摘要：3D bioprinting technology has emerged as a revolutionary breakthrough in tissue engineering,providing innovative solutions for bone defect repair.In recent years,significant advancements have been made in the application of 3D bioprinted scaffolds for bone tissue engineering.This article systematically reviews the current research status and development trends of this technology in bone defect repair.Regarding materials,hydrogel and bioceramic composite systems demonstrate excellent biocompatibility and osteoinductive properties.In terms of printing techniques,continuous innovations in inkjet printing and stereolithography have enabled precise control over scaffold microstructures.As for scaffold design,novel concepts such as hierarchical porosity and biomimetic gradient structures have significantly improved both mechanical properties and biological functionality.Currently,several 3D-printed bone repair products have entered clinical applications,demonstrating promising therapeutic outcomes in treating bone tumors,infections,and traumatic injuries.Looking ahead,with deeper interdisciplinary integration,3D bioprinted scaffolds are expected to provide optimized solutions for personalized bone defect repair.

摘要：目的 分析慢性共病对老年股骨颈骨折(femoral neck fracture,FNF)患者住院时间的影响,并通过倾向性评分匹配(propensity score matching,PSM)方法控制混杂因素,为优化围术期管理和缩短住院时间提供科学依据.方法 回顾分析 2021年 1月 1日至 2022年 1月 1日西安交通大学附属红会医院收治的 1091例老年 FNF 患者.根据是否合并≥2 种慢性病分为共病组(476 例)和非共病组(615 例).采用 PSM(卡钳值=0.05)进行 1∶1 匹配,共纳入 516 例(258 对).收集患者一般资料、实验室指标及手术相关数据,通过单因素和多因素 logistic 回归分析住院时间延长(prolonged hospital stay,PLOS)(≥9 天)的影响因素,通过多模型回归策略及分层分析进一步确定共病与 PLOS的关系.结果 1091例患者中,PLOS发生率为 30.8%(336例).共病组 PLOS 发生率显著高于非共病组,差异有统计学意义(39.7%vs.23.9%,P<0.001).PSM 后,单因素分析结果显示半髋关节置换术较全髋关节置换术住院延长的风险更高(OR=1.74,95%CI:1.07～2.83,P=0.026).血红蛋白(OR=0.99,95%CI:0.98～0.99,P=0.044)和血清白蛋白(OR=0.93,95%CI:0.89～0.98,P=0.004)为其保护性因素.匹配后单因素及多因素结果显示共病是老年 FNF 患者 PLOS 的独立危险因素(OR=1.58,95%CI:1.08～2.33,P=0.019);多模型回归策略及分层分析结果进一步确定共病患者 PLOS 的风险高于非共病患者(P<0.05).结论 慢性共病显著增加老年 FNF 患者 PLOS 的风险,半髋关节置换术也加剧此风险,而较高的血红蛋白值和血清白蛋白水平可降低风险.建议针对共病患者加强术前评估、优化手术选择及营养管理,以改善临床结局.

摘要：目的 分析脂肪肉瘤患者临床特征,并探索影响脂肪肉瘤无病生存期的危险因素.方法 回顾分析 2005 年 3 月至 2022 年 11 月,在中国医学科学院肿瘤医院首次接受手术治疗的 198 例脂肪肉瘤患者的临床资料,包括年龄、性别、病理类型、肿瘤原发部位、肿瘤大小、是否放疗、是否化疗.对患者进行长期随访,终点事件为术后复发或死亡,以无病生存期作为预后评价指标.使用 SPSS 29.0 处理患者数据,分析脂肪肉瘤患者无病生存期的危险因素,P<0.05 表示差异有统计学意义.结果 本组 198 例脂肪肉瘤患者的病理类型为:非典型/高分化的患者 97 例(49.0%),去分化 42 例(21.2%);≥50 岁者 131 例(66.2%);男性患者 117 例(59.1%);原发部位为四肢者 78 例(39.4%),腹膜后 67 例(33.8%),躯干 53 例(26.8%);肿瘤直径>5～≤10 cm 者 68 例(34.3%),≥15 cm 者 58 例(29.4%);接受过放疗者 41 例(20.7%),接受过化疗者26 例(13.1%);随访结束时复发者 108 例(54.5%),死亡 37 例(18.7%).单因素分析提示:年龄、性别、肿瘤直径、是否放疗、是否化疗对脂肪肉瘤无病生存期的影响差异无统计学意义,病理类型、肿瘤原发部位是无病生存期的预后因素.多因素分析提示:除外非典型/高分化的病理类型(P=0.001)、原发部位为腹膜后(P=0.005)是影响脂肪肉瘤无病生存期的独立危险因素.结论 本研究纳入的 198 例首次手术的脂肪肉瘤患者,总体复发率为 54.5%.分析表明,脂肪肉瘤患者的临床病理特征与术后预后密切相关,其中病理类型为非典型/高分化以外类型和原发部位为腹膜后是影响无病生存期的独立危险因素.

摘要：目的 本研究旨在探讨聚乙二醇化脂质体多柔比星联合达卡巴嗪治疗平滑肌肉瘤的疗效与安全性.方法 回顾分析 2019 年 8 月至 2024 年 7 月,北京大学肿瘤医院骨与软组织肿瘤科接受聚乙二醇化脂质体多柔比星联合达卡巴嗪方案化疗的平滑肌肉瘤患者.收集患者的临床资料,分析患者的总生存期(overall survival,OS),无进展生存期(progression free survival,PFS),客观缓解率(objective response rate,ORR),疾病控制率(disease control rate,DCR),预后因素以及不良反应.结果 共 116 例患者纳入,平均随访时间 13 个月,疾病进展 43 例(37.1%),死亡 15 例(12.9%).其中男 20 例,女 96 例,男女比 5∶24.平均年龄 53 岁.术后辅助化疗组 42 例,局部晚期/远处转移化疗组 74 例.全部患者的中位 OS 为 48(44～52)个月,术后辅助化疗和局部晚期/远处转移化疗组的中位 OS 未达到.全部患者的中位 PFS 为 18(10～26)个月,术后辅助化疗组的中位 PFS 未达到,局部晚期/远处转移化疗组的中位 PFS 为 13(9～17)个月.局部晚期/远处转移化疗组中有 55 例患者肿瘤变化的数据可评估,包括部分缓解(partial response,PR)11 例(20.0%),病变稳定(stable disease,SD)34 例(61.8%),病变进展(progressive disease,PD)10 例(18.2%),ORR 为 20.0%,DCR 为 81.8%.单因素分析发现,化疗周期数是影响局部晚期/远处转移组 OS 的危险因素,化疗周期数>4(未达到)较化疗周期数≤4(39 个月)的中位 OS 得到延长(P<0.05).其它因素对各组的 OS及 PFS的影响差异无统计学意义(P≥0.05).全部患者未发生心脏损伤,其它不良反应为肝损伤7 例(6.0%),恶心呕吐 6 例(5.2%),中性粒细胞减少 3 例(2.6%)、贫血 2 例(1.7%).结论 聚乙二醇化脂质体多柔比星联合达卡巴嗪治疗平滑肌肉瘤较传统方案疗效相近,同时安全性较好,心肌损害发生率较低.未来需要开展更大样本量、多中心的临床研究,以便为平滑肌肉瘤患者提供更优化的治疗策略.

摘要：3D printing technology is based on digital model files.It adopts a layer-by-layer approach to construct entities using specific materials through digital technology-driven material printing devices,which has the potential for a wide range of applications in the medical field.In recent years,this technology has made significant breakthroughs in the treatment of osteosarcoma(OS),providing strong support for the realization of personalized and precise treatment plans for osteosarcoma.The purpose of this paper is to comprehensively review and discuss the clinical application of 3D printing technology in the field of osteosarcoma treatment and its practical effects,and at the same time,to deeply analyze the innovative research progress of 3D printed bone tissue engineering scaffolds,to further explore its broad prospects for promoting the precise treatment of OS,and to provide theoretical guidance for clinical practice with a view to promote the precise and efficient OS treatment.

摘要：Objective To report the diagnosis and treatment of a case with systemic hypophosphoric osteomalacia caused by suprapatellar capsule phosphaturic mesenchymal tumor.Methods The diagnosis and treatment of a case of systemic hypophosphorus osteomalacia caused by suprapatellar capsule phosphaturic interstitial tumor in our department were reported and analyzed.Results After tumor resection,blood phosphorus gradually returned to normal level,and the symptoms of bone pain were significantly relieved.Conclusions PET-CT is of great significance for the diagnosis and localization of metabolic bone diseases and tumors,which can effectively avoid the occurrence of missed diagnosis and misdiagnosis.The surgery should be performed in time to obtain a good prognosis when the tumor is found.

摘要：A 32-year-old female patient with a history of atypical parosteal cartilaginous tumor-like proliferation of the distal radius was hospitalized due to postoperative recurrence.Imaging studies revealed an irregular bony mass located at the distal radial side,which appeared to be unconnected to the medullary cavity.Histological examination demonstrated the proliferation of atypical cartilaginous cells,osteoblasts,and spindle cells.The bony trabeculae were irregularly distributed,with certain areas displaying basophilic staining.Based on these findings,the diagnosis of recurrent bizarre parosteal osteochondromatous proliferation of the distal radius was confirmed to be accurate.The patient subsequently underwent radical resection of the distal radius,including removal of the underlying cortical bone.After a one-year follow-up period,there was no evidence of recurrence.

摘要：目的 比较关节镜下单排缝合与双排缝合治疗肩袖损伤的疗效,并分析术后并发慢性疼痛的危险因素.方法 回顾分析 2020 年 1 月至 2022 年 12 月,在我院行手术治疗的 80 例肩袖损伤患者的临床资料,根据手术方式分为单排组(n=42)及双排组(n=38).比较两组患者术前、术后 3 个月及 12 个月视觉模拟评分(visual analogue scale,VAS)、Constant-Murley 评分及美国加州大学洛杉矶分校肩关节(University of California Los Angeles,UCLA)评分.根据术后随访过程中是否并发慢性术后疼痛(chronic post-surgical pain,CPSP)分为 CPSP 组(n=12)和非 CPSP 组(n=68),采用 logistic 回归进行多因素分析,筛选术后并发 CPSP 的危险因素.结果 术后 3 个月与 12 个月,两组 VAS 评分显著降低[单排组术前(6.38±1.21),术后 3 个月(3.31±0.62)、12 个月(1.21±0.25);双排组术前(6.50±1.18),术后 3 个月(3.40±0.57)、12 个月(1.18±1.30)],(P<0.05);两组差异无统计学意义(P>0.05).术后 3 个月、12 个月,单排组与双排组的Constant-Murley 评分和 UCLA 评分较术前均显著升高(P<0.05).其中,单排组 Constant-Murley 评分术前为(62.50±8.34),术后 3 个月(80.52±10.15),12 个月(82.36±9.87);双排组术前(63.54±6.26),术后 3 个月(82.33±8.89),12 个月(89.85±7.78).UCLA 评分,单排组术前(10.15±2.21),术后 3 个月(26.35±3.87),12 个月(29.16±3.66);双排组术前(10.69±1.87),术后 3 个月(27.58±4.12),12 个月(32.15±3.10);双排组术后 12 个月 Constant-Murley 评分与 UCLA 评分明显高于对照组(P<0.05).80 例肩袖撕裂患者中,术后3 个月发生 CPSP 12 例(15.00%),未发生 CPSP 68 例(85.00%).多因素 logistic 回归分析结果显示女性、睡眠障碍及全层撕裂为肩袖撕裂患者术后发生 CPSP 的独立危险因素.结论 对中型肩袖撕裂患者,关节镜下单排缝合与双排缝合均能有效改善疼痛症状及关节功能,但双排缝合术后患者早期肩关节功能恢复效果更好.女性、睡眠障碍及全层撕裂为肩袖撕裂患者术后发生 CPSP的独立危险因素.

摘要：目的 探讨超声检查、X 线和 CT 诊断在儿童腓骨远端骨骺撕脱性骨折诊断和治疗中的价值.方法 收集 2019 年 6 月至 2022 年 6 月,在我院治疗的腓骨远端骨折 77 例患儿临床资料,入院 48 h 内行高频超声检查、X 线和 CT 检查,以 CT 检查结果作为金标准,比较超声、X 线和 CT 检查对腓骨远端骨骺撕脱性骨折诊治价值.结果 CT 检查明确有 69 例为腓骨远端骨骺撕脱性骨折,男性患儿占 63.77%,病因以运动伤多见,占 40.58%,Ogden Ⅶ 型骨折多见,占 39.13%,复位固定及踝关节固定术多见,占 46.38%.X 线、高频超声诊断的灵敏度分别为 71.01%和 94.20%(χ2=12.912,P=0.000),特异度分别为 50.00%、87.50%(χ2=2.618,P=0.106),诊断准确率分别为 68.83%、93.51%(χ2=15.336,P=0.000).高频超声对 Ogden Ⅶ 型骨折诊断正确率为 96.30%高于 X 线检查准确度 77.78%,两者差异有统计学意义(χ2=4.103,P=0.043).两种检查对 Salter-Harris Ⅰ、Salter-Harris Ⅱ、Salter-Harris Ⅲ、Salter-Harris Ⅳ 和 Range Ⅵ 骨折分型诊断正确率差异无统计学意义(P>0.05).高频超声和 X 线征象诊断腓骨远端骨骺撕脱性骨折的曲线下面积均>0.7,且高频超声曲线下面积大于 X 线显示面积.结论 相较 X 线检查,高频超声在儿童腓骨远端骨骺撕脱性骨折诊断和治疗方面具有重要应用价值,该方法图像分辨率高、质量高、经济简便、安全无辐射、可重复性好,是儿童腓骨远端骨骺撕脱性骨折不可或缺的辅助诊治手段.

摘要：目的 基于 GEO 及 TARGET 数据库,利用生物信息学方法构建并验证骨肉瘤乳酸化修饰相关基因的预后预测模型.方法 从 GEO 数据库中下载 GSE42352 数据集,利用"limma"R 包对骨肉瘤样本(组织/细胞)与正常骨组织及其前体细胞进行差异表达基因分析,将得到差异表达基因与乳酸化相关基因取交集,筛选出差异表达的乳酸化相关基因.下载 TARGET 数据库中骨肉瘤患者的 mRNA 基因表达数据和临床生存数据,通过单变量 Cox 回归及最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)回归分析,筛选出乳酸化相关的预后基因,并根据风险评分构建基于乳酸化修饰相关基因的骨肉瘤预后风险模型.利用基因富集分析(gene set enrichment analysis,GSEA)对乳酸化相关的预后风险模型进行 GO和 KEGG 富集分析,预测其可能参与的生物学功能和通路.构建基于乳酸化相关基因的骨肉瘤临床预后列线图,分别在 TARGET 及 GSE21257 队列中进行验证.结果 在 GSE42352 数据集中,共筛选出 852 个差异表达基因,与乳酸化相关基因取韦恩图交集后,共得到 30 个差异表达的乳酸化相关基因.生存分析结果显示:WAS、NDUFB9、SLC7A7、ZYX、TPM4 和 S100A4 与骨肉瘤预后相关,并以此构建了基于 6 个乳酸化相关基因的预后风险模型,低危组的总生存率明显高于高危组(TARGET队列 P<0.001,GSE21257队列 P=0.025).GSEA富集分析结果表明,风险基因主要富集在免疫相关的生物学过程中.利用 TARGET队列中的风险评分和临床特征构建骨肉瘤预后列线图,且受试者工作特征曲线(receiver operating characteristic,ROC)下面积(area under curve,AUC)、校准曲线及决策曲线分析(decision curve analysis,DCA)均表明该预测列线图具有良好的临床预测效能,并在 GSE21257 中得到进一步验证.结论 基于乳酸化相关基因构建的骨肉瘤预后模型具有临床预测价值,可用于指导骨肉瘤患者的个体化治疗.

摘要：This article reviews the evolution of treatment strategies for bone and soft tissue sarcomas,highlighting the shift from amputation-focused approaches to the modern goal of both life and limb preservation.The introduction of multi-agent chemotherapy in the 1970 s increased the 5-year survival rate for osteosarcoma from less than 20%to 60%-70%,paving the way for limb-sparing surgeries,microsurgical reconstruction,and adjuvant radiotherapy to achieve better local control and functional outcomes.Recent advances have centered on four key areas:(1)precision surgery and personalized reconstruction through technologies such as surgical navigation,intraoperative assessment,3D printing,extendable prostheses,and multidisciplinary collaboration;(2)radiotherapy innovations including IMRT/IGRT,proton and carbon ion therapy,and more individualized pre/postoperative and intraoperative applications;(3)improved perioperative chemotherapy regimens,such as VDC/IE for Ewing sarcoma and HD-IFO in relapsed cases,though benefits in soft tissue sarcoma remain limited;(4)Emerging value of targeted and immunotherapies in select subtypes,including VEGFR-TKIs,MDM2 inhibitors,TRK inhibitors,EZH2 inhibitors,and RANKL inhibitors,with immunotherapy combinations drawing increasing attention.Current challenges include limited survival gains,subtype heterogeneity,small study cohorts,unclear mechanisms of metastasis and drug resistance,and treatment-related toxicity and functional loss.Future directions emphasize the use of AI and big data to confirm diagnosis and decision-making,adoption of multi-omics and liquid biopsy for precise patient stratification and dynamic monitoring,exploration of cell/gene and combination therapies,and acceleration of clinical translation through high-quality trials and integration of medical and engineering innovations to achieve safer,more effective,and individualized long-term treatment outcomes.

摘要：Calcific tendinitis is one of the common causes of shoulder pain,typically involving the rotator cuff,particularly the supraspinatus tendon.Most cases present with small calcific deposits(in the resorptive phase)and can be managed conservatively with nonsteroidal anti-inflammatory drugs,physical therapy,or ultrasound-guided needle lavage.However,giant calcific deposits(diameter>3 cm)are rare and often refractory to conservative treatment,usually requiring surgical intervention.This article reports the diagnosis and treatment of a case of giant calcific tendinitis and discusses the technical considerations and clinical outcomes of arthroscopic surgery.The patient was a 60-year-old woman presenting with"right shoulder pain and limited mobility for 5 years,aggravated in the past week."Previous symptomatic treatments,including topical analgesics and oral painkillers(specific names and dosages unknown),provided no significant relief.Physical examination revealed markedly restricted internal rotation and positive Neer and Hawkins signs.Imaging studies showed a high-density calcific deposit(approximately 3 cm in diameter)along the supraspinatus tendon on X-ray,with significant perilesional edema and subacromial impingement on MRI.Given the large lesion size and prolonged symptoms,arthroscopic calcific deposit removal was performed.Using a standard posterior portal,toothpaste-like calcific material was visualized and completely debrided,followed by subacromial decompression to address impingement and tendon repair.Postoperatively,the patient experienced significant pain relief,and follow-up MRI at 5 weeks showed no recurrence.This case suggests that for rare,giant calcific tendinitis unresponsive to conservative treatment,arthroscopic surgery(with its magnified visualization)allows precise lesion removal while minimizing tissue damage and addressing concurrent impingement.Its advantages,including minimal invasiveness,direct visualization,and rapid recovery,make it the preferred treatment for such complex cases.

摘要：目的 本研究旨在分析初诊经典型骨肉瘤(conventional osteosarcoma,COS)患者治疗前凝血指标与预后的关系,评估其预测价值并构建预测总生存期的列线图模型.方法 回顾收集 2017 年 1 月至 2022年 12 月,在云南省肿瘤医院骨科就诊首次接受治疗的 141 例符合纳排标准的病理类型为 COS 患者的临床资料及实验室抽血指标,采用受试者操作特征曲线分析确定凝血酶原时间(prothrombin time,PT)、血浆纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-Dimer,D-D)、血小板(platelet,PLT)的最佳阈值,采用 χ2 检验分析PT、FIB、D-D、PLT 水平与患者临床特征的关系,采用 Kaplan-Meier 法和 Cox 比例风险模型研究 PT、FIB、D-D、PLT 对总生存期的影响.根据患者预后的独立危险因素建立列线图预测模型.结果 治疗前高 FIB 与肿瘤直径、病理性骨折、淋巴结转移相关(P<0.05),治疗前高 F-D 水平与肿瘤直径、淋巴结转移相关(P<0.05).高 PT、FIB、D-D、PLT 组的 3 年生存率与平均总生存期均低于低 PT、FIB、D-D、PLT 组(3 年生存率:47.20%,50.07%,48.80%,49.00%vs.66.70%,67.10%,70.08%,64.80%,平均总生存期:41.70 个月,42.09 个月,42.90 个月,51.77 个月 vs.59.52 个月,62.92 个月,64.35 个月,53.87 个月),两组总体生存率差异有统计学意义.单因素 Cox 回归分析结果显示肺转移、肿瘤直径、Enneking 分期、PT、FIB、D-D、PLT 水平与总生存期相关(P<0.05),多因素 Cox 回归分析结果显示肺转移、FIB、D-D 水平是影响 COS 患者预后的独立危险因素.根据 Cox 回归模型筛选出来的独立危险因素构建列线图,C 指数(C-index)提示该模型具有良好的预测性能,通过预测模型校正曲线可知该模型具有较好的准确度.结论 治疗前高 PT、FIB、D-D、PLT水平的 COS患者预后较差,以治疗前 FIB、D-D水平及肺转移情况为基础构建的列线图预测模型有较好的预测效能,可指导 COS患者的诊疗.

摘要：Tertiary Lymphoid Structures(TLS)are ectopic lymphoid tissues formed by the aggregation of various immune cells,including B cells,T cells,and dendritic cells.They typically develop under pathological conditions such as tumors and chronic inflammation,where they can facilitate antigen presentation,induce T cell activation,and enhance local anti-tumor immune responses.Sarcomas are highly heterogeneous malignant tumors of mesenchymal origin,with different pathological subtypes exhibiting distinct immune microenvironments and varying responses to immunotherapy.Studies suggest that the presence of TLS in advanced sarcomas may be associated with a better prognosis,although the role and underlying mechanisms of TLS in sarcomas remain to be elucidated.This review systematically summarizes the recent advancements in research related to TLS and sarcomas,exploring the correlation between TLS and the immune microenvironment of sarcomas,their response to immunotherapy,and clinical outcomes.

摘要：Malignant tumors occurring in the distal tibia are extremely rare,mainly including osteosarcoma and Ewing's sarcoma.Due to the difficulty in soft tissue coverage of this area and the satisfactory functional outcomes of below-knee prostheses,amputation has been the standard surgical procedure traditionally.However,with the advent of neoadjuvant chemotherapy,advancements in imaging techniques,improvements in surgical technology,and increased psychological acceptance among patients,the majority now opt for limb-salvage treatment.Nevertheless,the challenges of reconstructing bone and soft tissue after extensive resection are significant because of the difficulties in soft tissue coverage,high risks of infection,and wound-related complications in this region.Due to the low incidence,limited literature is available,resulting in ongoing debates regarding treatment strategies.This review provides a literature-based overview and discussion of various limb-salvage reconstruction methods.

摘要：Objective Clear cell sarcoma(CCS)is an extremely rare soft tissue sarcoma.Surgical resection is still the main treatment for CCS.Methods A 26-year-old patient with clear cell sarcoma of the soft tissue of the left clavicle underwent tumor resection,lymph node dissection,ipsilateral autogenous fibula transplantation,and plate internal fixation.After surgery,the patient was treated with AI+anlotinib chemotherapy regimen"doxorubicin+ifosfamide+anlotinib",and the chemotherapy was given for 6 cycles.And 30 sessions of radiotherapy were conducted in the surgical area,the left supraclavicular area and the anterior superior mediastinum.Results At present,the surgical wound healed well,the left shoulder joint function was good,and the MSTS functional score was 90%.There was no local tumor recurrence and progression.Conclusions Surgical resection combined with postoperative chemoradiotherapy and targeted therapy may be an option for the treatment of CCS of the clavicle.

摘要：Soft tissue sarcoma(STS)is a rare but highly heterogeneous group of mesenchymal-derived solid tumors comprising various pathological subtypes,with poor prognosis in advanced stages.The current first-line treatment for advanced STS is anthracycline-based chemotherapy,which has limited efficacy,significant toxic side effects,and poor response in certain STS subtypes.In addition to chemotherapy regimens selected based on pathological subtypes for second-line treatment,both Chinese and international clinical guidelines also recommend the use of anti-angiogenic targeted therapies.With the deepening understanding of molecular mechanisms of STS,other types of low-toxicity and high-efficiency targeted drugs have gradually entered the field of advanced STS treatment.Based on the basic characteristics of tumor biology,this review systematically examines targeted therapies currently entering clinical research on advanced STS from two aspects:targeting tumor cell signaling pathways and targeting the tumor microenvironment.Specifically,this article introduces the action mechanisms,clinical trial results,approved indications and clinical availability.This review aims to explore the current status and research progress of targeted therapy in advanced STS,and provide reference for more scientific and standardized use of targeted drugs to improve the therapeutic efficacy and prognosis of patients with advanced STS.

摘要：目的 骨样骨瘤好发于青少年,中老年患者非常罕见.本研究的目的是分析高龄骨样骨瘤患者的临床表现、影像学特点、手术方式和预后特征.方法 以 2015～2024 年,我院手术治疗的中老年骨样骨瘤病例为研究对象,本组共纳入 10 例,年龄 51～65 岁,平均 55.1 岁;男 6 例,女 4 例.全部病例均采用计算机智能化辅助方式,包括 8 例计算机导航辅助和 2 例机器人辅助.手术方式包括 8 例切开病灶刮除和 2 例微创射频消融.结果 患者手术前疼痛时间为 8～132 个月,平均 36.6 个月.病灶部位包括股骨 4 例、桡骨2 例、尺骨 1 例、肱骨 1 例、胫骨 1 例和腓骨 1 例.瘤巢位于干骺端 4 例、骨干 5 例、临近关节面 1 例.瘤巢与骨皮质的相对部位关系包括皮质中 4 例、皮质外 4 例和髓腔内 2 例.患者术前疼痛视觉模拟评分(visual analog scale,VAS)为 3～6 分,平均 4.7 分;术后疼痛 VAS 评分 0～1 分,平均 0.2 分.术后评分显著低于术前评分(P<0.001).术后随访 12～111 个月,平均 56.2 个月.术后 1 例复发.导航组的复发率为 12.5%(1/8),机器人组 0%(0/2),差异无统计学意义(P=0.621).切开手术(0%)与经皮射频手术(50%)的术后复发率比较,差异有统计学意义(P=0.026).术后 1 例伤口延迟愈合,未见其它并发症.结论 中老年骨样骨瘤患者的临床表现与青少年患者相似,但接受手术治疗前的疼痛病史相对较长.机器人或计算机导航辅助下的精准手术,可以有效地治疗骨样骨瘤,疼痛缓解满意,且安全性良好.

摘要：Low-grade central osteosarcoma is a highly differentiated malignant tumor located in the bone marrow.It is a rare subtype of osteosarcoma and is currently believed to be caused by chromosomal mutations.The most easily affected part is the long bone around the knee joint and clinical manifestations are mainly local pain and swelling.The presence of cortical fracture and extension to soft tissue should be paid attention to in imaging.The presence of cytologic atypia,mitotic activity,bone marrow infiltration,cortex destruction and extension into soft tissue should be taken into consideration in histology.CDK4 and MDM2 protein analysis has an important role in differentiating low-grade osteosarcoma from other tumors with similar appearance.Wide surgical resection is usually used for treatment and the prognosis is better than common typical osteosarcoma.If not treated properly,tumors can recur and transform to high-grade tumors,leading to poor prognosis.Definite and timely diagnosis and regular postoperative follow-up are particularly important for the diagnosis and treatment of low-grade central osteosarcoma.

摘要：目的 探讨基于 MRI 的椎体骨质量评分(vertebral bone quality,VBQ)在预测脊柱融合术后融合器沉降中的有效性.方法 本研究在 PubMed、Embase、Web of Science 及中国知网(CNKI)、中国生物医学文献数据库(CBM)中检索了从 2022 年 3 月 13 日至目前的相关文献,通过严格筛选最终纳入 14 篇符合标准的文章,涉及 2086 例患者,采用 RevMan 5.3 和 Stata 12.0 软件进行 Meta 分析.结果 数据分析显示,更高的VBQ 评分与术后融合器沉降风险显著增加相关(MD=0.72,95%CI:0.58～0.85),进一步验证了 VBQ 评分的预测价值.然而,研究间存在显著异质性(I2=81.0%,P<0.000 01),亚组分析后异质性降低(I2=48.7%,P=0.08),表明异质性可能主要来源于不同的手术方式.高 VBQ 评分患者易发生内固定松动或融合不良,导致翻修手术.较高的 VBQ 评分是脊柱融合术后融合器沉降的重要预测因素.结论 本研究在一定程度上证明了 VBQ评分在脊柱融合术前评估中的重要性,具有一定的指导临床决策中的潜在应用价值.