The enhancement of clinical skills always go hand in hand with the innovation of scientific technology. With the help of frontier technologies in Internet, big data and artificial intelligence, the Orthopedics in modern era has transformed greatly, affecting both surgeons and patients profoundly. It is especially true to the application of artificial intelligence in the precise treatment of bone diseases.
Bone tumors account for 2% to 3% of all tumors, of which one third are malignant. Bone tumors are often difficult to be diagnosed and treated, and have a poor prognosis and high possibility of death or disability. Primary malignant bone tumors are mostly seen in adolescents and middle-aged people, while secondary bone metastases are mostly found in middle-aged and elder population. Recent years have seen growing incidence of bone tumors. Early detection, accurate diagnosis and timely standard management are crucial to the prognosis of bone tumors.
Despite distinctive symptoms, lesion is too small to be detected.
Xiao Li, 15 years old, was in his prime age, but repeated knee pain has been disturbing his life for many years. He has had all kinds of tests and examinations at hospitals, but there is no definite diagnosis that can be reached, except growing pains that are often seen in adolescence. However, in addition to keen pain after exercise, Xiao Li would even wake up due to severe pain at night from time to time.
When Xiao Li's family took him to SAHZU for further consultation, SAHZU orthopedic surgeons finally found a very small lesion in the bone cortex of the root of his thigh bone, which was then considered to be an osteoid osteoma.
Osteoid osteoma is a benign osteogenic tumor that usually occurs in young people aged 10-20. The tumor growing at the root of Xiao Li's thigh bone secretes a lot of inflammatory factors, causing a local inflammatory response in the hip joint and stimulating nerves, leading to painful symptoms around the knee joint.
Despite the small lesion, surgeries are difficult.
Treatment of osteoid osteoma is primarily surgical, either removal of the lesion or radiofrequency ablation. But the procedure for Xiao Li is subject to two major challenges:
1. The lesion, extremely small and located within the bone cortex, is very difficult to be found during the surgery.
2. The lesion is in an extremely deep position and an open joint surgery is thus required that may cause great trauma and pain to the patient.
In the past, surgeons would have no options but to operate, taking big risks of surgical failure and trauma in order to help the patient, although it's tough for doctors and painful for patients. But now, with the O-arm surgical navigation system, SAHZU orthopedic surgeons could rise up to the challenge easily. The system enables surgeons to reach the lesion through an incision as small as one centimeter with extremely accurate imaging of the lesion location. Guided by the system, surgeons would be able to perform complete removal and ablation of the focal lesion while preserving the most normal bone structure with their best efforts. Thanks to the tiny incision, minimal trauma, and accurate location made possible by the system, Xiao Li had a much quicker recovery. He was able to walk hours after the surgery and discharged within the same day, pain-freely.
Xiao Li is one of many similar cases at SAHZU Orthopedics. SAHZU Orthopedic Department has long endeavored to adopt accurate and minimally invasive surgical management for bone diseases so as to enhance patient recovery, by utilizing advanced technologies such as artificial intelligence 3D printing, O-arm surgical navigation system, Mako robotic-assisted surgical system, intraoperative CT or MRI etc. The goal of SAHZU Orthopedics Department is to operate difficult and complicated surgeries more safely, minimal invasively, and accurately.
How to detect bone tumor early? What are the symptoms?
Bone tumors can be benign or malignant. Benign tumors may not present any symptoms and tend to be detected by an imaging examine for a different purpose. Or, it can be found with an imaging examine for a tangible hard lump under the skin or pain around certain body part as Xiao Li did.
For malignant tumors, however, the initial symptoms tend to be indistinctive. Patients gradually feel pain or sour, sometimes swelling, in the affected body part, or even wake up at night due to the pain. The symptoms could keep aggravating. Sometimes, malignant tumors might not be found until pathological bone fractures after falls.
Therefore, if anyone is experiencing similar discomfort, he or she is suggested to seek for medical opinions as soon as possible. CT or MRI scan are recommended when necessary.
Main symptoms include
★ Pain. It is an important manifestation of malignant bone tumor. Pain is intermittent at the beginning, and then becomes more frequent, particularly at night. At the late stage, pain would be so severe that the patients' work, study and sleep could be affected, and pain relievers are needed. Benign tumors have a slow course of disease, mild or painless pain.
★ Lump. A growing lump is a sign for the diagnosis of bone tumors. Benign lumps grow slowly, often undetected or detected by chance, and have little effect on the affected area. Malignant bone tumors grow rapidly in a short time. Enlarged lumps may have higher skin temperature and varicose veins, and those located in the long bone epiphysis may cause joint swelling and restricted movement. Tumors located in the pelvis can lead to constipation and difficulty in urination.
★Pathological fracture. Fracture with slight external force is often the first symptom of benign bone tumor, but also a common sign of malignant bone tumor and bone metastasis. It has the same manifestation of swelling, pain, deformity and abnormal activity as ordinary fracture.
★Symptoms at late stage. Malignant tumor in late stage may cause anemia, emaciation, loss of appetite, weight loss and increase of body temperature. Distant metastases are mostly hematogenous metastases, occasionally lymphatic metastases.
What should I do if I have a bone tumor? How to treat it?
Bone tumors have a low incidence in the population. Among bone tumors, benign tumor accounts for 50%, malignant 40%, and tumor-like lesions about 10%. Therefore, overall, the incidence of malignant bone tumors is very low, so there is no need to be nervous. Some benign tumors only require long-term follow-up.
Despite low incidence, bone tumors have many types and recent years see gradually increasing incidence rate. Tumors can invade all bones in the body and appear at different ages. After diagnosed with bone tumor, first of all, patients should have standardized treatment at the hospital. Through routine physical examination and imaging test, the characteristics, location and features of the tumor should be clarified in time, and if necessary, puncture biopsy should be done to achieve clear diagnosis.
Then how should bone tumor be managed?
Patient's age, general physical condition and possible prognosis, and details about the tumor, such as its size, stability and whether there are symptoms of nerve compression, and other factors should be considered as a whole to develop the best treatment plan for the patient. Currently, it is recommended to adopt a comprehensive treatment approach, including surgery, radiotherapy, chemotherapy, immunotherapy, molecular targeted therapy and so on.
For most benign tumors, as long as they do not affect the physical condition and appearance of the patient, they only require follow-up and observation. Most of benign tumors are stable, only a few turns into malignant. If the tumor happens to increase in size in a short period of time and become swollen and painful, it is likely it becomes malignant and needs surgical treatment.
For malignant bone tumor or metastatic bone tumor, a thorough evaluation is needed. A surgical operation to remove the lesion as much as possible, combined with radiotherapy, immunotherapy and targeted therapy should be used to manage the tumor. The earlier the treatment time, the better the treatment effect.
What kind of bone tumors are suitable for minimally invasive surgical treatment?
In addition to the abovementioned osteoid osteoma, minimally invasive surgery is suitable for some metastatic bone tumors with little possibility of complete cure, where bone cement can be precisely implanted under navigation to reduce patients' pain. Scraping of certain benign tumor lesions in the extremities, scapula and pelvis can also be treated with minimally invasive surgery; bone grafting can be implanted under navigation in order to prevent pathological fractures due to accidental falls or improve symptoms. In addition, puncture biopsy of some tumors can be performed more precisely under navigation.
What are the benefits of navigation system during bone tumor surgery?
The primary principle of bone tumor surgery is to remove the entire tumor. Therefore, the surgical margin is of great importance. In the past, surgeons have to completely rely on their personal experience and surgical skills to determine the margins, who usually tend to remove surrounding healthy tissues when encountering blind areas in the surgical field. However, with the help of computer navigation system, surgeons could determine the precise margins with preoperative CT and MRI scan results, and then accurately remove the tumor under the guidance of O-arm imaging system, CT and MRI intraoperatively, so as to preserve as much normal tissue and structure as possible, which is very important for the reconstruction of limb function of patients.
SAHZU Orthopedics is a patient-centered team, and is at the leading level in China in the treatment of various common orthopedic diseases.
Surgical navigation technology has been applied in spinal surgery, joint surgery, trauma surgery, bone tumor surgery and foot and ankle surgery at SAHZU. The Department of Orthopedics now owns Mako robotic-assisted navigation system for artificial joint replacement, O-arm imaging navigation system for spinal diseases, Smart Sky Eye robotic system for acetabular fracture surgery, minimally invasive surgical techniques for foot and ankle surgery and sports system diseases, etc. Meanwhile, each patient ward is equipped with a special post-operative rehabilitation team so that patients can recover quickly after surgery and return to normal life as soon as possible.
Author: LI JING | Reviewer: CHEN LU | Editor: LI JING | Source: SAHZU OFFICIAL WECHAT | Date:2021-12-17 | Views: