Результаты модульного эндопротезирования параацетабулярной области при опухолевом поражении вертлужной впадины и тазобедренного сустава

Introduction. surgical treatment of patients with pelvic bone tumors, in particular periacetabular tumors, remains challenging. There are many different reconstruction options after resection of these tumors. These include allo- and autografts, megaprosthesis, saddle endoprosthesis, custom-made endoprosthesis, 3D printing endoprosthesis, and femur transposition with the formation of neo-arthrosis. However, all of them are characterized by technical complexity and high risk of postoperative complications. There is still no standard procedure for reconstruction after resection of malignant periacetabular tumors. To date, modular endoprosthesis is a well-established reconstructive device in orthopaedic oncology to manage wide bone resections. Modular systems provide patient-specific endoprostheses that could be modified during surgery. In this article, we present the results of modular acetabular endoprostheses in the treatment of patients with periacetabular tumors.Material and Methods. From 2011 to 2018, 30 patients underwent modular endoprosthetic reconstruction after periacetabular resection. There were 13 (43 %) male and 17 (57 %) female patients aged from 23 to 63 years (median age 45 years). Primary malignant bone tumors were detected in 19 (63 %) patients, giant cell tumor in 5 (17 %), local soft tissue sarcoma in 1 (3 %), solitary metastases of kidney cancer in 2 (7 %) and recurrent sarcoma after previous surgical treatment in 3 (10 %) patients.Results. The average duration of surgery was 310 minutes (range: 145-520 minutes), blood loss was 5520 ml (range: 600-20000 ml). The median follow-up time was 36 months. Histological examination revealed a positive resection margin in 3 (10 %) patients. At a follow-up from 6 to 40 months, disease progression was detected in 10 (33 %) patients. Eight (27 %) patients died on disease progression. Complications of various types were diagnosed in 11 (37 %) patients. Infectious complications were the most common (30 % of patients). The average value of the functional assessment by the MSTS scale was 59 % (15-82%).Conclusion. Modular endoprosthetic replacement for tumors of the acetabulum and hip joint is a promising surgical technique allowing adequate functional results to be achieved.Введение. Хирургическое лечение больных с опухолевым поражением костей таза, в частности параацетабулярной области, является одним из наиболее сложных разделов современной онкоортопедии. Существуют различные методики реконструкции вертлужной впадины: при помощи алло- и аутографтов, мегаэндопротезов, седловидных эндопротезов, индивидуальных эндопротезов, 3Б-принтинга и транспозиции бедренной кости с формированием неоартроза. Однако все они характеризуются технической сложностью выполнения, достаточным риском развития послеоперационных осложнений. Вследствие этого универсальной методики, удовлетворяющей всем поставленным задачам, не существует. Одним из наиболее современных методов реконструкции костей таза является использование модульных эндопротезов на основе конической ножки, преимуществом которых является возможность интра-операционно смоделировать эндопротез, наиболее полно удовлетворяющий конкретной клинической ситуации. В статье представлены результаты использования модульных эндопротезов вертлужной впадины при лечении пациентов с опухолевым поражением параацетабулярной области.Материал и методы. В период с 2011 по 2018 г хирургическое лечение в объеме параацетабулярной резекции с реконструкцией модульным эндопротезом выполнено 30 больным, из них мужчин - 13 (43 %), женщин - 17 (57 %). Средний возраст - 45 лет (23-63 года). Первичные злокачественные опухоли костей были у 19 (63 %) больных, гигантоклеточная опухоль - у 5 (17 %), местнораспространенная саркома мягких тканей - у 1 (3 %), солитарные метастазы рака почки - у 2 (7 %), рецидивы сарком хирургического лечения - у 3 (10 %) пациентов. Результаты. Средняя продолжительность операции - 310 мин (145-520 мин), средний объем интраоперационной кровопотери - 5 520 мл (600-20 000 мл). Положительный край резекции по результатам планового морфологического исследования выявлен у 3 (10 %) больных. Средний срок наблюдения составил 36 мес (4-73 мес). Прогрессирование в сроки от 6 до 40 мес выявлено у 10 (33 %) больных, из них умерло 8 (27 %) пациентов. Осложнения разного типа диагностированы у 11 (37 %) больных, среди которых преобладали инфекционные процессы - 9 (30 %). Среднее значение функционального результата по шкале MSTS составило 59 % (15-82 %).Заключение. Применение модульных систем эндопротезирования вертлужной впадины и тазобедренного сустава при опухолевом поражении является перспективной хирургической методикой, позволяющей добиться адекватных функциональных результатов при сравнимом количестве послеоперационных осложнений

Results of modular endoprosthetic reconstruction of periacetabular bone defects in patients with tumors of the acetabulum and hip joint

Introduction. surgical treatment of patients with pelvic bone tumors, in particular periacetabular tumors, remains challenging. There are many different reconstruction options after resection of these tumors. These include allo- and autografts, megaprosthesis, saddle endoprosthesis, custom-made endoprosthesis, 3D printing endoprosthesis, and femur transposition with the formation of neo-arthrosis. However, all of them are characterized by technical complexity and high risk of postoperative complications. There is still no standard procedure for reconstruction after resection of malignant periacetabular tumors. To date, modular endoprosthesis is a well-established reconstructive device in orthopaedic oncology to manage wide bone resections. Modular systems provide patient-specific endoprostheses that could be modified during surgery. In this article, we present the results of modular acetabular endoprostheses in the treatment of patients with periacetabular tumors.Material and Methods. From 2011 to 2018, 30 patients underwent modular endoprosthetic reconstruction after periacetabular resection. There were 13 (43 %) male and 17 (57 %) female patients aged from 23 to 63 years (median age 45 years). Primary malignant bone tumors were detected in 19 (63 %) patients, giant cell tumor in 5 (17 %), local soft tissue sarcoma in 1 (3 %), solitary metastases of kidney cancer in 2 (7 %) and recurrent sarcoma after previous surgical treatment in 3 (10 %) patients.Results. The average duration of surgery was 310 minutes (range: 145-520 minutes), blood loss was 5520 ml (range: 600-20000 ml). The median follow-up time was 36 months. Histological examination revealed a positive resection margin in 3 (10 %) patients. At a follow-up from 6 to 40 months, disease progression was detected in 10 (33 %) patients. Eight (27 %) patients died on disease progression. Complications of various types were diagnosed in 11 (37 %) patients. Infectious complications were the most common (30 % of patients). The average value of the functional assessment by the MSTS scale was 59 % (15-82%).Conclusion. Modular endoprosthetic replacement for tumors of the acetabulum and hip joint is a promising surgical technique allowing adequate functional results to be achieved

PROGNOSTIC FACTORS OF RELAPSE IN THE SURGICAL TREATMENT OF DESMOID FIBROIDS OF THE TRUNK AND EXTREMITIES

Purpose of the study. Evaluation of the results of surgical treatment of desmoid fibroids (DF) using reconstructive plastic surgery and determination of possible prognostic factors of relapses.Patients and methods. The results of surgical treatment of 40 patients with desmoid fibroids of extra abdominal local­ization were analyzed. In 45% of patients, the tumor was located in soft tissues of the shoulder girdle and upper limb, in 35% — on the trunk, in 20% — in soft tissues of the lower limb and in 7% of patients on the neck. The tumor size varied from 2 to 20 cm, the median was 8 ± 4.38 cm. Surgical treatment for newly diagnosed DF was performed in 22 (55%) patients, and for recurrent tumors — in 18 (45%) patients.Results. According to the planned histological study, negative resection boundaries were established in 24/40 patients (63%). In the remaining 16 cases (37%) positive resection margins were obtained: R1 in 14 patients and R2 in 2 patients. Adjuvant treatment is recommended for 14 patients with resection R1/R2. The duration of follow — up after treatment ranged from 6 to 107 months, median‑16.5 months. During follow-up, relapses were diagnosed in 14 patients (35%). No deaths have been reported.Conclusion. Surgical treatment of DF of extraabdominal localization is accompanied by a sufficiently high frequency of relapses. According to the results of the study, an unfavorable factor in the development of relapses is the location of the tumor in soft tissues of the shoulder girdle and upper limb

Preliminary results of the first scientific drilling on Lake Baikal, Buguldeika site, southeastern Siberia

The Baikal Drilling Project (BDP) is a multinational effort to investigate the paleoclimatic history and tectonic evolution of the Baikal sedimentary basin during the Late Neogene. In March 1993 the Baikal drilling system was successfuly deployed from a barge frozen into position over a topographic high, termed the Buguldeika saddle, in the southern basin of Lake Baikal. The BDP-93 scientific team, made up of Russian, American and Japanese scientists, successfully recovered the first long (\u3e100 m) hydraulic piston cores from two holes in 354 m of water. High quality cores of 98 m (Hole 1) and 102 m (Hole 2), representing sedimentation over the last 500,000 years, were collected in 78 mm diameter plastic liners with an average recovery of 72% and 90%, respectively. Magnetic susceptibility logging reveals an excellent hole-to-hole correlation. In this report the scientific team describes the preliminary analytical results from BDP-93 hole 1 cores. Radiocarbon dating by accelerator mass spectrometry provides an accurate chronology for the upper portion of Hole 1. Detailed lithologic characteristics, rock magnetic properties and inorganic element distributions show a significant change to the depositional environment occuring at 50 m subbottom depth, approximately 250,000 BP. This change may be due to uplift and rotation of the horst block in the Buguldeika saddle. The sedimentary section above 50 m is pelitic with varve-like laminae, whereas the section below 50 m contains a high proportion of sand and gravel horizons often organized into turbidite sequences. Accordingly, high resolution seismic records reveal a change in sonic velocity at this depth. It is inferred that sedimentation prior to 250 ka BP was from the west via the Buguldeika river system. After 250 ka BP the Buguldeika saddle reflects an increase in hemipelagic sediments admixed with fine-grained material from the Selenga River drainage basin, east of Lake Baikal. Variations in the spore-pollen assemblage, diatoms, biogenic silica content, rock magnetic properties, clay mineralogy and organic carbon in the upper 50 m of BDP-93-1 reveal a detailed record of climate change over approximately the last 250,000 years. These variables alternate in a pattern characteristic of glacial/interglacial climatic fluctuations. The present age model suggests that the climate signal recorded in Lake Baikal sediments is similar to Late Quaternary signals recorded in Chinese loess sections and in marine sediments. Copyright © 1996 INQUA/ Elsevier Science Ltd