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Abstrak :
Latar Belakang: Giant Cell Tumor (GCT) adalah tumor yang sering mengenai individu berusia 20-45 tahun. Penatalaksanaan GCT radius distal adalah untuk menghilangkan massa tumor sepenuhnya dan mempertahankan pergelangan tangan. Beberapa metode rekonstruksi dapat dilakukan seperti arthrodesis total, Free Vascularized Fibular Graft (FVFG) atau Non-Vascularized Fibular Graft (NVFG), dengan prosedur rekonstruksi terutama melibatkan artroplasti atau arthrodesis pergelangan tangan parsial. Penelitian ini disusun untuk mengetahui perbandingan luaran fungsional pasien rekonstruksi GCT radius distal menggunakan teknik FVFG, NVFG, dan arthrodesis. Metode: Penelitian ini merupakan penelitian analitik dengan desain studi potong lintang yang menilai keluaran. post operasi dan tidak pada subjek tidak terdapat perlakuan khusus pada pasien. Pengambilan data akan dilakukan di RSUPN Cipto Mangunkusumo, Jakara, dan dilaksanakan pada bulan Juli 2020 – Juli 2021. Populasi target pada penelitian ini yaitu pasien yang telah didiagnosis dengan GCT tulang distal radius dan telah dilakukan operasi penyelamatan ekstrimitas beserta prosedur rekonstruksi berupa NVFG atau FVFG atau arthrodesis. Hasil : Terdapat 21 pasien GCT radius distal di RSCM pada penelitian ini yang termasuk kriteria inklusi dan di ikutkan dalam proses analisis data. Jumlah subjek laki-laki adalah 12 orang dan perempuan 9 orang (rasio 4:3). Golongan usia yang paling banyak adalah 21-30 tahun (33,3%). Tidak didapatkan hubungan yang bermakna di antara ketiga prosedur tersebut dengan luaran fungsional pasien (p = 0,49). Namun apabila dilihat dari rerata skor MSTS yang terbaik adalah metode FVFG dengan skor 24,4. Rerata FVFG lebih baik bila dibandingkan dengan arthrodesis 23,2 dan NVFG 23,18. Kesimpulan: Tidak terdapat perbedaan luaran fungsional dari tatalaksana operasi penyelamatan ekstremitas pada pasien dengan GCT tulang distal radius yang dilakukan prosedur NVFG, FVFG, dan arthrodesis. ......Background: Giant Cell Tumor (GCT) is a tumor that often affects individuals aged 20- 45 years. Management of the distal radius GCT is to completely remove the tumor mass and preserve the wrist. Several reconstruction methods can be performed such as total arthrodesis, Free Vascularized Fibular Graft (FVFG) or Non-Vascularized Fibular Graft (NVFG), with the reconstructive procedure primarily involving arthroplasty or partial wrist arthrodesis. This study was structured to compare the functional outcomes of patients with distal radius GCT reconstruction using FVFG, NVFG, and arthrodesis techniques. Method: This study is an analytic study with a cross-sectional design that assesses outcomes. postoperatively and not on the subject there is no special treatment for the patient. Data collection will be carried out at Cipto Mangunkusumo General Hospital, Jakarta, and will be held in July 2020 – July 2021. The target population in this study are patients who have been diagnosed with GCT of the distal radius and have undergone extremity rescue surgery along with reconstruction procedures in the form of NVFG or FVFG or arthrodesis. Result: There were 21 distal radius GCT patients at the RSCM in this study which included the inclusion criteria and were included in the data analysis process. The number of male subjects was 12 people and 9 female subjects (4:3). The most common age group is 21-30 years (33.3%). There was no significant relationship between the three procedures and the patient's functional outcome (p = 0.49). However, when viewed from the average MSTS score, the best is the FVFG method with a score of 24.4. The mean FVFG was better when compared to arthrodesis 23.2 and NVFG 23.18. Conclusion: There was no difference in the functional outcome of limb salvage surgical management in patients with GCT of the distal radius who underwent NVFG, FVFG, and arthrodesis procedures.

Abstrak :
Diabetes melitus (DM) menyebabkan gangguan saraf autonom, sensorik, dan motorik, terutama di kaki dan pergelangan kaki yang menyebabkan perubahan postur kaki dan deformitas. Artritis pergelangan kaki penyandang DM mengakibatkan gangguan fungsional sehingga artrodesis merupakan suatu opsi tata laksana pembedahan. Sayangnya, gangguan metabolik DM mengakibatkan komplikasi yang tak jarang yakni non-union. Terapi sel dan derivatnya merupakan opsi terapi regeneratif untuk meningkatkan kesembuhan tulang. Pembuatan model artritis hewan DM dengan injeksi streptozotosin (STZ), diet tinggi lemak (HFD), dan injeksi complete freud adjuvant (CFA) dilanjutkan studi eksperimental in vivo dengan fokus hasil augmentasi fusi dengan granul hidroksiapatit (HA), sel punca mesenkimal asal tali pusat (SPM-TP), dan sekretom jaringan adiposa (JA). Sebanyak 16 sampel kaki dibagi menjadi 3 kelompok: kontrol negatif (kelompok 1), kontrol positif yang diberikan autologous bone graft (kelompok 2), dan perlakuan yang diberikan HA, SPM-TP, dan sekretom-JA (kelompok 3). Dilakukan evaluasi parameter klinis, radiologis, profil histomorfometris, dan ekspresi biomarker di subjek model artritis DM tikus Sprague Dawley (SD). Status DM tercapai setelah induksi STZ dengan rerata kadar glukosa 421 ± 27,16 mg/dL. Kelompok artritis menunjukkan perubahan diameter ankle yang bermakna dibanding kontrol serta perubahan radiologis sendi pergelangan kaki. Artritis berat (skor 3) ditemukan di mayoritas (80%) sampel kelompok 1 yang merupakan kontrol negatif (hanya induksi DM). Kelompok perlakuan menunjukkan skor artritis terendah serta osifikasi di sisi anterior tibiotalar. Terdapat perbedaan bermakna osteokalsin (p = 0,017) dan gen chordin (p = 0,003) antara ketiga kelompok. Simpulan: Model artritis DM pada tikus SD berhasil dibuat dengan injeksi STZ dan HFD serta induksi artritis kronik dengan injeksi CFA di sendi pergelangan kaki selama 4 minggu. Pemberian SPM-TP, sekretom JA, dan granul HA menunjukkan skor artritis yang lebih rendah. Namun, pemberian ketiga bahan tersebut tidak menghasilkan gambaran fusi yang lebih baik, serta tidak meningkatkan kadar osteokalsin, namun menghasilkan jumlah chordin (protein inhibisi BMP) yang lebih kecil dibandingkan baku standar. ......Diabetes mellitus (DM) can cause disturbances in the autonomic, sensory, and motor nerves, particularly in the feet and ankles, eventually leading to changes in foot posture and specific deformities. The advancement of management using stem cells and their secretome has shown promising outcomes. A model of DM arthritis can be created by inducing experimental animals with streptozotocin (STZ). In the DM arthritis model, the evaluation of ankle arthrodesis augmented with umbilical cord mesenchymal stem cell (MSC-Uc) and adipose tissue secretome (Secretome-AD) can be carried out to observe the existing outcomes. This study is divided into two stages wherein the first stage involves creating an arthritis model in DM animals. The study utilizes a pretest-posttest design to measure clinical and laboratory parameters before and after treatment. Subsequently, the second stage involves an in vivo experimental study focusing on the outcomes of fusion augmentation with MSC-Uc, secretom-AD, and HA granule. The second stage of the study includes assessments using single-blinding methods for clinical, radiological, histomorphometric profile, and biomarker expression in the SD rat model of DM arthritis. DM status was achieved after STZ injection, with an average glucose level of 421 ± 27.16 mg/dL. The final diameter averages in groups 1 – 3, which were not induced with arthritis (9.64 ± 0.49 mm), significantly differed from group 4 (12.50 ± 0.87 mm, p = 0.003) and 5 (11.85 ± 0.74 mm, p = 0.037). The arthritis groups showed radiological changes in the ankle joint. After modeling, there was a significant increase in fasting blood glucose compared to pre-modeling measurements. Severe arthritis (score 3) was found in the majority (80%) of samples in group 1, which served as the negative control (DM induction only). Anova test results for the IHC parameter showed significant differences (p = 0.017) in osteocalcin and chordin gene (p = 0.003) among the three groups. Conclusion: A model of DM arthritis in SD rats was successfully created by STZ and HFD induction, followed by the induction of chronic arthritis with CFA injection in the ankle joint for 4 weeks. The administration of MSC-Uc, secretome-AD, and HA granule indicated lower arthritis scores. However, the administration of these three substances did not produce a better fusion picture, nor did it increase osteocalcin levels, but it resulted in a smaller amount of chordin (BMP inhibition protein) compared to the standard.