News - LDK “Customized Pelvis” prosthesis for pelvic malignancies treatment
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LDK “Customized Pelvis” prosthesis for pelvic malignancies treatment

Recently, Liu Hucheng, director of the Department of Bone and Soft Tissue Oncology at the First Affiliated Hospital of Nanchang University, completed “pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + lumbar pedicle screw internal fixation” with LDK customized pelvic prosthesis, and the operation went smoothly.
 
The patient was referred to an external hospital for recurrent back pain and discomfort. After completing hip-related examinations, the patient was suggested a possible osteo-malignant lesion, but she did not pay attention to it, and then her pain symptoms worsened and her mobility was limited. Then the patient came to the Department of Bone and Soft Tissue Oncology of the First Affiliated Hospital of Nanchang University for treatment.
 
After being admitted to the hospital and completing pelvic bone biopsy, the patient was diagnosed with osteosarcoma. After a thorough surgical plan was formulated jointly by multiple departments and preoperative preparation was completed, Director Liu Hu Cheng team performed “pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + lumbar arch screw internal fixation” for the patient.
 
Description:
Patient, female, 52 years old
Complaint:
More than 3 months after chemotherapy for pelvic bone osteosarcoma
Present medical history:
The patient complained that on 2022-10, there was no obvious cause for recurrent low back pain and discomfort, with soreness and swelling, accompanied by pain in the left lower extremity, located in the left hip, the left lower extremity, the posterior side of the thigh, the posterior side of the calf to the left foot, numbness in the bottom of the left foot, the pain increased after prolonged standing and walking, and could be relieved when resting, during which no attention was paid, and then the pain symptoms began to increase and could not walk.
The MRI suggested: 1) abnormal signal of the left iliac bone, considering the possibility of malignant lesion; 2) a small amount of fluid in the left hip joint. No special treatment was given, and now the patient was admitted to the hospital for further treatment.
 
Clinical diagnosis:
“Post-chemotherapy myelosuppression” admission
The proposed procedure is “pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + internal fixation with lumbar pedicle screw”
 
Specimens sent for examination
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The left pelvic tumor was sent for examination: unshaped bone tissue, size 19.5X17X9 cm, with muscle tissue attached, size 16.5X16X3.5 cm, multi-sectional incision, 1.5 cm from the cautery margin, a mass was seen in the muscle tissue, size 8X6.5X4.5 cm, grayish gray-red, tough, and poorly delineated between the focal area and bone tissue.
Left sciatic nerve tumor: gray-red unshaped tissue, size 9.5X3X3m, gray-white gray-red tough on cut surface.
Microscopically, the tumor showed a solid lamellar distribution, invading the peripheral fibrofat, transverse muscle and nerve tissue, with irregularly shaped cells, obvious nucleoli, easy to see nuclear schizophrenia, obvious heterotypes and a lot of necrosis.
Pathologic diagnosis:
(Left pelvis) Combined with clinical, imaging and history, it was consistent with a response after chemotherapy for high-grade osteosarcoma (common type).
Huvos grading: grade II (mildly effective chemotherapy, >50% tumor tissue necrosis, surviving tumor tissue).
Tissue cautery margin: no lesion involvement was seen.
(left sciatic nerve) visible lesion involvement: 2 other lymph nodes seen, no metastasis seen (0/2) Immunohistochemistry shows: CK(-);Vimentin(3+);Ki-67(75%+);SATB2(+);IMP3(+);MDM2(+);P16(+);S-100(scattered +);H3.3G34W(-);Brachyury(-);Desmin(-);CD68(-)。
Surgical planning:
Pelvic tumor resection + sacral osteotomy + pelvic replacement + hip replacement + lumbar pedicle screw internal fixation
 
Preoperative
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Postoperative
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Surgeon Introduction
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Prof. Hucheng Liu
The First Affiliated Hospital of Nanchang University Orthopedic Hospital
Chief, Department of Bone and Soft Tissue Oncology
Chief physician, Associate Professor, Master’s supervisor
 

Director of Bone and Soft Tissue Tumor Group, Orthopedic Branch, Jiangxi Medical Association
Vice Chairman of Bone and Soft Tissue Tumor Committee of Jiangxi Physicians Association Orthopedic Branch


Post time: Apr-26-2023