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ABSTRAK
Pendahuluan Penggunaan megaprostesis sebagai pilihan dalam manajemen LSS memberikan harapan baru bagi pasien tumor tulang di Indonesia. Namun, sampai saat ini belum ada data hasil luaran dari tata laksana ini. Metode Penelitian ini merupakan prospektif observational pada 34 pasien tumor tulang di RS Cipto Mangunkusumo pada tahun 2011-2015. Diagnosis ditegakkan melalui Clinical Pathological Conference. Evaluasi pascaoperasi dilakukan pada bulan ke-3, 6, 9, 12, 24, 36, dan 48 dengan menggunakan skoring dari MSTS. Luaran onkologi dievaluasi dengan adanya rekurensi dan metastasis jauh. Komplikasi berupa infeksi, dislokasi, cedera saraf dan pembuluh darah, serta gangguan mekanisme ekstensor juga dievaluasi. Hasil Dua orang ahli bedah muskuloskeletal onkologi melakukan operasi LSS dan rekonstruksi dengan megaprostesis. Dua pasien dieksklusi karena keputusan intraoperatif untuk memakai non modular endoprostesis. Kehilangan darah intraoperatif memiliki median (RAK) 890,0 (700,0?1200,0) ml. Skor MSTS sebagian besar pasien menunjukkan kategori baik dan sangat baik, yaitu 67.9% baik pada MSTS 6 bulan, 79,2% baik pada MSTS 9 bulan, 63.4% sangat baik pada 12 bulan, 90% sangat baik pada 24 bulan dan 100% sangat baik pada MSTS 36 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu jenis tumor (p=0,001), usia (p=0,039), jenis kelamin (p=0,049), dan hasil laboratorium ALP (p=0,031) dengan luaran fungsional MSTS 3 bulan. Terdapat hubungan bermakna antara karakteristik pasien yaitu perdarahan intraoperatif (p=0,013) dan ALP (p=0,009) dengan mortalitas; dan juga antara tumor tulang yang menjalani rekonstruksi jaringan lunak ekstensif dengan komplikasi (p=0,019) namun antara lokasi tumor dan komplikasi tidak terdapat hubungan bermakna. Kesimpulan Luaran fungsional pada pasien yang dilakukan rekonstruksi megaprostesis adalah baik dan sangat baik sehingga dapat menjadi tatalaksana pilihan bagi pasien tumor tulang yang akan menjalani LSS. Luaran onkologi pada pasien yang dilakukan prosedur LSS baik dengan rendahnya rekurensi lokal, metastasi, dan komplikasi. ABSTRACT
Introduction Advancement in bone tumor management has elaborated surgeon?s choice of treatment not merely sentenced the patients into a limb ablation. Likewise, patients with bone tumors, regardless its malignant nature and limited survival time, had an equal privileges to opt for LSS to experience a better quality of life. In this study, we manage to evaluate the functional and oncologic outcome of lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors were prospectively reviewed between 2011 and 2015 in a tertiary referral general hospital. All patients were managed through a Clinical Pathology Conference. Functional outcome was evaluated using MSTS score and follow up was recorded at 3, 6, 12 months; and 2, 3, 4 years. Results Two orthopedic musculoskeletal oncologic surgeons were performing the surgeries. Two patients were excluded because the final instruments used were not a modular type. The final result of functional score was good to excellent with 67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months, 90% excellent at 24 months and 100% excellent at 36 months. Complications occurred and varied. A statistical significant result was found between age (p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months functional outcome; between intraoperative blood loss (p=0,013) and mortality, as well as SAP with mortality (p=0,009); between tumor that underwent extensive soft tissue reconstruction procedure and complication (p=0,019). Conclusion Megaprosthesis reconstruction in bone tumors gives a good and excellent result, which provides orthopaedic oncologic surgeons a rationalization to make a selective decision-making in tumor cases regardless its survival and tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s choice of treatment not merely sentenced the patients into a limb ablation. Likewise, patients with bone tumors, regardless its malignant nature and limited survival time, had an equal privileges to opt for LSS to experience a better quality of life. In this study, we manage to evaluate the functional and oncologic outcome of lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors were prospectively reviewed between 2011 and 2015 in a tertiary referral general hospital. All patients were managed through a Clinical Pathology Conference. Functional outcome was evaluated using MSTS score and follow up was recorded at 3, 6, 12 months; and 2, 3, 4 years. Results Two orthopedic musculoskeletal oncologic surgeons were performing the surgeries. Two patients were excluded because the final instruments used were not a modular type. The final result of functional score was good to excellent with 67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months, 90% excellent at 24 months and 100% excellent at 36 months. Complications occurred and varied. A statistical significant result was found between age (p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months functional outcome; between intraoperative blood loss (p=0,013) and mortality, as well as SAP with mortality (p=0,009); between tumor that underwent extensive soft tissue reconstruction procedure and complication (p=0,019). Conclusion Megaprosthesis reconstruction in bone tumors gives a good and excellent result, which provides orthopaedic oncologic surgeons a rationalization to make a selective decision-making in tumor cases regardless its survival and tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s choice of treatment not merely sentenced the patients into a limb ablation. Likewise, patients with bone tumors, regardless its malignant nature and limited survival time, had an equal privileges to opt for LSS to experience a better quality of life. In this study, we manage to evaluate the functional and oncologic outcome of lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors were prospectively reviewed between 2011 and 2015 in a tertiary referral general hospital. All patients were managed through a Clinical Pathology Conference. Functional outcome was evaluated using MSTS score and follow up was recorded at 3, 6, 12 months; and 2, 3, 4 years. Results Two orthopedic musculoskeletal oncologic surgeons were performing the surgeries. Two patients were excluded because the final instruments used were not a modular type. The final result of functional score was good to excellent with 67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months, 90% excellent at 24 months and 100% excellent at 36 months. Complications occurred and varied. A statistical significant result was found between age (p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months functional outcome; between intraoperative blood loss (p=0,013) and mortality, as well as SAP with mortality (p=0,009); between tumor that underwent extensive soft tissue reconstruction procedure and complication (p=0,019). Conclusion Megaprosthesis reconstruction in bone tumors gives a good and excellent result, which provides orthopaedic oncologic surgeons a rationalization to make a selective decision-making in tumor cases regardless its survival and tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s choice of treatment not merely sentenced the patients into a limb ablation. Likewise, patients with bone tumors, regardless its malignant nature and limited survival time, had an equal privileges to opt for LSS to experience a better quality of life. In this study, we manage to evaluate the functional and oncologic outcome of lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors were prospectively reviewed between 2011 and 2015 in a tertiary referral general hospital. All patients were managed through a Clinical Pathology Conference. Functional outcome was evaluated using MSTS score and follow up was recorded at 3, 6, 12 months; and 2, 3, 4 years. Results Two orthopedic musculoskeletal oncologic surgeons were performing the surgeries. Two patients were excluded because the final instruments used were not a modular type. The final result of functional score was good to excellent with 67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months, 90% excellent at 24 months and 100% excellent at 36 months. Complications occurred and varied. A statistical significant result was found between age (p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months functional outcome; between intraoperative blood loss (p=0,013) and mortality, as well as SAP with mortality (p=0,009); between tumor that underwent extensive soft tissue reconstruction procedure and complication (p=0,019). Conclusion Megaprosthesis reconstruction in bone tumors gives a good and excellent result, which provides orthopaedic oncologic surgeons a rationalization to make a selective decision-making in tumor cases regardless its survival and tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.;Introduction Advancement in bone tumor management has elaborated surgeon?s choice of treatment not merely sentenced the patients into a limb ablation. Likewise, patients with bone tumors, regardless its malignant nature and limited survival time, had an equal privileges to opt for LSS to experience a better quality of life. In this study, we manage to evaluate the functional and oncologic outcome of lower extremity bone tumors following a LSS using megaprosthesis. Methods Thirty-four patients with lower extremity bone tumors were prospectively reviewed between 2011 and 2015 in a tertiary referral general hospital. All patients were managed through a Clinical Pathology Conference. Functional outcome was evaluated using MSTS score and follow up was recorded at 3, 6, 12 months; and 2, 3, 4 years. Results Two orthopedic musculoskeletal oncologic surgeons were performing the surgeries. Two patients were excluded because the final instruments used were not a modular type. The final result of functional score was good to excellent with 67.9% good at 6 months, 79,2% good at 9 months, 63.4% excellent at 12 months, 90% excellent at 24 months and 100% excellent at 36 months. Complications occurred and varied. A statistical significant result was found between age (p=0,001), age (p=0,039), gender (p=0,049), SAP (p=0,031) and 3 months functional outcome; between intraoperative blood loss (p=0,013) and mortality, as well as SAP with mortality (p=0,009); between tumor that underwent extensive soft tissue reconstruction procedure and complication (p=0,019). Conclusion Megaprosthesis reconstruction in bone tumors gives a good and excellent result, which provides orthopaedic oncologic surgeons a rationalization to make a selective decision-making in tumor cases regardless its survival and tumor type. Oncologic outcome as well gave out good result with low incidence of far metastasis and local recurrence.

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ABSTRAK
Latar Belakang: Simple bone cyst (SBC) adalah tumor tulang jinak, berisi cairan. Tujuan utama terapi SBC adalah mendapatkan penyembuhan tulang, mencegah fraktur patologis, dan manajemen gejala khususnya nyeri. Terdapat berbagai metode pengobatan SBC, namun saat ini masih kontroversial karena angka kesembuhan dan tingkat invasi operasi. Terapi injeksi perkutaneus steroid merupakan metode operasi dengan tingkat invasi rendah sehingga penyembuhan tulang dan luaran fungsional lebih baik. Metode: Total terdapat 10 pasien (6 laki-laki, 4 perempuan, rerata usia13 tahun) SBC yang terbagi dalam dua kelompok. 5 pasien (proksimal femur 3; proksimal humerus 1; calcaneus 1) dilakukan terapi injeksi perkutaneus steroid dan 5 pasien (proksimal femur 2; proksimal humerus 2, radius 1) terapi kurease dengan hidroksiapatit. Injeksi perkutaneus steroid dilakukan sebanyak tiga kali dengan interval waktu tiap satu bulan. Rerata follow up adalah 12-26 bulan. Evaluasi penyembuhan tulang dinilai secara radiologi dengan kriteria Chang dkk. Luaran fungsional dinilai berdasarkan skor MSTS. Hasil: Penyembuhan tulang komplit didapatkan pada kedua kelompok, namun solid union lebih cepat terjadi pada kelompok terapi injeksi perkutaneus steroid. Luaran fungsional didapatkan nilai yang lebih baik pada kelompok injeksi perkutaneus steroid terutama pada bulan ke-3 (55%) dan ke-6 (84%) pasca operasi berdasarkan skor MSTS dibandingkan terapi kuretase dengan hidroksiapatit (bulan ke-3 47% dan ke-6 69,3%). Simpulan: Terapi injeksi perkutaneus steroid masih tetap menjadi pilihan utama metode terapi SBC dengan solid union lebih cepat, tingkat prosedur operasi invasi rendah, lebih mudah, efektif, dan aman. ABSTRACT
Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The main goals of the therapy are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatment, however still remains controversial because of their healing rate and invasiveness of surgery. Steroid injection therapy is a surgical procedure with a low level of invasiveness so that better bone healing and functional outcomes. Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were divided into two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2 proximal humerus, radius 1) performed curretage with hydroxyapatite therapy. Percutaneous steroid injection was performed three times at intervals of each month. The mean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed by Chang criteria and the functional outcome by MSTS score. Results: Complete bone healing was found in both group, but solid union occurred faster in steroid injection theraphy group. The functional outcomes found better value in the steroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) than curettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) post operation based on MSTS score. Conclusions: Percutaneus steroid injection therapy is still the main choice of SBC treatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The main goals of the therapy are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatment, however still remains controversial because of their healing rate and invasiveness of surgery. Steroid injection therapy is a surgical procedure with a low level of invasiveness so that better bone healing and functional outcomes. Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were divided into two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2 proximal humerus, radius 1) performed curretage with hydroxyapatite therapy. Percutaneous steroid injection was performed three times at intervals of each month. The mean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed by Chang criteria and the functional outcome by MSTS score. Results: Complete bone healing was found in both group, but solid union occurred faster in steroid injection theraphy group. The functional outcomes found better value in the steroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) than curettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) post operation based on MSTS score. Conclusions: Percutaneus steroid injection therapy is still the main choice of SBC treatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.;Background: Simple bone cysts (SBC) are a benign bone tumor, fluid-filled. The main goals of the therapy are to get the bone healing, prevent pathological fractures, and management of pain symptom. There are various methods of the SBC treatment, however still remains controversial because of their healing rate and invasiveness of surgery. Steroid injection therapy is a surgical procedure with a low level of invasiveness so that better bone healing and functional outcomes. Methods: A total of 10 patients (6 males, 4 females, mean age 13 year) SBC were divided into two groups. 5 patients (proximal femur 3; proximal humerus 1; calcaneus 1) performed percutaneous steroid injection therapy and 5 patients (proximal femur 2; 2 proximal humerus, radius 1) performed curretage with hydroxyapatite therapy. Percutaneous steroid injection was performed three times at intervals of each month. The mean follow-up of 12-26 months. Evaluation of bone healing radiological asseesed by Chang criteria and the functional outcome by MSTS score. Results: Complete bone healing was found in both group, but solid union occurred faster in steroid injection theraphy group. The functional outcomes found better value in the steroid injection theraphy group, particulary at 3 months (55%) and 6 months (84%) than curettage with hydroxyapatite therapy(3 months 47% and 6 months 69,3%) post operation based on MSTS score. Conclusions: Percutaneus steroid injection therapy is still the main choice of SBC treatment with faster solid union, a lower level operating procedures invasion, easy, effective, and safe.

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ABSTRAK
Pendahuluan. Kesulitan dalam tatalaksana defek tulang yang luas merupakan salah satu tantangan dewasa ini. Selain tatalaksananya yang kompleks juga dapat memberikan dampak jangka panjang negatif yang berat. Penggunaan BMP-2 dalam tatalaksana fraktur dengan defek tulang yang luas memegang peranan penting. BMP-2 berperan pada proses osteogenesis dan chondrogenesis dan menghambat osteoclastogenesis melalui RANKL signaling. Penelitian ini bertujuan untuk mengetahui efek dari perbedaan dosis BMP-2 terhadap penyembuhan fraktur dengan defek tulang yang luas. Metode. Penelitian dilakukan di Laboratorium Animal Gizi di FKUI dan Laboratorium Patologi Anatomi FKUI-RSCM, pada bulan Juli hingga September 2015. Desain penelitian adalah randomized post test control group. Sejumlah 25 ekor tikus putih Sprague Dawley dengan usia 3-4 bulan dan berat badan antara 250 ? 350 gram, dibagi secara acak menjadi kelompok kontrol hidroksiapatit (HA) saja dan kelompok kombinasi HA + BMP-2 1 μg/ml, HA + BMP-2 5 μg/ml, HA + BMP-2 10 μg/ml, HA + BMP-2 20 µg/ml. Tiap kelompok dilakukan tindakan berupa frakturisasi dengan defek tulang 10mm pada femur kanan dan dilakukan fiksasi interna dengan menggunakan intramedullary k-wire ukuran 1,4 mm secara retrograd. Setelah 6 minggu dilakukan penilaian secara histomorfometri, radiologis dan Scanning Electron Microscope (SEM). Hasil. Berdasarkan hasil penelitian secara histomorfometri ditemukan terdapat perbedaan rerata total area kalus yang bermakna diantara kelompok penelitian (p<0,001),terdapat perbedaan bermakna rerata area penulangan antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,009, p=0,016, p=0,009 dan p=0,016), terdapat perbedaan bermakna rerata area kartilago antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,009, p=0,009, p=0,009 dan p=0,028), terdapat perbedaan bermakna rerata area fibrosis antara kelompok kontrol dengan kelompok 1 μg/ml dengan kelompok kontrol dan 10 μg/ml(masing-masing p=0,047 dan p=0,009).Secara radiologis dengan RUST score didapatkan perbedaan bermakna antara kelompok kontrol dengan kelompok 1 μg/ml, 5 μg/ml, 10 μg/ml, 20 μg/ml (masing-masing p=0,005, p=0,006, p=0,005 dan p=0,006). Dengan SEM didapatkan gambaran kalus yang lebih homogen dan padat pada kelompok 10μg/ml dibandingkan dengan 5 μg/ml dan 20 μg/ml. Kesimpulan: Pemberian BMP-2 dapat menstimulasi proses penyembuhan fraktur pada defek tulang luas (critical bone defect) yang bermakna secara statistik, histomorfometri, radiologis maupun secara kualitatif dengan SEM. Terdapat dosis optimal dalam pemberian BMP-2.ABSTRACT
Introduction: Difficulties in the management of extensive bone defects is one of today's challenges. It is not only complex treatment but also can provide long-term negative severe effects. The use of BMP-2 in the treatment of fractures with extensive bone defect plays an important role. BMP-2 plays a role in the process of osteogenesis and chondrogenesis and inhibits osteoclastogenesis via the RANKL signaling. This study aims to determine the effect of differences in doses of BMP-2 on the healing of the fracture with extensive bone defects. Methods: The study was conducted at the Laboratory of Animal Nutrition at the Faculty of Medicine University of Indonesia (FMUI) in July until September 2015. The study design was randomized posttest control group. A number of 25 Sprague Dawley rats aged 3-4 months and bodyweight between 250-350 grams, were randomly divided into a control group of hydroxyapatite (HA) alone and HA+BMP-2 1 µg / ml, HA+BMP -2 5 ug / ml, HA + BMP-2 10 µg / ml, HA + BMP-2 20 ug / ml. Each group carried out fracturization with 10mm bone defect in right femur and internal fixation by using intramedullary K-wire size of 1.4 mm retrograde. After 6 weeks we did histomorfometri assessment, radiological and Scanning Electron Microscope (SEM). Results: Based on the research results histomorfometrcally found there are differences in the mean total area of ​​callus significantly between the study group (p <0.001), there were significant differences in the mean area of ​​woven bone between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.016, p = 0.009 and p = 0.016), there were significant differences in the average area of ​​the cartilage between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.009, p = 0.009 and p = 0.028), there were significant differences in the average area of ​​fibrosis between the control group with group 1 ug / ml in the control group and 10 mg / ml (respectively -masing p = 0.047 and p = 0.009) .In radiologist assessment with RUST scores obtained significant differences between the control group and group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 µg / ml (respectively p = 0.005 , p = 0.006, p = 0.005 and p = 0.006). SEM features with callus more homogeneous and dense in the group of 10μg / mL compared with 5 ug / ml and 20 µg / ml. Conclusion: Administration of BMP-2 could stimulate the process of fracture healing in large bone defects (critical bone defect) which was statistically significant with histomorfometri assestment, radiological and qualitatively with the SEM. There is an optimal dose in the administration of BMP-2.;Introduction: Difficulties in the management of extensive bone defects is one of today's challenges. It is not only complex treatment but also can provide long-term negative severe effects. The use of BMP-2 in the treatment of fractures with extensive bone defect plays an important role. BMP-2 plays a role in the process of osteogenesis and chondrogenesis and inhibits osteoclastogenesis via the RANKL signaling. This study aims to determine the effect of differences in doses of BMP-2 on the healing of the fracture with extensive bone defects. Methods: The study was conducted at the Laboratory of Animal Nutrition at the Faculty of Medicine University of Indonesia (FMUI) in July until September 2015. The study design was randomized posttest control group. A number of 25 Sprague Dawley rats aged 3-4 months and bodyweight between 250-350 grams, were randomly divided into a control group of hydroxyapatite (HA) alone and HA+BMP-2 1 µg / ml, HA+BMP -2 5 ug / ml, HA + BMP-2 10 µg / ml, HA + BMP-2 20 ug / ml. Each group carried out fracturization with 10mm bone defect in right femur and internal fixation by using intramedullary K-wire size of 1.4 mm retrograde. After 6 weeks we did histomorfometri assessment, radiological and Scanning Electron Microscope (SEM). Results: Based on the research results histomorfometrcally found there are differences in the mean total area of ​​callus significantly between the study group (p <0.001), there were significant differences in the mean area of ​​woven bone between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.016, p = 0.009 and p = 0.016), there were significant differences in the average area of ​​the cartilage between the control group with group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 ug / ml (respectively p = 0.009, p = 0.009, p = 0.009 and p = 0.028), there were significant differences in the average area of ​​fibrosis between the control group with group 1 ug / ml in the control group and 10 mg / ml (respectively -masing p = 0.047 and p = 0.009) .In radiologist assessment with RUST scores obtained significant differences between the control group and group 1 ug / ml, 5 µg / ml, 10 µg / ml, 20 µg / ml (respectively p = 0.005 , p = 0.006, p = 0.005 and p = 0.006). SEM features with callus more homogeneous and dense in the group of 10μg / mL compared with 5 ug / ml and 20 µg / ml. Conclusion: Administration of BMP-2 could stimulate the process of fracture healing in large bone defects (critical bone defect) which was statistically significant with histomorfometri assestment, radiological and qualitatively with the SEM. There is an optimal dose in the administration of BMP-2.

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ABSTRAK
Pendahuluan. Parameter spinopelvik merupakan parameter untuk mengukur keseimbangan poros tulang belakang terhadap ekstrimitas bawah pada penampang sagital. Parameter ini terdiri dari sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateral view dalam keadaan berdiri. Pengukuran parameter ini penting sebagai dasar analisa keseimbangan sagital dalam operasi rekonstruktif tulang belakang, karena dengan tidak adanya keseimbangan pada penampang sagital ini akan berakibat timbulnya adjacent segment degeneration yang akan memengaruhi luaran klinis. Hingga saat ini belum ada studi yang mengevaluasi hubungan antara luaran parameter spinopelvik dengan luaran klinis di indonesia. Metode Penelitian. Penelitian ini adalah penelitian analitik potong lintang dengan subyek 19 pasien dewasa pasca operasi stabilisasi dan fusi tulang belakang torakal dan lumbal di Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta pada tahun 2012-2014. Pasien tersebut dilakukan evaluasi X-ray parameter spinopelvik SVA, PI, PT, dan SS dilakukan penilaian skor Indeks Disabilitas Oswestry (IDO) pada saat 1 tahun pasca operasi. Lalu dilakukan analisis statistik dengan menggunakan uji hipotesis komparatif numerik dengan menggunakan pearson dimana dibandingkan luaran parameter spinopelvik SVA, PI, PT, dan SS dengan luaran fungsional skor IDO. Temuan dan Diskusi Penelitian. Didapatkan hasil korelasi antara IDO dan SVA (p<0,001) (r=0,866). Korelasi antara IDO dan PI (p=0,006) (r=0,603). Korelasi antara IDO dan PT (p=0,107) (r=0,382). Korelasi IDO dan SS (p=0,051) (r=0,454). Simpulan. Didapatkan korelasi kuat antara IDO dan SVA serta IDO dan PI. Tidak didapatkan korelasi antara IDO dan PT serta IDO dan SS. SVA dan PI merupakan parameter spinopelvik yang berpengaruh pada luaran pasca operasi fusi tulang belakang torakal dan lumbal. ABSTRACT
Introduction. Spinopelvic parameter is a parameter that used to measure the sagital balance of vertebrae in congruency with lower extrimity in sagital plane. This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateral view in standing position. Measurement of this parameter is important as basic analysis for achieve sagital balance in reconstructive operation of the vertebrae, because if the sagital balance is interupted will cause the adjacent segment degeneration that will influence the clinical outcomes. Up until now, there is no study that evaluate the spinopelvic parameter with the clinical outcomes in Indonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patient that had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwent x-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluation of Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then the statistical work was done with numeric comparative pearson test analysis to determine whether there is correlation between SVA, PI, PT, and SS with IDO score. Result and Discussion. There is strong correlation between IDO and SVA (p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603). No correlation between IDO and PT (p=0,107) (r=0,382). No correlation between IDO and SS (p=0,051) (r=0,454). Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI. There is no correlation between IDO and PT, also in IDO and SS. SVA and PI are the important spinopelvic parameter that have influence on clinical outcome in post thoracal and lumbar fusion and stabilization patient. ;Introduction. Spinopelvic parameter is a parameter that used to measure the sagital balance of vertebrae in congruency with lower extrimity in sagital plane. This parametr is consist of sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence (PI) dan diukur melalui X-ray whole spine lateral view in standing position. Measurement of this parameter is important as basic analysis for achieve sagital balance in reconstructive operation of the vertebrae, because if the sagital balance is interupted will cause the adjacent segment degeneration that will influence the clinical outcomes. Up until now, there is no study that evaluate the spinopelvic parameter with the clinical outcomes in Indonesia. Methods. This study is a cross-sectional analytic with 19 subject of adult patient that had undergo thoracal and lumbar fusion and stabilization in Rumah Sakit Dr. Ciptomangunkusumo (RSCM) Jakarta in 2012-2014. The subject was underwent x-ray evaluation of SVA, PI, PT, and SS. The patient also underwent evaluation of Indeks Disabilitas Oswestry (IDO) score in 1 year after operation. Then the statistical work was done with numeric comparative pearson test analysis to determine whether there is correlation between SVA, PI, PT, and SS with IDO score. Result and Discussion. There is strong correlation between IDO and SVA (p<0,001) (r=0,866). Strong correlation between IDO and PI (p=0,006) (r=0,603). No correlation between IDO and PT (p=0,107) (r=0,382). No correlation between IDO and SS (p=0,051) (r=0,454). Conclusion. Strong correlation is indicated in IDO and SVA, also in IDO and PI. There is no correlation between IDO and PT, also in IDO and SS. SVA and PI are the important spinopelvic parameter that have influence on clinical outcome in post thoracal and lumbar fusion and stabilization patient.

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ABSTRAK
Pendahuluan: Biopsi jarum inti dianggap memiliki hasil akurasi yang sama dengan biopsi terbuka dan telah menjadi prosedur rutin untuk menegakkan diagnosis lesi muskuloskeletal. Namun demikian uji diagnostik biopsi jarum inti di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN CM) belum dilaporkan. Tujuan dari analisis retrospektif ini adalah untuk mendapatkan nilai ketepatan diagnosis biopsi jarum inti pada lesi muskuloskeletal. Metode: Dari Januari 2011 hingga Agustus 2015, semua pasien dengan lesi muskuloskeletal di RSUPN CM yang menjalani biopsi jarum inti dan eksisi tumor diidentifikasi dan diambil datanya. Ketepatan diagnosis dianalisis baik untuk kesimpulan histopatologi maupun kesimpulan clinical pathology conference (CPC). Hasil: Sebanyak 86 sampel dikumpulkan dalam penelitian ini. Ketepatan diagnosis biopsi jarum inti dibandingkan dengan spesimen pasca eksisi adalah 74,4%. Setelah dilakukan CPC, nilai ketepatan menjadi 83,7% dengan sensitivitas 98%, spesifisitas 59%, NDP 87%, NDN 93% (p = 0.00). Ketepatan biopsi jarum inti setelah pulasan imunohistokimia naik menjadi 84,9% (p = 0,438). Ketepatan untuk membedakan lesi jinak dan ganas adalah 97,1% (jinak) dan 82,7% (ganas) (p = 0.00). Ketepatan untuk membedakan lesi primer dan metastasis adalah 97,2% (primer) dan 85,7% (metastasis) (p = 0.00). Diskusi: Kami mendapatkan nilai ketepatan biopsi jarum inti yang sedikit lebih rendah karena dalam penelitian ini dituntut untuk membuat diagnosis sampai tingkat morfologi (ICD O dan ICD X). Namun demikian, dengan modalitas lain seperti imunohistokimia dan kesimpulan CPC, ketepatan menjadi meningkat. Ketepatan diagnosis untuk membedakan lesi jinak-ganas dan primer-metastasis tinggi. Biopsi jarum inti direkomendasikan untuk penegakkan diagnosis lesi muskuloskeletal.ABSTRACT
Introduction: Core needle biopsy is considered to have similar results with open biopsy in accuracy and already become a routine procedure to establish the diagnosis of musculoskeletal lesion. However, diagnostic test of core needle biopsy application in Cipto Mangunkusumo Hospital has not been reported. Therefore, the aim of this retrospective analysis was to attain the accuracy of musculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy and subsequent tumour excision were indentified and enrolled. Diagnostic accuracy were calculated for both histopathology and clinical pathology conference (CPC) conclusion. Results: A total of 86 samples were indentified and enrolled in this study. The accuracy of core needle biopsy compared to subsequent excision is 74.4%. With CPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%, PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is 84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguish primary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p= 0.00). Discussion: We found slightly inferior results for core needle biopsy accuracy compared to literature due to high specificity diagnosis obligatory (ICD O and ICD X morphology) in our study. However, with other modalities such as immunohistochemistry and CPC, the accuracy is increased. The accuracy to distinguish between benign vs malignant and primary vs metastatic lesion is high. Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions. ;Introduction: Core needle biopsy is considered to have similar results with open biopsy in accuracy and already become a routine procedure to establish the diagnosis of musculoskeletal lesion. However, diagnostic test of core needle biopsy application in Cipto Mangunkusumo Hospital has not been reported. Therefore, the aim of this retrospective analysis was to attain the accuracy of musculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy and subsequent tumour excision were indentified and enrolled. Diagnostic accuracy were calculated for both histopathology and clinical pathology conference (CPC) conclusion. Results: A total of 86 samples were indentified and enrolled in this study. The accuracy of core needle biopsy compared to subsequent excision is 74.4%. With CPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%, PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is 84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguish primary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p= 0.00). Discussion: We found slightly inferior results for core needle biopsy accuracy compared to literature due to high specificity diagnosis obligatory (ICD O and ICD X morphology) in our study. However, with other modalities such as immunohistochemistry and CPC, the accuracy is increased. The accuracy to distinguish between benign vs malignant and primary vs metastatic lesion is high. Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions. ;Introduction: Core needle biopsy is considered to have similar results with open biopsy in accuracy and already become a routine procedure to establish the diagnosis of musculoskeletal lesion. However, diagnostic test of core needle biopsy application in Cipto Mangunkusumo Hospital has not been reported. Therefore, the aim of this retrospective analysis was to attain the accuracy of musculoskeletal lesion diagnosis using core needle biopsy. Methods: From January 2011 to August 2015, all patients with musculoskeletal lesion in Cipto Mangunkusumo Hospital underwent core needle biopsy and subsequent tumour excision were indentified and enrolled. Diagnostic accuracy were calculated for both histopathology and clinical pathology conference (CPC) conclusion. Results: A total of 86 samples were indentified and enrolled in this study. The accuracy of core needle biopsy compared to subsequent excision is 74.4%. With CPC conclusion, the accuracy is 83.7% with sensitivity 98%, specificity 59%, PPV 87%, NPV 93% (p=0.00). The accuracy with immunohistochemistry is 84.9% (p=0.438). The accuracy to distinguish benign and malignant lesion is 97.1% (benign) and 82.7% (malignant) (p= 0.00). The accuracy to distinguish primary and metastatic lesion is 97,2% (primary) and 85,7% (metastatic) (p= 0.00). Discussion: We found slightly inferior results for core needle biopsy accuracy compared to literature due to high specificity diagnosis obligatory (ICD O and ICD X morphology) in our study. However, with other modalities such as immunohistochemistry and CPC, the accuracy is increased. The accuracy to distinguish between benign vs malignant and primary vs metastatic lesion is high. Core needle biopsy is recommended to establish diagnosis for selected musculoskeletal lesions.