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Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft

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Chinese Journal of Traumatology 2003年第2期6卷 91-98页

作者：王志刚刘建胡蕴玉孟国林金格勒袁志王海强戴先文 Orthopaedic Department of Xijing Hospital

Objective: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. Methods: Twenty patients ( 13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients. Results: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. Conclusions: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

关键词： External fixators bone transplantation bone lengthening bone defects

Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

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Chinese Journal of Traumatology 2008年第5期11卷 301-305页

作者：刘先哲杨述华许伟华刘国辉杨操李进叶哲伟刘勇张宇坤 Department of Orthopedics Union Hospital TongjiMedical College Huazhong University of Science andTechnology Wuhan 430022 China

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures. Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised. Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.

关键词： Reconstructive surgical procedures Arthroplasty, replacement, hip bone transplantation

Massive allograft replacement in management of bone tumors

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The Chinese-German Journal of Clinical Oncology 2008年第3期7卷 159-163页

作者： Xiaohui Niu Lin Hao Qing Zhang Yi Ding Department of Orthopaedic Oncology Beijing Jishuitan Hospital Beijing 100035 China

Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts （n = 95）, hemi-condylar （n = 15）, massive （n = 23）, allograft-prosthesis composite （n = 12）, intercalary grafts （n = 15） or hemi-pelvic grafts （n = 4）. Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. Results： At a median follow-up of 47 months （range, 12 to 168 months） after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one （12.8%） patients had local recurrence and 38 （23.2%） nonunion. Late complications included 11 （6.7%） fractures of the allograft and 18 （11.0%） infections of the graft, instability of the joint in the form of subluxation was noted in 13 （7.9%） patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion： AIIografts can be used for reconstruction of bony defects after tumor resection. AIIograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. AIIograft implantation is a high complication reconstruction method, and the dsk of recurrence increases when less surgical margin achieves.

关键词： bone neoplasms bone transplantation allografts

Free iliac crest grafts with periosteum for treatment of old acetabular defects

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Chinese Journal of Traumatology 2006年第6期9卷 338-340页

作者：赵德伟孙强王本杰崔大平 Department of Orthopedics Affiliated Zhongshan Hospital of Dalian UniversityDalianLiaoning Province 116001China

Objective ： To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. Methods： From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave （ iliac fossa） side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws. Results ： Postoperative syndrome was not found in any of the cases. Harris＇ score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases. Conclusions, Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.

关键词： Acetabulum bone transplantation Periosteum

Monitoring island flap for fibular graft in 30 patients with long bone defects

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Chinese Journal of Traumatology 2003年第5期6卷 275-279页

作者：郭奇峰徐中和蔡维山朱家恺 Department of Orthopedics First People's HospitalGuangzhou Medical College Department of Microsurgery First Affiliated HospitalZhongshan University

Objective: To study the effect of vascularized fibular graft on large defects of long bones and the monitoring method for the vascular status of the grafted fibula. Methods: From March 1988 to February 1998, 30 patients with long bone defects over 6 cm in length received vascularized fibular graft including a monitoring island flap in our department to monitor the blood circulation of the fibulae. Results: Monitoring island abnormalities were indicated in 6 flaps, which accurately gave the alarm of the circulation crisis of the fibular graft. Surgical exploration was performed timely and the blood supply was recovered instantaneously. All the bone defects were healed at 6 months postoperatively. After 4 years of follow up, all the grafted fibulae were thickened and were just like tibiae. Conclusions: A monitoring island flap is a satisfactory method for repairing large defects of the long bones and a reliable method for assessing the vascular status of the grafted fibulae.

关键词： Surgical flaps Fibula bone transplantation Monitoring, physiologic

Anti-infective reconstituted bone xenograft used for primary bone grafting to repair contaminated defect in the radius in dogs

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Chinese Journal of Traumatology 2003年第2期6卷 86-90页

作者：袁志赵黎胡蕴玉刘建孙梁李丹廉凯吕荣 Institute of Orthopedics

Objective: To investigate the effect of anti-infective reconstituted bone xenograft as a primary graft to repair a segmental with severe contamination. Methods: A canine model of contaminated defect of 1.5 cm in size in the radius was used, in which anti-infective reconstituted bone xenograft or reconstituted bone xenograft was implanted as a primary graft followed by internal fixation. The effectiveness of the two grafting materials in repairing a contaminated segmental defect was compared. Results: The animals which had received implant of anti-infective reconstituted bone xenograft should largely healed defects 6 months after operation while the defects implanted with reconstituted bone xenograft remained unrepaired with bone infection. Conclusions: Besides its strong osteoinductive and osteoconductive activity, anti-infective reconstituted bone xenograft is highly antibacterial and can be used as a primary graft to repair the severely contaminated segmental defect.

关键词： bone transplantation Gentamicins bone morphogenetic proteins Wound infection

Nonunion of the scaphoid treated by anterior vascularized bone graft： a review of 26 cases

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Chinese Journal of Traumatology 2011年第4期14卷 205-208页

作者： Mohamed Faouzi Hamdi Karim Amara Lamjed Tarhouni Sayed Baccari Department of Trauma and Orthopaedic Surgery F.Bourguiba University Hospital Monastir 5000 Tunisia Department of Hand and Reconstructive Surgery Institute Kassab of Trauma and Orthopaedic SurgeyManouba 2010 Tunisia

[Abstract] Objective： To evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid. Methods： This is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot＇s classification and only one case showed a proximal pole necrosis （type IV）. The fixation was ensured by K-wire. The mean immobilization period was 9 weeks. Results： At mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18°. Nineteen patients （73%） were free of pain, and the others had occasional pain Conclusions： It is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.

关键词： Scaphoid bone Pseudarthrosis bone transplantation Radius

Simultaneous Upper and Lower Jaw Extractions, Autogenous bone Augmentation and Temporary Implant Placement with Immediate Loading

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Open Journal of Stomatology 2020年第12期10卷 383-395页

作者： Philippe Van Camp Geert Klomp Erik Nout Department of Oral and Maxillofacial Surgery Elisabeth-Tweesteden Hospital Tilburg The Netherlands

Aims: We expanded the known technique for simultaneously augmenting an atrophic maxilla and placement of immediate provisional implants (IPI), followed by immediate loading by performing surgery in both jaws simultaneously. Feasibility of this new technique, implant survival and success were evaluated as well as prosthetic success. Materials and Methods: All patients undergoing simultaneous bone grafting and IPI placement with immediate loading at our institute between the 1st of June 2016 and the 30th of May 2018 were included and followed up for at least one year postoperatively. Results: 3 patients were followed for a mean period of 25.67 months (20 - 29 months). 33 IPIs were placed. All were immobile at second stage surgery without signs of infection. No provisional bridges were lost and no infections were noted. After second stage surgery, none of these 36 final dental implants were lost. There was some bone loss at one implant. In all patients, good functional and aesthetic results were obtained without any unforeseen complications. This renders the implant survival at 100% and the success rate at 97%. Conclusion: The technique is complex due to the intricate step-by-step process that is required and depends on a dedicated team to ensure a proper workflow. When performed correctly, the protocol shows good and predictable results.

关键词： Dental Implant Surgery Immediate Dental Implant Loading Implant-Supported Dental Prosthesis bone transplantation

Experimental Study on the Enhancement of Rat Skull Defects Repair by Induced Osteogenesis

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Journal of Medical Colleges of PLA 1988年第1期 13-18页

作者：金大地区伯平 Department of Orthopaedic Surgery Nanfang Hospital First Medical College of PLA Guangzhou

The repairing capacities of bone matrix gelatin(BMG),decalcified bonematrix(DBM)and deep frozen bone(DFB)were tested in experimental defects onskulls of *** healing of defects were judged by roentgenographic,histological and atomic absorption spectrophotometric *** healing ofdefects was most effective with BMG(Pbone induction was very weak in *** the BMG and DBMgroups,skull defects were completely healed in 12 weeks after the operation,but inthe DFB group healing was *** control group failed to *** results suggest that during the process of resorption of BMGand DBM,bone morphogenetic protein(BMP)was released by diffusion,whichinduced mesenchymal cells originating from the dura mater to differentiate intochondrocytes and osteobIasts,resulting in formation of new *** inducedosteogenesis is considered to be a complex process regulated not only by BMP butalso by various systemic and local growth factors.

关键词： bone transplantation osteogenesis bone matrix gelatin bone morphogenetic protein