTS 93 score of 15 patients with tumor was 25.0±1.7 (range, 22-28), including 7 excellent and 8 good. One patient developed liver and lung metastases 10 months after surgery and died 18 months after surgery. The remaining patients, as of the last follow-up, were alive and had no local recurrence or distant metastases. Tumor-free survival time was 25.8±8.4 months (range, 12-36 months).Conclusion:The spherical motion axis hinge knee prosthesis reconstruction for distal femoral bone defects is simple and fast in intraoperative prosthesis installation, and there are no prosthetic related complications during short-term follow-up. The clinical efficacy is satisfactory.

目的:观察3D打印人工椎体应用于脊柱结核椎体重建的临床结果.方法:2018年5月～2021年6月,我科连续住院手术治疗36例脊柱结核患者,其中10例采用病灶清除、3D打印人工椎体重建,包括3例定制假体,7例非定制假体;男性4例,女性6例;年龄26～73岁,中位年龄59岁.颈椎1例,胸椎4例,胸腰段2例,腰椎1例,腰骶段2例.累及3个相邻椎体2例,2个相邻椎体8例.所有患者术前接受2周正规抗结核药物化疗,根据椎体病灶大小规划手术切除范围,个体化设计假体与骨的接触面和固定模式.术后继续口服抗结核药物治疗12～18个月,每月复查血沉、血常规、肝肾功能,定期随访手术部位影像片、VAS疼痛评分、Frankel神经功能、假体融合情况、日常活动功能等.结果:平均随访20.1±9.1个月(12～45个月),手术节段角度术前为-24°～24°,末次随访时为-8°～32°,后凸改善0～32°.术前VAS评分6.4±2.6分,末次随访时为2.0±1.8分;末次随访Frankel脊髓功能分级:8例改善1级或以上,2例维持稳定;除1例耐药结核外,所有假体位置稳定,无假体松动、下沉和移位.假体融合情况Bridwell分级为Ⅰ级2例,Ⅱ级5例,Ⅲ级3例.CT评估界面融合,完全融合1例,初步融合4例,延迟融合4例,不愈合1例.结论:3D打印人工椎体用于脊柱结核具有个体化、即刻稳定性好、融合节段少的特点;临床短期随访疗效确切,假体融合情况需长期随访.

目的:对比分析全脊椎切除术和次全脊椎切除术治疗脊柱转移瘤的临床疗效.方法:回顾性分析2004年5月～2017年2月在我院接受手术治疗的43例脊柱转移瘤患者的资料,根据手术方式分为两组:全脊椎切除组14例,次全脊椎切除组29例.两组患者性别、年龄、原发肿瘤性质、病灶类型等一般资料差异均无统计学意义(P＞0.05).分别采用 KPS(Karnofsky performance scale)评分、视觉模拟量表(visual analogue scale,VAS)评分、Frankel分级对患者术前、术后1个月的功能状态、疼痛程度以及神经功能进行评估.术后随访观察患者生存情况,绘制Kaplan-Meier曲线,使用Log-rank检验进行比较.结果:全脊椎切除组与次全脊椎切除组患者术前VAS评分分别为5.29±1.54分、5.00±1.58分,KPS评分分别为70.71±8.29分、69.31±11.00分,术后1个月VAS评分分别为1.00±1.52分、0.97±1.88分,KPS评分分别为85.00±7.60分、85.17±17.45分,均较术前明显改善,差异有统计学意义(P＜0.001),而两组组内无统计学差异(P＞0.05).两组患者术后Frankel分级较术前明显改善,差异有统计学意义(P＜0.001),两组组间比较无统计学差异(P＞0.05).术后6例出现局部复发,其中全脊椎切除组1例,次全脊椎切除组5例,两组差异有统计学意义(x2=6.416,P=0.011).生存分析结果显示全脊椎切除组患者术后中位生存时间为10.0个月(95％CI:0.29～19.71);次全脊椎切除组患者术后中位生存时间为11.0个月(95％CI:4.60～17.40),全脊椎切除与次全脊椎切除的两组患者术后半年累积生存率分别为63.6％、63.2％,术后1年生存率分别为45.2％、42.1％,两组间无统计学差异(P＞0.05).结论:全脊椎切除与次全脊椎切除手术均能明显改善脊柱转移瘤患者功能状态、疼痛程度以及神经功能,全脊椎切除有助于减少脊柱转移瘤术后局部复发.

Objective:To summarize the technical points of microwave ablation for inactivating the preserved bone in situ combined with hip prosthesis for proximal femoral malignancy and analyze its clinical efficacy.Methods:A total of 28 patients with proximal femoral malignancy who were treated in Tianjin Hospital from January 2018 to December 2021 were included in the study. There were 12 males and 16 females, aged 65.3±10.9 years (range 39-85 years); 26 metastatic bone tumors and 2 patients with proximal femoral primary tumors accompanying marrow cavity jumping focus in the study. According to whether the tumor bone mass was preserved in situ during microwave ablation, the patients were divided into the bone mass preservation group (18 cases) and conventional surgery group (10 cases). In the bone mass preservation group, according to the evaluation of preoperative CT and MRI, part of the tumor bone was preserved in situ and hip arthroplasty was performed after microwave inactivation. In the conventional surgery group, total resection of the tumor and microwave inactivation were performed firstly, and then hip prosthesis replacement was performed. Clinical efficacy was evaluated by comparing the length of osteotomy, the postoperative prosthesis stability and Musculoskeletal Tumor Society (MSTS) score.Results:The follow-up time of 28 patients was 11.9±5.9 months (range 4 to 24 months). The intraoperative length of osteotomy was 9.2±2.5 cm in the bone mass preservation group and the intraoperative length of osteotomy was 15.4±3.6 cm in the conventional surgery group, and the difference between the two groups was statistically significant ( t=5.40, P=0.002). There were 5 common hip prosthesises and 13 modular hip prosthesises in the bone mass preservation group. In 2 patients with common prosthesis, X-ray showed partial bone resorption at the osteotomy interface 3 and 8 months after operation, no loosening or fracture at the prosthesis-bone interface, and no pain or limitation of walking. There were 10 modular hip prosthesises in the conventional surgery group, with one patient suffered pain while walking at 19 months after surgery, and the X-ray suggested loosening between the prosthesis-bone interface. MSTS score of bone mass preservation group at 3 months post-operation was 16.6±1.9 points, including good 6 cases and moderate 12 case, and the excellent and good rate was 33%, meanwhile MSTS score of conventional surgery group was 15.5±3.6 points, including good 3 cases, moderate 5 cases and poor 2 cases, and the excellent and good rate was 30% at 3 months post-operation, and the difference between the two groups was not statistically significant ( t=0.94, P=0.366). MSTS score of bone mass preservation group at 6 months post-operation was 21.7±3.2 points, including excellent 3 cases, good 9 cases, moderate 1 case and poor 1 case, and the excellent and good rate was 86% (12/14), meanwhile MSTS score of conventional surgery group at 6 months post-operation was 16.5±4.9 points, including excellent 1 case, good 3 cases, moderate 3 cases and poor 2 cases, and the excellent and good rate was 44% at 6 months post-operation, and the difference between the two groups was statistically significant ( t=3.03, P=0.006). MSTS score of bone mass preservation group at 12 months post-operation was 22.3±7.6 points, including excellent 8 cases, good 2 cases, moderate 1 case and poor 1 case, and the excellent and good rate was 83% (10/12), meanwhile conventional surgery group at 12 months post-operation was 22.1±6.6 points, including excellent 3 case, good 3 cases, moderate 1 cases and poor 1 cases, and the excellent and good rate was 75%(6/8), and the difference was not statistically significant ( t=0.06, P=0.957). The MSTS scores of 6 months after operation, including movement function, acceptance degree, brace assistance and walking ability, were significantly improved in the bone mass preservation group compared with the conventional surgery group, and the differences were statistically significant ( t=2.33, P=0.030; t=2.74, P=0.012; t=2.80, P=0.011; t=2.59, P=0.026). Conclusion:Preserved bone mass in situ inactivated by microwave ablation combined with tumor hip prosthesis is an alternative surgical method for the treatment of proximal femoral malignancy, which can increase the stability of the prosthesis, facilitate the biological reconstruction of soft tissues and early functional recovery.

Objective:To evaluate the clinical value of the New England spinal metastasis score (NESMS) in predicting the prognosis of patients with spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:The data of 179 patients with spinal metastases from January 2008 to December 2018 were retrospectively collected. There were 108 males (60.3%) and 71 females (39.7%) with an average age of 59.79±10.88 years old (range 27-84 years). The patient demographic characteristics, primary tumor type, spinal metastases and segments, vertebral pathological fractures, neurological Frankel classification, physical function status, Karnofsky performance scale (KPS), visual analogue score (VAS), the spinal instability neoplastic score (SINS), modified Bauer score, NESMS score, Tomita score and modified Tokuhashi score were collected. The clinical value of NESMS score, Tomita score and modified Tokuhashi score in predicting the survival of patients with spinal metastases were compared. The independent factors affecting survival in these patients were analyzed by Cox proportional hazards regression model.Results:Among the 179 patients, the peak incidence of spinal metastases was in the age group of 61-75 years (45.3%, 81/179) of all patients. Lung cancer was the most common primary tumor (46.9%, 84/179). 40.8% (73/179) of patients had multi-segment metastasisand thoracic spine was the most common site with single-site metastasis (26.3%, 47/179). 28.5% (51/179) of the patients had visceral metastases and 52.0% (93/179) of the patients had extraspinal bone metastases. 31.3% (56/179) of the patients had pathological fractures of the involved vertebral bodies.114 patients received surgical treatment (63.4%). The mortality rates in 3-months, 6-months and 1-year were 22.4% (40/179), 51.4% (92/179) and 77.1% (138/179), respectively. The median survival time of patients with NESMS score of 0-3 was 3, 4, 8, and 10 months respectively with the mean survival time was 3.60±2.10, 6.77±3.39, 9.69±5.71 and 10.53±6.25 months. The 1-year mortality rates were 100% (13/13), 87.5% (42/48), 71.6% (63/88) and 66.7% (20/30) respectively. The consistency of NESMS score, Tomita score and modified Tokuhashi score in predicting survival of all patients was 0.63, 0.58 and 0.55, respectively. For patients with spinal metastases, the NESMS score was better than the Tomita score and modified Tokuhashi score in predicting survival at 3-months (AUC=1.00, 0.63, 0.42) and 6-months (AUC=0.71, 0.63, 0.45). But the accuracy of Tomita score was best in predicting survival at 1-year (AUC=0.66, 0.61, 0.38). Multivariate Cox proportional hazards regression model analysis showed that growth rate of primary tumor, neurological function Frankel score, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases ( P<0.05). Conclusion:The consistency and accuracy of NESMS score in predicting survival of patients with spinal metastases are better than Tomita score and modified Tokuhashi score, especially in predicting 3- and 6-month survival. The growth rate of primary tumor, Frankel classification, albumin level and surgical treatment were independent factors affecting the survival time of patients with spinal metastases.

Objective:To explore the reasons for revision of tumor prosthesis of knee joint and summarize the experience of revision surgery.Methods:We conducted a retrospective study of 33 patients who underwent revision surgery for tumor prosthesis of knee joint in Tianjin Hospital and the 960th Hospital of the People's Liberation Army Hospital from June 2004 to June 2018. There were 25 male and 8 female patients, the mean age was 45±13.1 years (range 19-64 years) at the time of revision. Histological diagnosis was giant cell tumor in 17 patients, osteosarcoma in 9 patients, malignant fibrous histiocytoma in 3 patients and one for each of chondrosarcoma, peripheral schwannoma, ligamentoid fibroma and bone metastases. The reasons for revision were aseptic loosening in 23 cases, dislocation, stem breakage and periprosthetic fracture in 2 cases, infection in 3 cases, and local recurrence in 1 case. The general outcome, oncological outcome, reasons for prosthesis revision, postoperative limb function, and complications were summarized.Results:The median follow-up of the 33 patients was 48.0 (24.0, 107.0) months. The most common reason for revision was aseptic loosening (88%, 29/33), followed by infection (9%, 3/33) and local recurrence (3%, 1/33). The MSTS of 32 patients with survival more than 1 year was 24.28±4.74 points (range 9-30 points), which was statistically different from preoperative 11.78±5.23 points (range 4-21 points) ( t=10.02, P<0.001). The postoperative median TESS score of 32 patients with survival more than 1 year was 86.67(80.00, 91.67) points, and the preoperative median score was 56.0(43.17, 65.33) points, which was statistically significant ( Z=6.78, P<0.001). Postoperative complications occurred in 12 patients, most commonly mechanical problems (15%, 5/33) and infection (15%, 5/33), followed by local recurrence (6%, 2/33), with an overall complication rate of 36% (12/33). Conclusion:The main reason for revision of tumor prosthesis of knee joint is aseptic loosening. Revision surgery can achieve ideal postoperative function and should be the first choice for failure of prosthesis after initial replacement.

目的 分析脊柱肿瘤全椎切除术后应用3D打印人工椎体进行脊柱重建的可行性.方法 选取11例接受脊柱肿瘤全椎切除术并应用3D打印人工椎体进行脊柱重建的患者资料.记录患者手术时间、术中出血量、住院时间、内固定稳定程度,采用视觉模拟评分(VAS)对术前、术后24 h、术后6个月及末次随访的疼痛程度进行评估,并依据日本骨科协会评估治疗分数(JOA)对上述时点脊柱功能进行评估.末次随访时,采用脊髓损伤Frankel分级对脊髓损伤严重程度进行评估,随访期间记录并发症发生情况.结果 全部患者随访8～15个月,平均11个月;患者手术时间(320.21±43.21)min、出血量(1354.28±101.54)mL、住院时间(22.21±10.24)d.11例患者中10例末次随访时Frankel分级有至少1个等级的改善;所有患者均未出现椎弓根钉位置移动和断裂,假体无脱位.术前、术后24 h及术后6个月的VAS评分呈依次降低趋势(P<0.01),但末次随访VAS评分与术后6个月比较差异无统计学意义;除术前与术后24 h JOA评分差异无统计学意义以外,其余各时点JOA评分呈依次升高趋势(P<0.01);1例骨巨细胞瘤患者术后3个月复发,1例脊柱继发甲状腺癌患者术后9个月死亡.结论 脊柱肿瘤全椎切除术后应用3D打印人工椎体重建,稳定性高,并发症少,安全性较高,预后良好.

Objective:To investigate the possibility of basic fibroblast growth factor (bFGF) and bone morphogenetic protein (BMP)-12 genes into rabbit adipose stem cells to differentiate into fibroblasts.Methods:The study was conducted from January 2017 to December 2018. The cells were derived from subcutaneous fat in the neck and back of the New Zealand big-eared rabbits. Rabbit adipose-derived stem cells (ADSCs) were cultured, and CD44, CD49d and CD106 were used to identify the cultured cells. Liposome was used to sequentially transfect BMP-12 and bFGF genes. Western blotting was used to detect the protein expression of BMP-12 and bFGF. Real time-PCR assay was used to detect the mRNA expression of type Ⅰ collagen and elastin. One-way ANOVA was used to compare the differences among the groups. P<0.05 was considered statistically significant. Results:The ADSCs isolated from rabbit adipose tissue were positive for CD44 and CD49d while negative for CD106. The expression of BMP-12 (0.229±0.005) and bFGF (0.208±0.019) proteins was stable in the selected ADSCs ( F=120.221, P<0.05). The mRNA expression of type Ⅰ collagen (2.250±0.007, F=340.103, P<0.05) and elastin (1.807±0.008, F=107.314, P<0.05) in ADSCs transfected with two genes was the highest and the difference was statistically significant. Conclusion:PcDNA3.1+ green fluorescent protein (GFP)-BMP-12 and pcDNA3.1+ red fluorescence protein (RFP)-bFGF could promote the differentiation of ADSCs into fibroblasts, which may play an important role in tissue engineering to repair ligament damage.

Objective:To study the expression of long-nocoding RNA (lncRNA) FOXD2-AS1 in osteosarcoma tissues and cell lines, and its effect and mechanism on proliferation, apoptosis, invasion and migration of osteosarcoma cells.Methods:The expression of FOXD2-AS1 in 36 osteosarcoma tissues and adjacent tissues was detected by real-time quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR), and the relationship betweenthe expression and clinicopathological features was analyzed. The expression of FOXD2-AS1 in osteosarcoma cell line (MG63, Saos-2, U2-OS, 143B) and human osteoblast cell line (hFOB1.19) was detected. The proliferation, apoptosis, invasion and migration of osteosarcoma cells were detected by cell counting kit-8 (CCK-8), Annexin V-fluoresceine isothiocyanate (FITC)/propidium iodide (PI) flow cytometry and Transwell experiments, and the effects of FOXD2-AS1 on enhancer of zeste homolog 2 (EZH2) and p21 were detected by RNA binding protein immunoprecipitation (RNA-IP), Western blotting and ChIP.Results:The expression of FOXD2-AS1 in osteosarcoma tissue was higher than that in the adjacent tissues ( t=17.900, P<0.01), and the expression was more significant in osteosarcoma with large tumor and high TNM stage ( χ2=4.208, 9.257, P<0.01). The expression of FOXD2-AS1 in osteosarcoma cell lines was higher than that in human osteoblasts ( t=14.540, 9.970, 5.890, 2.910, P<0.01), and especially in MG63 and Saos-2, and the expression of foxd2-as1 in osteosarcoma was higher than that in adjacent tissue ( P<0.01), and the expression was more significant in osteosarcoma with large volume and high TNM stage ( P<0.01). The expression of foxd2-as1 in osteosarcoma cell lines was higher than that in human osteoblasts ( P<0.01). Especially in MG63 and Saos-2 cell lines, knockdown of FOXD2-AS1 could inhibit proliferation ( P<0.05), promote apoptosis ( P<0.01), and inhibit invasion and migration ( P<0.01). RNA-IP, Western blotting and ChIP results showed that FOXD2-AS1 interacted with EZH2. Knockdown of FOXD2-AS1 decreased the binding of EZH2 and H3K27me3 to p21 promoter. Conclusion:FOXD2-AS1 can indicate poor clinical prognosis and promote the malignant biological behavior of osteosarcoma cells. The mechanism may be that foxd2-as1 interacts with EZH2 to inhibit the expression of p21.