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Abstract：
OBJECTIVE: The orthopedic surgical treatment strategies for patients with tumor-induced osteomalacia (TIO) require improvement, especially for patients where the causative tumors are located in surgically challenging areas, requiring a greater degree of in-depth investigation. This work aims to summarize and investigate clinical features and orthopedic surgical treatment effects of patients with tumor-induced osteomalacia (TIO), whose causative tumors are located in the hip bones.
METHODS: A retrospective analysis was conducted on the clinical data of all patients diagnosed with culprit tumors located in the hip bones who underwent surgical treatment at the orthopedic bone and soft tissue tumor sub-professional group of Peking Union Medical College Hospital from January 2013 to January 2023. This retrospective study summarized the clinical data, preoperative laboratory test results, imaging findings, surgery-related data, perioperative changes in blood phosphorus levels, and postoperative follow-up data of all patients who met the inclusion criteria. Normally distributed data are presented as mean and standard deviation, while non-normally distributed data are shown as the means and 25th and 75th interquartile ranges.
RESULTS: The clinical diagnostic criteria for TIO were met by all 16 patients, as confirmed by pathology after surgery. Among the 16 patients, we obtained varying degrees of bone pain and limited mobility (16/16), often accompanied by difficulties in sitting up, walking, and fatigue. An estimated 62.5% (10/16) of patients had significantly shorter heights during the disease stages. All 16 patients underwent surgical treatment for tumors in the hip bones, totaling 21 surgeries. In the pathogenic tumor, there were 16 cases of skeletal involvement and none of pure soft tissue involvement. Out of the 16 patients, 13 cases had a gradual increase in blood phosphorus levels following the latest orthopedic surgery, which was followed up for 12 months to 10 years. Due to unresolved conditions after the original surgery, four patients received reoperation intervention. Two cases of refractory TIO did not improve in their disease course.
CONCLUSIONS: In summary, the location of the causative tumor in the hip bone is hidden and diverse, and there is no defined orthopedic surgical intervention method for this case in clinical practice. For patients with TIO where the tumors are located in the hip bones, surgical treatment is difficult and the risk of postoperative recurrence is high. Careful identification of the tumor edge using precise preoperative positioning and qualitative diagnosis is crucial to ensure adequate boundaries for surgical resection to reduce the likelihood of disease recurrence and improve prognosis.
METHODS: A retrospective analysis was conducted on the clinical data of all patients diagnosed with culprit tumors located in the hip bones who underwent surgical treatment at the orthopedic bone and soft tissue tumor sub-professional group of Peking Union Medical College Hospital from January 2013 to January 2023. This retrospective study summarized the clinical data, preoperative laboratory test results, imaging findings, surgery-related data, perioperative changes in blood phosphorus levels, and postoperative follow-up data of all patients who met the inclusion criteria. Normally distributed data are presented as mean and standard deviation, while non-normally distributed data are shown as the means and 25th and 75th interquartile ranges.
RESULTS: The clinical diagnostic criteria for TIO were met by all 16 patients, as confirmed by pathology after surgery. Among the 16 patients, we obtained varying degrees of bone pain and limited mobility (16/16), often accompanied by difficulties in sitting up, walking, and fatigue. An estimated 62.5% (10/16) of patients had significantly shorter heights during the disease stages. All 16 patients underwent surgical treatment for tumors in the hip bones, totaling 21 surgeries. In the pathogenic tumor, there were 16 cases of skeletal involvement and none of pure soft tissue involvement. Out of the 16 patients, 13 cases had a gradual increase in blood phosphorus levels following the latest orthopedic surgery, which was followed up for 12 months to 10 years. Due to unresolved conditions after the original surgery, four patients received reoperation intervention. Two cases of refractory TIO did not improve in their disease course.
CONCLUSIONS: In summary, the location of the causative tumor in the hip bone is hidden and diverse, and there is no defined orthopedic surgical intervention method for this case in clinical practice. For patients with TIO where the tumors are located in the hip bones, surgical treatment is difficult and the risk of postoperative recurrence is high. Careful identification of the tumor edge using precise preoperative positioning and qualitative diagnosis is crucial to ensure adequate boundaries for surgical resection to reduce the likelihood of disease recurrence and improve prognosis.
摘要：
目的：肿瘤诱导的骨软化症（TIO）患者的骨科手术治疗策略需要改进，特别是对于致病肿瘤位于手术挑战性区域的患者，需要更深入的调查。本文旨在总结和探讨肿瘤诱导骨软化症(TIO)患者的临床特点及骨科手术治疗效果,其致病肿瘤位于髋骨。
方法：回顾性分析2013年1月至2023年1月在北京协和医院骨科骨与软组织肿瘤亚专业组接受手术治疗的所有髋骨内肿瘤患者的临床资料。这项回顾性研究总结了临床资料,术前实验室检查结果，影像学发现，手术相关数据,围手术期血磷水平的变化，以及所有符合纳入标准的患者的术后随访数据。正态分布数据以平均值和标准偏差表示，而非正态分布的数据显示为均值和第25和第75四分位数范围。
结果：所有16例患者均符合TIO的临床诊断标准，经手术后病理证实。在16名患者中，我们获得了不同程度的骨痛和活动受限（16/16），经常伴随着坐起来的困难，走路,和疲劳。估计62.5%(10/16)的患者在疾病阶段具有显著较短的身高。所有16例患者都接受了髋骨肿瘤的手术治疗，共21次手术。在致病性肿瘤中，16例骨骼受累，无单纯软组织受累。在16名患者中，13例血磷水平在最近的骨科手术后逐渐增加，随访12个月至10年。由于原始手术后未解决的情况，4例患者接受了再手术干预.2例难治性TIO的病程没有改善。
结论：总之，髋骨中致病肿瘤的位置是隐藏和多样的，在临床实践中，这种情况没有明确的骨科手术干预方法。对于肿瘤位于髋骨的TIO患者，手术治疗困难，术后复发风险高。使用精确的术前定位和定性诊断仔细识别肿瘤边缘对于确保手术切除的足够边界以减少疾病复发的可能性并改善预后至关重要。
方法：回顾性分析2013年1月至2023年1月在北京协和医院骨科骨与软组织肿瘤亚专业组接受手术治疗的所有髋骨内肿瘤患者的临床资料。这项回顾性研究总结了临床资料,术前实验室检查结果，影像学发现，手术相关数据,围手术期血磷水平的变化，以及所有符合纳入标准的患者的术后随访数据。正态分布数据以平均值和标准偏差表示，而非正态分布的数据显示为均值和第25和第75四分位数范围。
结果：所有16例患者均符合TIO的临床诊断标准，经手术后病理证实。在16名患者中，我们获得了不同程度的骨痛和活动受限（16/16），经常伴随着坐起来的困难，走路,和疲劳。估计62.5%(10/16)的患者在疾病阶段具有显著较短的身高。所有16例患者都接受了髋骨肿瘤的手术治疗，共21次手术。在致病性肿瘤中，16例骨骼受累，无单纯软组织受累。在16名患者中，13例血磷水平在最近的骨科手术后逐渐增加，随访12个月至10年。由于原始手术后未解决的情况，4例患者接受了再手术干预.2例难治性TIO的病程没有改善。
结论：总之，髋骨中致病肿瘤的位置是隐藏和多样的，在临床实践中，这种情况没有明确的骨科手术干预方法。对于肿瘤位于髋骨的TIO患者，手术治疗困难，术后复发风险高。使用精确的术前定位和定性诊断仔细识别肿瘤边缘对于确保手术切除的足够边界以减少疾病复发的可能性并改善预后至关重要。
