2023年 · 第61卷第08期

Primary malignant or invasive benign tumors of the lower tibia are relatively rare, and 70% ~95% of patients with primary malignant tumors of the lower tibia can get rescue limb salvage treatment opportunities^{［1, 2］}。 However, due to the limited amount of soft tissue coverage of lower tibia and complex biomechanical factors, it is extremely difficult to perform limb salvage surgery. Biological reconstruction methods after lower tibial tumor resection reported by scholars include allogeneic bone reconstruction, tumor segment inactivation and reimplantation, fibula reconstruction, etc. Related complications include implant fracture, infection, nonunion, tumor recurrence, etc., and high-dose chemotherapy after surgery for malignant bone tumors increases the risk of complications^{［3, 4］}。 Mechanical reconstruction can provide sufficient mechanical strength for complete weight bearing, but the incidence of complications such as poor incision healing, prosthetic infection and ankle instability remains high^［5］。 We build on the design of 3D printed porous prostheses^{［6, 7］}Six patients with primary malignant or invasive benign tumors of the middle and lower tibia were completely resected, and then reconstructed with a fusion ankle prosthesis with three-dimensional printed metal trabecular bone. The prosthesis was fixed and fused with the articular surface of the talus. The short-term and medium-term results of patients after surgery are summarized and analyzed, and the preliminary experience of prosthesis design and surgery is shared, so as to provide reference for the clinical application of fusion ankle prosthesis.

Brucellosis is an acute or chronic zoonotic infectious disease of animal origin caused by Brucella. Aortic aneurysms account for only 0.06% of Brucella cardiovascular complications, according to literature reports^{［1, 2］}However, the mortality rate is high, ranging from 21% to 22%^{［3, 4］}。 At present, the literature of Brucella aortic aneurysm is mostly a case report, and the treatment method is mostly aortic replacement, which has high surgical risk, great trauma, long postoperative recovery time, and affects the labor ability; However, simple endovascular aortic repair itself has the risk of postoperative stent infection, and patients still need to live in the epidemic area after operation, which further increases the risk of postoperative reinfection and recurrence of brucellosis. Based on the actual situation of patients in our district, we explored an endovascular repair method combining systemic + local antibacterial drug therapy, and proposed to discuss with colleagues.

The patient was a 59-year-old male. He was admitted to hospital on October 11, 2018 for the main reason of "physical examination found that the right liver occupied space for 1 week". During abdominal ultrasound examination 1 week ago, the patient found that the right liver occupied space, with a size of about 17 mm ×13 mm, and went to our hospital for further treatment. The patient had no special discomfort, and no obvious positive signs were found on physical examination. He has a history of hepatitis B for more than 20 years and has not been controlled by drugs. Tumor marker examination: alpha-fetoprotein 3 430 μ g/L, combined with enhanced CT, gadoxetate disodium enhanced MRI and other examination results (Figure 1), the preliminary diagnosis is: (1) primary liver cancer with portal vein tumor thrombosis; (2) Chronic hepatitis B cirrhosis. Chinese liver cancer stage IIIA, Barcelona liver cancer clinical stage C, program type II, liver function Child grade A.

A 33-year-old male was admitted to the hospital on 20-Apr-2021 due to "Ankylosing spondylitis for 20 years, bilateral hip rigidity, kyphosis for 10 years". The patient was diagnosed with ankylosing spondylitis at the age of 13. Ten years ago, he progressed to a "razor back" deformity characterized by bilateral hip flexion ankylosis and kyphosis fusion, and lost the vertical standing appearance and mobility of both hips, severely limited walking ability, unable to look up and lie on his back. The range of mobility of lumbar spine and bilateral hip joints was lost, the range of mobility of bilateral knee joints was 0° ~130°, the dorsal extension of bilateral ankle joints was 20°, and the plantar flexion was 45°. When walking, the main activities were flexion and extension of tarsometatarsal joints and ankle joints of both feet. Imaging examination: Typical bamboo-like changes were observed in full-length anterior and lateral radiographs of the spine. Severe imbalance in coronal and sagittal positions, with apical vertebrae located in L_1~2Intervertebral disc, the upper vertebrae is located at T₁₀The lower end vertebrae is located at L₄。 Antero-posterior pelvic X-rays showed bilateral sacroiliac space destruction (grade 4), extreme pelvic tilt, bilateral hip fusion at 45° flexion, 25° external rotation on the right side, and 30° internal rotation on the left side (Figure 1). Laboratory test: white blood cell count 7.84×10⁹/L, neutrophil percentage 57.6%, hemoglobin 161 g/L, CRP 12.2 mg/L, erythrocyte sedimentation rate 2 mm/1 h, human leukocyte antigen B27 (+), rheumatoid factor (-), antinuclear antibody profile (-). Diagnosis: Ankylosing spondylitis (terminal stage), scoliotic kyphosis deformity with bone fusion, bilateral hip destruction with bone fusion.