Showing papers by "Robert S. Bell published in 1995"

Cephalad sacral resection with a combined extended ilioinguinal and posterior approach.

Abstract: A combined anterior and posterior approach was used for the resection of a large tumor (a chordoma, a giant-cell tumor, an osteosarcoma, or a chondrosarcoma) of the cephalad part of the sacrum in twelve patients. The anterior aspect of the sacrum was exposed through an extended ilioinguinal approach, and the posterior aspect, through a midline approach. This widely extensile procedure permitted simultaneous visualization of the anterior, posterior, and circumferential aspects of the sacrum at the time of the osteotomy and facilitated the resection of these difficult lesions. At the time of follow-up (average duration for the eleven surviving patients, thirty-seven months; median, thirty months; range, twenty to sixty-nine months), ten patients were able to walk independently (four with the use of a cane) and one was confined to a wheelchair. One patient had died immediately postoperatively. The results of the present study indicate that a combined extended ilioinguinal and posterior approach can be used effectively for the wide resection of a tumor arising in the cephalad part of the sacrum.

Complex acetabular reconstruction for metastatic tumor.

Abstract: Twenty-six hips were reconstructed in 25 patients with periacetabular metastatic lesions. Twelve hip reconstructions were performed using a modified Harrington technique with polymethyl methacrylate, cancellous screws, and reinforcement rings (type I). Fourteen hip reconstructions were performed using bulk bone-graft and reinforcement rings (type II). According to the Musculoskeletal Tumor Society functional rating score, there was no appreciable difference between the two types of reconstructions. Either technique can give satisfactory results depending on the anatomic location and extent of bone loss. Careful patient selection is the prime determinant of a successful outcome.

The effect of intramedullary cement on intercalary allograft reconstruction of bone defects after tumour resection: a pilot study.

Abstract: OBJECTIVE A pilot study to evaluate the surgical and functional results of resection and reconstruction of diaphyseal bone tumours with cemented and uncemented intercalary allografts. DESIGN A retrospective case series. SETTING A quaternary care unit within a teaching hospital. PATIENTS Twenty-two patients with diaphyseal bone tumours treated between 1988 and 1992, with mean follow-up of 38 months (range from 20 to 70 months). INTERVENTIONS Diagnostic biopsy in all patients. Preoperative and postoperative chemotherapy in patients with high-grade sarcoma. En-bloc excision of all tumours. Reconstruction of the defect with cemented (15 patients) or uncemented (7 patients) intercalary allografts. MAIN OUTCOME MEASURES Nonunion at one or both osteosynthesis sites, death from systemic disease, amputation. RESULTS Six of the 22 patients died of systemic disease with the graft intact, and 3 subsequently had amputation for either local recurrence (2 patients) or failure of free tissue transfer (1 patient), leaving 13 patients alive with the allograft in situ at an average of 36 months (range from 24 to 64 months). There were no revision procedures to remove or replace the original allograft. Five patients had nonunion at one or more osteosynthesis sites on plain radiographs 9 months after resection. Four patients with nonunion were in the cemented group of 13 patients available for assessment at 9 months, and 1 was in the uncemented group of 5 patients available for assessment at 9 months. There were two graft fractures, both in the uncemented group. CONCLUSION The results of this pilot study offer guarded support for the use of pressurized cement in allografts prior to reconstruction of intercalary defects.