PubMed · 7800618
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M A Ritter. 1994. The cemented all-poly tibia.. https://doi.org/10.3928/0147-7447-19940901-32
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With the objectives of reducing toxicity and improving the mechanical properties of the prior Sulfix-6 cement, a new low-viscosity bone cement with a new catalyst (Sulfix-60), and a gentamycin containing cement (Allofix-G) were developed. Although static strength could be improved in comparison with the older Sulfix-6 cement, investigations regarding improved fatigue strength and the influence of vacuum mixing on the mechanical properties were missing. Dynamic weakness was the major disadvantage of the older Sulfix-6 cement. To investigate fatigue strength specimens of the new bone cements were tested with load guiding until breakage or 20 million cycles. In the three series, hand mixing, vacuum mixing, and vacuum mixing with additional pressurization were performed, respectively. Vacuum mixing led to increased fatigue stability from 6.3 to 9.1 MPa for Sulfix-60, and from 6.3 to 8.2 MPa for Allofix-G. Additional compression had no significant effect. A 200% increased fatigue strength was detectable in comparison with the older cement. In the four-point bending test, similar results were found. It could be proved that an increased polymerization rate achieved with the use of the new catalyst was responsible for the improved mechanical properties of the new bone cement Sulfix-60.
From 1930 to 1994, 54 patients with primary malignant tumors of the sternum were seen. Fifty patients were first seen with a mass, and one half of them also had pain in the sternal region. Two patients had no symptoms at presentation. Among 39 solid tumors were 26 chondrosarcomas, 10 osteosarcomas, 1 fibrosarcoma, 1 angiosarcoma, and 1 malignant fibrous histiocytoma. Of these, 25 were low-grade and 14 were high-grade tumors. Among 15 small cell tumors were 8 plasmacytomas, 6 malignant lymphomas, and 1 Ewing's sarcoma. Partial or subtotal sternectomy was done in 37 patients and total sternectomy in 3. Of the remaining 14 patients, 3 had local excision; 10 had external radiation or chemotherapy without operation, or both; and 1 had no treatment. All but one patient treated by wide resection (N = 40) had some form of skeletal reconstruction of the chest wall defect. Thirty-one (78%) underwent repair with Marlex mesh, and in 25 this was combined with methyl methacrylate. The skin edges were closed per primum in 32 patients; 8 required muscle, omentum, or skin flaps. Resection in chondrosarcomas yielded a 5-year survival (Kaplan-Meier) of 80% (median follow-up, 17 years). The 5-year survival in osteosarcomas was 14%. Resection was curative in 64% of low-grade sarcomas but in only 7% of high-grade sarcomas. In small cell tumors, resection and radiation were helpful for local control; all failures were a result of distant metastases. We conclude that primary sarcomas of the sternum though uncommon are potentially curable by wide surgical excision. With rigid prostheses to repair the skeletal defects, the surgical complication rates are low. Overall survival after complete surgical resection is related to tumor histologic type and grade.
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