Orthopaedics and Trauma最新文献

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Bone and soft tissue tumours: non-surgical management 骨和软组织肿瘤：非手术治疗

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.03.004

Lesley Speed

The majority of patients with a malignant bone lesion will have bone metastases from a distant primary tumour. This could be present at the time of diagnosis of malignancy or develop later in the course of the disease. Some primary tumour types are more likely than others to develop bone secondaries. This common clinical problem requires a multidisciplinary approach in order to reduce skeletal events and symptoms for patients, and maintain their quality of life. Almost all patients with metastatic bone disease will have incurable cancer and this needs to be acknowledged when considering treatment options. Conversely primary malignant bone tumours are relatively rare conditions that need to be managed by specialist centres, often requiring intensive multimodality, multi-professional treatment. Patients with localized disease can be cured but there remains a high risk of both local recurrence and metastases. Soft tissue sarcomas will often require radiotherapy and surgical treatment as primary management. Chemotherapy plays more of a role when treating metastatic disease.

大多数患有恶性骨病变的患者会发生远处原发肿瘤的骨转移。这可能在诊断为恶性肿瘤时出现，也可能在病程的后期出现。一些原发性肿瘤类型比其他肿瘤类型更容易发展为骨继发性肿瘤。这种常见的临床问题需要多学科的方法，以减少骨骼事件和症状的患者，并保持他们的生活质量。几乎所有患有转移性骨病的患者都会患有无法治愈的癌症，在考虑治疗方案时需要认识到这一点。相反，原发性恶性骨肿瘤是相对罕见的情况，需要由专科中心管理，通常需要多模式、多专业的强化治疗。局部疾病的患者可以治愈，但仍然存在局部复发和转移的高风险。软组织肉瘤通常需要放射治疗和手术治疗作为主要治疗方法。化疗在治疗转移性疾病时发挥更大的作用。

引用次数: 0

Soft tissue sarcomas for trauma and orthopaedic exam candidates 创伤和骨科考试考生的软组织肉瘤

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.03.002

Farhan Eitezaz, Kathryn H Steele, Nicholas Eastley

Soft tissue sarcomas (STS) represent a diverse group of malignant tumours for which surgery is the cornerstone of curative treatment. All STS patients should be managed by a specialized sarcoma multidisciplinary team (MDT). For non-metastatic STS, the surgical aim of treatment is the wide excision of the tumour. Amputations are infrequently employed as a first-line treatment, although may be required in complex or recurrent cases. Wound complications following STS surgery are not uncommon, and reconstructive surgery is key to promote healing. Radiotherapy may be utilized for large, high-grade STS, or those close to essential anatomical structures that necessitate a marginal resection. This radiotherapy may be delivered pre- (neoadjuvant) or post- (adjuvant) operatively, with the aim of reducing local recurrence rates. Systemic treatments such as chemotherapy are generally not utilized for localized STS, other than for a few, specific subtypes. In metastatic patients, systemic treatment may be employed with palliative intent. The management of localized STS recurrence follows the same principles as those of primary disease, with emphasis placed on re-staging all patients to rule out metastatic disease. Long-term patient follow-up is crucial to detect disease recurrence (local or systemic) and any significant treatment-related complications.

软组织肉瘤（STS）代表了一组不同的恶性肿瘤，手术是治疗的基石。所有STS患者应由一个专门的肉瘤多学科小组（MDT）进行治疗。对于非转移性STS，手术治疗的目的是广泛切除肿瘤。虽然在复杂或复发病例中可能需要截肢，但截肢很少被用作一线治疗。STS手术后的伤口并发症并不少见，重建手术是促进愈合的关键。放疗可用于大的、高级别的STS，或那些靠近必要解剖结构需要边缘切除的STS。这种放疗可以在手术前（新辅助）或手术后（辅助）进行，目的是减少局部复发率。除了少数特定亚型外，局部STS一般不采用全身治疗，如化疗。对于转移性患者，可以采用全身治疗来缓解病情。局部STS复发的处理遵循与原发疾病相同的原则，重点是对所有患者进行重新分期，以排除转移性疾病。长期患者随访对于发现疾病复发（局部或全身）和任何显著的治疗相关并发症至关重要。

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引用次数: 0

Surgical management of primary bone sarcomas 原发性骨肉瘤的外科治疗

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.03.003

Thomas DA Cosker, Christopher Anthony, Raja Bhaskara Rajasekaran, Christopher LMH Gibbons

This article aims to address the principles of surgical treatment of primary bone sarcomas including chondrosarcoma, osteosarcoma and Ewing's sarcoma of bone. This piece aims to serve as a guide to experienced orthopaedic surgeons who have limited knowledge of managing musculoskeletal tumours especially primary bone sarcomas. Important principles surrounding surgery involving bone sarcomas, principles of biopsy of such lesions and reconstruction techniques have been discussed. Limb salvage is the expectation in today's era and though endoprosthesis replacement is an important tool in a surgeon's armoury, biological methods of reconstruction have also shown to be effective in many settings. Chemotherapy and radiotherapy are vital adjuvant therapies associated with these sarcomas, and they have been discussed in this article.

本文旨在阐述原发性骨肉瘤包括软骨肉瘤、骨肉瘤和尤文氏肉瘤的手术治疗原则。这篇文章旨在为经验丰富的骨科医生提供指导，他们在管理肌肉骨骼肿瘤特别是原发性骨肉瘤方面的知识有限。讨论了涉及骨肉瘤手术的重要原则、病变活检原则和重建技术。残肢保留是当今时代的期望，尽管假体置换术是外科医生的重要工具，但生物重建方法在许多情况下也显示出有效性。化疗和放疗是与这些肉瘤相关的重要辅助治疗，并在本文中进行了讨论。

引用次数: 0

Recent advances in metastatic bone disease 转移性骨病的最新进展

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.03.005

Jason Mavrotas, Amit Kumar

Metastatic bone disease (MBD) is a common sequela of malignancy and can lead to significant morbidity on patients. Systemic medical therapies and oncology surgery have greatly enhanced cancer survival rates over recent decades. Orthopaedic surgeons occupy a key position within the multidisciplinary team and coordinate surgical care for bone metastases where appropriate. This review describes the investigations for, and management of, patients with metastases to the appendicular skeleton. National British Orthopaedic Association Standard (BOASt) guidelines exist to help orthopaedic clinicians and departments optimize patient care. We outline and illustrate the freely available OPTIModel app, which is an innovative, straightforward and useful tool for prognostic evaluation and suggestion of loco-regional treatment options for patients with symptomatic long bone metastases.

转移性骨病（MBD）是恶性肿瘤的常见后遗症，可导致患者显著的发病率。近几十年来，系统的医学治疗和肿瘤手术大大提高了癌症的存活率。骨科医生在多学科团队中占据关键地位，并在适当的情况下协调骨转移的手术护理。这篇综述描述了对阑尾骨骼转移患者的调查和处理。国家英国骨科协会标准（自夸）指南存在，以帮助骨科临床医生和部门优化患者护理。我们概述并说明免费提供的OPTIModel应用程序，这是一个创新的，简单的和有用的工具，用于预后评估和建议有症状的长骨转移患者的局部区域治疗方案。

引用次数: 0

The basic science of musculoskeletal tumours 肌肉骨骼肿瘤的基础科学

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.03.006

Kenneth S Rankin

The basic science of musculoskeletal tumours is a complex subject and has been historically related to pathological descriptions of the lesions. Our understanding of these conditions has increased rapidly with the advent of genetic sequencing and molecular diagnostic techniques. This article covers the main topics and touches on the relevant research strategies which seek to open up further management options, particularly for the sarcomas.

肌肉骨骼肿瘤的基础科学是一门复杂的学科，历史上一直与病变的病理描述有关。随着基因测序和分子诊断技术的出现，我们对这些疾病的了解迅速增加。这篇文章涵盖了主要的主题，并触及了相关的研究策略，寻求开辟进一步的管理选择，特别是对肉瘤。

引用次数: 0

Amputations of the lower limb: an overview of principles with surgical tips and advances 下肢截肢：手术技巧和进展的原则概述

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-14 DOI: 10.1016/j.mporth.2025.04.001

Heledd Havard, Sanjay Gupta

Amputations are an operation that can strike fear into the heart of a trauma and orthopaedic surgeon with a sense of doom and gloom on occasion for both the surgeon and the patient. At one extreme there may be the emergency life-saving setting, and on the other the more controlled elective setting often following multiple attempted limb-salvage procedures. Either way, there can be a feeling of failure at the end of the treatment road. This need not be the case. Patients coming out of a protracted treatment pathway sometimes wonder why they did not have the limb removed sooner and are usually grateful for the sense of freedom that the operation has given them. This review aims to provide a brief historical perspective through to an update on current techniques with a dedicated discussion around osseointegration. There are suggested techniques, that will provide at the very least a refresher or indeed an alternative thought process to approach both the operation and the patient. Amputations are often the beginning of a new life, but not necessarily the end of the old one.

截肢手术会让创伤和整形外科医生心中充满恐惧，有时会让医生和病人都感到厄运和沮丧。在一种极端情况下，可能是紧急救生情况，而在另一种极端情况下，更受控制的选择情况通常是在多次尝试挽救肢体手术后。无论哪种方式，在治疗之路的尽头都会有一种失败的感觉。事实并非如此。在经历了漫长的治疗过程后，患者有时会想，为什么没有早点切除肢体，他们通常会感激手术给他们带来的自由感。这篇综述的目的是提供一个简短的历史观点，通过对当前技术的更新，并围绕骨整合进行专门的讨论。这里有一些建议的技术，它们至少会让你对手术和病人都有一个新的认识。截肢往往是新生活的开始，但不一定是旧生活的结束。

引用次数: 0

Benign and intermediate soft tissue tumours for trauma and orthopaedic exam candidates 创伤和骨科考试考生的良性和中度软组织肿瘤

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-13 DOI: 10.1016/j.mporth.2025.03.001

Thomas Robert William Ward, Nicholas Eastley

A soft tissue swelling is a common clinical presentation, and although the majority of causes are benign, an intermediate or malignant diagnoses must be ruled out. A thorough history and examination are key to highlight any red flags such as rapid growth, a large tumour size (>5 cm), a deep location, pain or recurrence. These flags should be investigated thoroughly, and if there is any diagnostic uncertainty patients should be discussed with a sarcoma multidisciplinary team (MDT) prior to treatment, and biopsy considered. The inadvertent resection of a malignant soft tissue sarcoma (termed a ‘whoops’ procedure) must be avoided at all costs. Ultrasound is a cheap and easily accessible first-line imaging modality that in specialist hands can identify or rule out aggressive features accurately. Magnetic resonance imaging is the gold standard cross-sectional imaging modality for soft tissue tumours, and allows a detailed anatomical assessment key for surgical planning. Most benign lesions can be managed conservatively or with active surveillance, although symptomatic patients may benefit from a surgical excision. Intermediate tumours should be managed in conjunction with a sarcoma MDT given their rarity and complexity, and will usually require an excision.

软组织肿胀是一种常见的临床表现，虽然大多数原因是良性的，但必须排除中间或恶性诊断。彻底的病史和检查是突出任何危险信号的关键，如快速生长、大肿瘤（5厘米）、深部、疼痛或复发。这些标志应彻底检查，如果有任何诊断不确定的患者应在治疗前与肉瘤多学科小组（MDT）讨论，并考虑活检。必须不惜一切代价避免无意中切除恶性软组织肉瘤（称为“哎呀”手术）。超声是一种便宜且容易获得的一线成像方式，在专家手中可以准确地识别或排除侵袭性特征。磁共振成像是软组织肿瘤的金标准横断面成像方式，并允许详细的解剖评估关键手术计划。大多数良性病变可以保守治疗或积极监测，尽管有症状的患者可能受益于手术切除。考虑到中间肿瘤的罕见性和复杂性，中间肿瘤应与肉瘤MDT联合治疗，并且通常需要切除。

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引用次数: 0

CME questions on Orthopaedic Oncology 关于骨科肿瘤学的CME问题

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-10 DOI: 10.1016/j.mporth.2025.03.008

引用次数: 0

Answers to the CME questions on Major Trauma CME关于重大创伤的问题解答

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-05-10 DOI: 10.1016/j.mporth.2025.03.007

引用次数: 0

Management of the spine in the polytrauma victim 多发伤患者脊柱的处理

Q4 Medicine

Orthopaedics and Trauma

Pub Date : 2025-04-01 DOI: 10.1016/j.mporth.2025.01.002

M Zaki B Choudhury, Athanasios I Tsirikos

Major trauma is a common occurrence globally and a leading cause of death in younger patients. Its definition and epidemiology is described in depth elsewhere in the symposium. In the UK there are approximately 22,000 cases presenting per year. Overall management strategy dictates that major trauma is directed to centres experienced in its management. It is, however, important that all clinicians recognize and are aware of it, with implications for resource utilization. The spine can be injured through a variety of mechanisms but importantly in major trauma it is unusual for the spine to be injured in isolation, unless a direct impact is sustained. Conversely, it is critical to be aware of the possibility of vertebral and spinal cord injury which may be masked by distracting injury. Strategies and guidelines for the management of the spine in major trauma will be discussed, and some case examples will be shown in order to demonstrate key concepts and pitfalls.

严重创伤在全球范围内很常见，也是年轻患者死亡的主要原因。它的定义和流行病学在研讨会的其他地方有深入的描述。在英国，每年大约有22000例病例出现。总体管理战略规定，重大创伤应直接送往有管理经验的中心。然而，重要的是所有临床医生都认识到并意识到这一点，这对资源利用有影响。脊柱可通过多种机制损伤，但重要的是，在重大创伤中，脊柱不常见孤立损伤，除非持续的直接冲击。相反，关键是要意识到椎体和脊髓损伤的可能性，这可能被分散的损伤所掩盖。我们将讨论重大创伤中脊柱管理的策略和指导方针，并将展示一些案例，以演示关键概念和陷阱。

引用次数: 0

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