目的 本研究旨在探讨使用计算机导航行胫骨肿瘤节段性切除的准确性.方法 回顾性分析我科2009年12月至2015年6月7例使用计算机导航行胫骨肿瘤节段性切除者.男3例,女4例,中位年龄16(13～27)岁.骨肉瘤5例,软骨肉瘤、造釉细胞瘤各1例.患者术前行胫骨肿瘤增强CT及MRI检查.将CT及MRI数据导入计算机辅助导航工作站中进行术前设计,记录设计的瘤段截除长度及肿瘤边缘到近端截骨边界及远端截骨边界的距离.使用计算机辅助导航进行节段性切除,获得术后标本后将标本用甲醛溶液固定24 h,再用电锯将瘤段标本沿冠状面剖开,使用精度为毫米的直尺测量瘤段的长度,将该长度与术前设计的截骨长度进行比较.标本送病理科后由骨肿瘤病理医生制作切片,测量出肿瘤边缘到近端截骨边界及远端截骨边界的距离,将该距离与术前设计进行比较.结果 术后标本瘤段长度与设计的截除长度进行比较,差值为(-2～2)mm,绝对值差异平均为1 mm,二者差异无统计学意义(P=0.70).术后实际肿瘤边界减去术前设计边界为肿瘤边界差值,差值为(-2～2)mm,绝对值差异平均为1.4 mm,术后实际边界与设计边界差异无统计学意义(P=0.68).结论 本研究证实计算机导航技术辅助下进行胫骨肿瘤的节段性切除准确性高,可以满足保留关节等精确切除手术的要求.

Objective To detect the serum pyridinoline cross-linked N-telopeptides of typeⅠ collagen ( NTx) level of giant cell tumor of bone( GCT) patients, and to investigate the effects of zoledronic acid and surgery on it. Methods Thirty-five GCT pa-tients were enrolled, and randomly divided into group A and group B. Patients in group A were given zoledronic acid ( Zometa) and surgery, while patients in group B only received surgery. Blood collection was performed before and after the treatments. Level of serum NTx were tested by ELISA method. Factors affecting the serum NTx level of GCT patients were analyzed by single factor analysis of vari-ance. Results For group A, NTx levels after zoledronic acid were (28?50±7?06) and (21?38±3?33) nmol BCE/L before and after zoledronic acid(P<0?05), and then dropped to (20?60±3?28)nmol BCE/L after surgery(P<0?05). For group B, NTx levels were (26?05±4?37) and (24?38±3?56) nmol BCE/L before and after surgery(P<0?05). The change rate of NTx after treatment in group A was higher than that in group B( P<0?05) . According to statistical analysis, the serum NTx level of GCT patients all decreased sig-nificantly after receiving zoledronic acid, surgery and zoledronic acid plus surgery ( P<0?05) . Tumor location was found to be a signifi-cant influential factor of serum NTx level ( P<0?05) . Conclusion The serum NTx level of the GCT patients can be decreased by ei-ther zoledronic acid or surgery,showing the potential value in assisting the diagnosis and treatment of GCT.

10538 Background: The aim of this study was to investigate the efficacy and safety of chemotherapy combined with re-endostatin (endostar) against stage IIB ostosarcoma. Methods: Patient of stage II...

Objective To investigate the efficacy and safety of chemotherapy combined with rh-endostatin(endostar) against stage ⅡB ostosarcoma.Methods Patients of stage ⅡB ostosarcoma enrolled in Beijing Jishuitan Hospital from January 2008 to April 2012 were divided into combined group and control group.The regimen of chemotherapy was as follows: methotrexate 10g/m2 iv d1,ifosfamide 3g/m2 iv d1-d5,cisplatin 120mg/m2 iv d1,doxorubicin 30mg/m2 iv d1-d3.Based on the same chemotherapy,endostar was added in combined group(15mg iv d1-d14,21days was a cycle,for 4 cycles).Results A total of 388 patients were enrolled in this study,and 58 cases were excluded in the final analysis.In the 330 patients could be evaluated,272 cases were in control group and 58 in combined group.Patients were followed up 6-59 months with a median period of 20.2 months.In the control group,1-,2-and 3-year distant metastasis-free survival rates were 79%,70% and 65% respectively,while those of combined group were 93%,86% and 77% with statistical difference(P=0.045).In control group,1-,2-and 3-years of progression-free survival rates were 76%,66% and 60%,respectively,while those of combined group were 90%,83% and 74% with statistical difference(P=0.025).In the control group,1-,2-and 3-year overall survival rates were 94%,84% and 79%,while those of combined group were 98%,94% and 85% without statistical difference(P=0.220).The side effects in the two groups were mainly in grade 1-2,and the common grade 3-4 side effects were leucopenia,anemia,hepatic dysfunction,nausea and vomiting.There was no difference in side effects of the two groups.Conclusion The combination of chemotherapy and endostar can significantly improve the distant metastasis-free survival and progression-free survival in osteosarcoma patients,with tolerable side effects,worthy further study.