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Higuchi, Takashi ; Yamamoto, Norio ; Nishida, Hideji ; Hayashi, Katsuhiro ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Miwa, Shinji ; Inatani, Hiroyuki ; Shimozaki, Shingo ; Kato, Takashi ; Aoki, Yu ; Abe, Kensaku ; Taniguchi, Yuta ; Tsuchiya, Hiroyuki
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Purpose: To preserve the joint structure in order to maintain good limb function in patients with osteosarcoma, we perfo
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rm epiphyseal or metaphyseal osteotomy and reconstruction using frozen autografts that contain a tumour treated with liquid nitrogen. There are two methods of using liquid nitrogen-treated autografts: the free-freezing method and the pedicle-freezing method. The purpose of this study was to evaluate the results of intentional joint-preserving reconstruction using the free-freezing method and the pedicle-freezing method in patients with osteosarcoma. Methods: Between 2006 and 2014, we performed joint-preserving surgery (12 with the free-freezing method and six with the pedicle freezing method) to treat 18 cases of osteosarcoma (12 distal femurs and six proximal tibias) in patients who had achieved a good response to neoadjuvant chemotherapy. Results: Among the 18 patients (nine boys and nine girls) who had a mean age of 11.6 years, 13 remained continuously disease-free, three showed no evidence of disease, one was alive with the disease, and one died from the disease. Functional outcomes were assessed as excellent in 15 patients and poor in three, with a mean follow-up period of 46.1 months. The mean Musculoskeletal Tumour Society (MSTS) score was 90.2%. Except for one patient who underwent amputation, all patients could bend their knee through >90° flexion, and nine achieved full ROM. All but two patients could walk without aid, and 11 were able to run normally throughout the follow-up period. No intraoperative complications were observed, such as surrounding soft-tissue damage, neurovascular injury, or recurrence from frozen bone. Conclusions: Joint-preserving reconstruction using frozen autografts yielded excellent function in patients with osteosarcoma. © 2017 The Author(s)<br />in Press / Embargo Period 12 months
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Tsuchiya, Hiroyuki ; Takeuchi, Akihiko ; Yamamoto, Norio ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Nishida, Hideji ; Tomita, Katsuro
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金沢大学医薬保健研究域医学系
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Tsuchiya, Hiroyuki ; Takeuchi, Akihiko ; Yamamoto, Norio ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Nishida, Hideji ; Tomita, Katsuro
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Watanabe, Koji ; Tsuchiya, Hiroyuki ; Yamamoto, Norio ; Shirai, Toshiharu ; Nishida, Hideji ; Hayashi, Katsuhiro ; Takeuchi, Akihiko ; Matsubara, Hidenori ; Nomura, Issei
概要:
Background: The aim of this study was to investigate the long-term functional capabilities of patients who underwent bon
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e distraction for the treatment of bone defects caused by bone tumor excision. Methods: Bone distraction was indicated for patients with stage IIB malignant bone tumors when chemotherapy was judged to be effective and an epiphysis could be preserved or for patients with low-grade or aggressive benign bone tumors. Twenty-two patients who underwent reconstruction with bone distraction and were followed up for at least 10 years were retrospectively investigated. Patients included 8 males and 14 females, with a mean age of 25.3 years. Tumor types included seven osteosarcomas, two osteofibrous dysplasias, one Ewing's sarcoma, five low-grade osteosarcomas, two adamantinomas, and five giant cell tumors. Chemotherapy was performed during bone distraction in 8 cases. Bone transport was used in 17 cases, while shortening distraction was used in 5 cases. Results: The mean distraction length was 8.1 cm, and the mean external fixation period was 301 days. The average Musculoskeletal Tumor Society score (used to measure functional outcome) was 91.5 % at mean follow-up of 202 months. Fourteen patients were able to play sports without any difficulty. Conclusions: Epiphyseal preservation and reconstruction by bone distraction require both time and effort, but can provide excellent long-term outcomes, resulting in a stable reconstruction that functionally restores the natural limb. © 2012 The Japanese Orthopaedic Association.
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Watanabe, Koji ; Tsuchiya, Hiroyuki ; Yamamoto, Norio ; Shirai, Toshiharu ; Nishida, Hideji ; Hayashi, Katsuhiro ; Takeuchi, Akihiko ; Matsubara, Hidenori ; Nomura, Issei
概要:
Background: The aim of this study was to investigate the long-term functional capabilities of patients who underwent bon
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e distraction for the treatment of bone defects caused by bone tumor excision. Methods: Bone distraction was indicated for patients with stage IIB malignant bone tumors when chemotherapy was judged to be effective and an epiphysis could be preserved or for patients with low-grade or aggressive benign bone tumors. Twenty-two patients who underwent reconstruction with bone distraction and were followed up for at least 10 years were retrospectively investigated. Patients included 8 males and 14 females, with a mean age of 25.3 years. Tumor types included seven osteosarcomas, two osteofibrous dysplasias, one Ewing's sarcoma, five low-grade osteosarcomas, two adamantinomas, and five giant cell tumors. Chemotherapy was performed during bone distraction in 8 cases. Bone transport was used in 17 cases, while shortening distraction was used in 5 cases. Results: The mean distraction length was 8.1 cm, and the mean external fixation period was 301 days. The average Musculoskeletal Tumor Society score (used to measure functional outcome) was 91.5 % at mean follow-up of 202 months. Fourteen patients were able to play sports without any difficulty. Conclusions: Epiphyseal preservation and reconstruction by bone distraction require both time and effort, but can provide excellent long-term outcomes, resulting in a stable reconstruction that functionally restores the natural limb. © 2012 The Japanese Orthopaedic Association.
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Shirai, Toshiharu ; Tsuchiya, Hiroyuki ; Yamamoto, Norio ; Hayashi, Katsuhiro ; Nishida, Hideji ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Miwa, Shinji ; Ikeda , Hiroko
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Takata, Munetomo ; Sugimoto, Naotoshi ; Yamamoto, Norio ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Nishida, Hideji ; Tanzawa, Yoshikazu ; Kimura, Hiroaki ; Miwa, Shinji ; Takeuchi, Akihiko ; Tsuchiya, Hiroyuki
概要:
Insufficient bone union is the occasional complication of biomechanical reconstruction after malignant bone tumor resect
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ion using temperature treated tumor bearing bone; freezing, pasteurization, and autoclaving. Since bone morphogenetic protein (BMP) plays an important role in bone formation, we assessed the amount and activity of BMP preserved after several temperature treatments, including -196 and -73 °C for 20 min, 60 and 100 °C for 30 min, 60 °C for 10 h following -80 °C for 12 h as an allograft model, and 4 °C as the control. The material extracted from the human femoral bone was treated, and the amount of BMP-7 was analyzed using an enzyme-linked immunosorbent assay. Then, the activity of recombinant human BMP-7 after the treatment was assessed using a bioassay with NIH3T3 cells and immunoblotting analysis to measure the amount of phospho-Smad, one of the signaling substrates that reflect the intracellular reaction of BMPs. Both experiments revealed that BMP-7 was significantly better preserved in the hypothermia groups. The percentages of the amount of BMP-7 in which the control group was set at 100% were 114%, 108%, 70%, 49%, and 53% in the -196, -73, 60, 100 °C, and the allograft-model group, respectively. The percentages of the amount of phospho-Smad were 89%, 87%, 24%, 4.9%, and 14% in the -196, -73, 60, 100 °C, and the allograft-model group, respectively. These results suggested that freezing possibly preserves osteoinductive ability than hyperthermia treatment. © 2011 Elsevier Inc. All rights reserved.
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Shimozaki, Shingo ; Yamamoto, Norio ; Shirai, Toshiharu ; Nishida, Hideji ; Hayashi, Katsuhiro ; Tanzawa, Yoshikazu ; Kimura, Hiroaki ; Takeuchi, Akihiko ; Igarashi, Kentaro ; Inatani, Hiroyuki ; Kato, Takashi ; Tsuchiya, Hiroyuki
概要:
Background: Of the biological reconstruction methods for malignant bone and soft tissue tumors, reconstruction with liqu
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id nitrogen has the advantage of maintaining continuity on the distal side of the tumor bone site (pedicle freezing procedure; PFP). This method is expected to result in early blood flow recovery, with early union and low complication rate. The purpose of this study was to compare the outcomes of the PFP and free freezing procedure (FFP) in the lower extremities. Methods: The study included 20 patients (12 men and 8 women) with frozen autografts (FFP, 13 cases; PFP, 7 cases). The mean age of the subjects was 36.3 years (range 11-79 years), and the mean follow-up period was 56.4 months (range 12-142 months). Results: Final bone union occurred in 11 patients in the FFP group (84.6 %) and in 7 patients in the PFP group (100 %). The mean union period in patients who did not need additional surgery was 9.8 months (range 4-21 months) in the FFP group and 4.8 months (range 2-7 months) in the PFP group. Postoperative complications occurred in 8 cases: infection in 3 cases, fracture in 3 cases, and joint destruction in 2 cases. Six FFP patients, and 2 PFP patients (two cases of fracture), developed postoperative complications. Conclusions: The union period was shorter and the rate of postoperative complications was lower with the PFP than with the FFP. We considered that early blood flow recovery might have led to the above results in the PFP. © 2013 The Japanese Orthopaedic Association.
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