A histomorphometric and molecular study on stress adaptability of freeze-dried bone allograft

Objective To Investigate stress adaptability of freeze-dried bone allograft.Methods Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals.The left transplanted allograft was free from fixation and bore a normal physiological lcad,while the right transplanted allograft was protected from loading by a simple external fixator and bore less load.Animals were sacrificed at the 2nd,4th,8th,16th week after transplantation and specimens were taken out for bone histomorphometry studies and analysis of collagen gene expression by in situ Cdna-Mrna hybridization.Results Labeled surface(LS)and bone mineral apposition rate(MAR)of the normally loaded graft-host bone interface were significantly higher than that of the less loaded side at the 4th,8th,16th week after transplantation.Parameters reflecting the internal repair process of the allograft,such as LS in cortical and cancellous bone or MAR in cortical bone of the normally loaded side were significantly higher than those of the less loaded side at the 16th week after transplantation.The result of in situ hybridization indicated that more osteoblast-like cells expressing the type Ⅰ collagen gene were found in the interface or interior of normally loaded grafts.Conclusion The stimulus of physiologic load can accelerate the early union of allograft-host bone interface and later new bone creep substitution to the necrotic allograft.

Anterior cruciate ligament reconstruction using the bone-posterior cruciate ligament-bone allograft

Background Allografts were widely used in anterior cruciate ligament （ACL） reconstruction for patients with ACL rupture of the knee. This study was to approve the feasibility of bone-posterior cruciate ligament-bone （BPCLB） allograft transplantation in ACL reconstruction. Methods Eight patients underwent ACL reconstructions with BPCLFI allografts and were followed up for an average period of 32 months after operation. Results Subjective parameters including Intemational Knee Documentation Committee （IKDC）, modified Larson knee ligament, Lysholm, and Tegner rating scales were much improved and side to side KT-2000 arthrometer difference was much less postoperatively. Pivot shift test was negative in all patients. The reconstructed ACL had satisfactory shape and tension. Conclusions BPCLB allograft is an optional choice for ACL reconstruction.

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

AN EXPERIMENTAL STUDY ON TRANSPLANTATION OF FROZEN CANINE PHALANGEAL JOINT ALLOGRAFTS INCORPORATED WITH AUTOGENIC BONE MARROW

目的 探讨经过多重钻孔并复合自体骨髓的冷冻异体犬足趾关节移植的疗效。方法 24只健康成年杂交犬，制备双侧后肢第2足趾近侧趾间关节1．5cm缺损模型，共48侧，随机分成A、B、C3组（n=16）。分别采用新鲜自体趾间关节（A组）、经钻孔并复合自体新鲜骨髓的冷冻异体趾间关节（B组）及单纯冷冻异体趾间关节（C组）修复缺损。于术后1、3、6和12个月分别行X线摄片和组织病理学检查，了解移植骨关节的成活情况。结果 根据移植关节术后X线片和组织学改变，犬趾骨关节移植后的病变可分为轻度、中度和重度变性3级。A组移植骨关节3～12个月始终表现为轻度变性；B组移植骨关节1～6个月为轻度变性，骨孔中央软骨内成骨现象明显，12个月部分移植骨关节为中度变性；C组从1个月出现移植骨关节中度变性，3个月移植骨关节重度变性。结论 冷冻异体犬足趾关节内多重钻孔并复合自体新鲜骨髓．能有效延缓异体骨关节的早、中期变性，单纯冷冻异体骨关节移植后早期可能发生严重变性。

Scapular bone grafting with allograft pin fixation for repair of bony Bankart lesions: A biomechanical study

BACKGROUND Severe bony Bankart lesions are a difficult challenge in clinical treatment and research.The current treatment methods consist mostly of Latarjet-Bristow surgery and its modified procedures.While good results have been achieved,there are also complications such as coracoid fracture,bone graft displacement,and vascular and nerve injury.AIM To analyze the techniques and biomechanical properties of transversely fixing a bone block from the scapular spine using bone allograft pins with suture threads to repair bony Bankart lesions.METHODS Fresh human shoulder joint specimens and a cadaver specimen model for scapular bone grafting with allograft pin fixation for repair of bony Bankart lesions were used.When the humeral rotation angles were 0°,30°,60°and 90°,and the axial loads were 30 N,40 N,and 50 N,the humerus displacement was studied by biomechanical experiments.RESULTS When the angle of external rotation of the humerus was 0°,30°,60°,and 90°,with axial loads of 30 N,40 N,and 50 N,the data of the normal control group,allograft pin repair group,and titanium alloy hollow screw repair group were compared with each other by the q-test,which showed that there were no statistically differences among the three groups(P>0.05).CONCLUSION The joints repaired with bone block from the scapular spine transversely fixed with allograft bony pins to repair bony Bankart lesions show good mechanical stability.The bone block has similar properties to normal glenohumeral joints in terms of biomechanical stability.

Effect of impaction on gene-modified cells seeded on granular bone allografts in vitro and in vivo

Background While attempting to restore bone stock, impaction bone grafting employed during revision joint surgery may result in slow and limited allograft incorporation into host bone. A new approach including gene-modified bone marrow stromal cells （BMSCs） in combination with impaction bone grafting may effectively restore bone stock and improve allograft incorporation. This study aimed to investigate the effect of impaction on gene-modified BMSCs seeded on granular bone allografts in vitro and in vivo.Methods Deep-frozen, granular, cancellous bone allografts from canines were prepared to serve as cell delivery scaffolds and were seeded with green fluorescent protein （GFP） genetically-modified BMSCs to construct cell-allograft composites. The composites were impacted in a simulative, in vitro impaction model and cultured for further analysis under standard conditions. Four Beagle dogs, treated with bilateral, uncemented proximal tibial joint hemiarthroplasty with a prosthesis, were implanted with autologous GFP gene-modified cell-allograft composites to repair the bone cavity around each prosthesis.Results A significant reduction in cell viability was observed after impaction by fluorescence microscopy in vitro.However, there remained a proportion of GFP-positive cells that were viable and functionally active, as evidenced by the secretion of GFP protein in vitro and in vivo.Conclusions Gene-modified BMSCs seeded on granular allografts were able to withstand the impaction forces and to maintain their normal functions in vitro and in vivo, in spite of a partial loss in cell viability.

Initial Experience with Tricortical Iliac Crest Bone Graft and Human Amniotic Allograft in Evans Calcaneal Osteotomy

Background: Adult acquired flatfoot deformity is generally mediated with an Evans procedure where a wedge of bone is placed into the calcaneus to better align the foot and decrease the deformity. The purpose of this study was to assess the efficacy and safety of human amniotic allograft applied to allogeneic tri-cortical grafts in Evans calcaneal osteotomy. Methods: The medical records of patients who had Evans calcaneal osteotomy with implantation of tri-cortical iliac crest bone graft with human anmiotic allograft for surgical management of adult acquired flatfoot deformity with 2 years follow-up data were reviewed. Results: A total of 63 patients (mean age: 33.3 yr, range: 18 - 66 yr) were enrolled with adult acquired flatfoot deformity. Median time to weight-bearing was 6 weeks. Time to wearing normal shoes was 10 weeks, and time to radiographic healing was 16 weeks. Conclusions: The use of human amniotic allograft did not diminish the long term outcome of procedure or the short term benchmarks for healing after surgery. There were no nonunion, wound dehiscence, infection, or allergic or immune reaction reported. This retrospective study demonstrated that tri-cortical iliac crest bone graft and HAA could be safely used in Evans calcaneal osteotomy with favorable results.

Revision of Outcomes and Complications Following Open Reduction, and Zigzag Osteotomy Combined with Fibular Allograft for Developmental Dysplasia of the Hip in Children

Background: Reports of the efficacy of open reduction and Zigzag Osteotomy combined Fibular Allograft (ZOFA) for developmental dysplasia of the hip. The purposes of this study were to evaluate the long-term outcomes and complications after surgery. Methods: We performed a retrospective match-controlled study in which 158 patients had 181 hips with developmental dysplasia of the hip. Radiographs were found of acetabular index, height of dislocation, Tönnis grade, abduction angle in the spica cast, and Severin grade. At final follow-up, deformity of femoral head or neck or acetabulum was evaluated according to the Severin. Avascular necrosis was rated according to Kalamchi. Clinical evaluation was made according to modified McKay criteria. Results: Between 2009 and 2012, 133 girls (84.2%) and 25 boys (15.8%) with developmental dysplasia of the hip underwent open reduction and ZOFA;135 (85.4%) were unilateral, and 23 (14.6%) were bilateral. Patients were divided into 2 groups: group 1 included 54 patients (62 hips) aged 12 months - ≤18 months and group 2 included 84 patients (119 hips), aged >18 months - ≤36 months. According to Tönnis system: type 3 appeared in 127 hips (70.2%), and Type 4 in 54 hip (29.8%). The anterior approach was used to expose inner table of the ilium and ZOFA in all cases. Acetabular index was improved;preoperation was 42.95°, and latest follow-up 17.26°. The Kirschner Wires (KW) were not used to fix the fibular allograft at the pelvic osteotomy site. All of the fibular allografts were completely incorporated in mean time of 14 weeks (range, 12 weeks - 17 weeks) post-surgery. Clinical evaluation according to modified McKay criteria: satisfactory result (excellent and good) was achieved in 141 hips (77.9%). Avascular Necrosis (AVN) happened in 61 hips (33.7%), redislocation in 18 hips (9.9%), coxa vara in 4 hips (2.2%), trendelenburg gait in 4 hips (2.2%), and supracondylar femoral fractures in 2 hips (1.1%). Conclusions: On the basis of this study, ZOFA was strength and graft was not resorption, graft problems;without medial displacement of the distal fragment. Acetabular index was improved, without KW problem. Surgical technique with ZOFA did not expose outer table of the illium, limiting abductor muscle injury with negative trendelenburg gait;on the other hand, the blood loss from this procedure is acceptable. Some complications have been seen in this study: AVN, redislocation, coxa magna, coxa vara, trendelenburg gait, and distal femoral fracture.

Use of demineralized bone matrix in the extremities

Autologous bone graft is considered as the gold standard for all indications for bone grafting procedures but the limited availability and complications in donor site resulted in seeking other options like allografts andbone graft substitutes. Demineralized bone matrix(DBM) is an allograft product with no quantity limitation. It is an osteoconductive material with osteoinductive capabilities, which vary among different products, depending on donor characteristics and differences in processing of the bone. The purpose of the present review is to provide a critical review of the existing literature concerning the use of DBM products in various procedures in the extremities. Clinical studies describing the use of DBM alone or in combination with other grafting material are available for only a few commercial products. The Level of Evidence of these studies and the resulting Grades of Recommendation are very low. In conclusion, further clinical studies of higher quality are required in order to improve the Recommendation Grades for or against the use of DBM products in bone grafting procedures.

Bone graft substitutes for spine fusion: A brief review

Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.

Human Amniotic Allograft in Use on Talar Dome Lesions: A Prospective Report of 37 Patients

One of the most challenging joint conditions facing ankle surgeons today is the treatment of Osteochondritis Dissecans (OCD) of the talar dome. The use of human amniotic allograft (HAA) in various surgical procedures, has been proven to facilitate bone growth and both soft tissue and cartilage healing. The authors of this paper propose the addition of HAA to the surgical repair of talar dome lesions to improve postoperative results, specifically pain reduction. For the study, 37 patients were identified having an OCD lesion of the talus measuring no larger than 2 cm2. All patients were treated surgically with an arthroscopic micro-fracture repair along with the addition of HHA. Modified ACFAS ankle scores were taken pre-operatively and at 3 months, 12 months, and at 24 months postoperatively. Visual analog scores were also taken preoperative and 24 months postoperatively. The size of the talar lesions documented with pre-operative MRI’s was compared with intra-operative measurements for each patient. Additional surgical repairs, comorbidities and any complications were also recorded and evaluated. All patients were treated with micro-fracture with HAA. Postoperative ACFAS scores for 3 months, 12 months and 24 months were significantly improved (p < 0.0001) compared with average preoperative scores. Additionally, VAS scores were also significantly improved when comparing the average pre-operative (4.9) and post-operative (1.1) pain scores (p < 0.0001). The size of the lesions documented by pre-operative MRI correlated to intra-operative measurements. There were no identified complications. The addition of HAA to arthroscopic micro-fracture repair of talar dome lesions measuring less than 2 cm2?has shown to significantly improve both post-operative VAS scores, when compared to preoperative scores. This improvement in ACFAS and VAS scores speaks to the potential use of HAA in the treatment of OCD.

Strength and selection of corticocancellous allografts for anterior interbody spinal fusion

Objective: To quantify the strength of the grafts from different body sites and determine the optimalselection of corticocancellous allografts for anterior interbody fusion. Methods: Complete sets of paired freshfrozen femurs, humeri, tibias and iliac crests were obtained from 6 individual donors. One centimeter thick slicesstarting from the proximal and distal bone ends were cut from the non--diaphysial portions of the long bones usinga razor saw with a customized miter box. 2. 5 cm× 3. 0 cm × 1. 0 cm unicortical bone blocks were shaped similarlyfor clinical use as a lumbar interbody graft. Multiple 1 cm thick grafts with 1. 5 cm depth were obtained from theiliac crests, to simulate a cervical interbody graft. The left and right sides of each pair were randomized intoperpendicular and parallel cut groups in the long bones or tricortical and bicortical preparations of the iliac graft.The samples were tested on an MTS by applying a compressive load to failure. Results: The failure loads of distaltibia and femoral head grafts were significantly higher than distal femur, proximal tibia and burneral head grafts(PR0. 05). The strength of the grafts prepared by parallel cutting decreased significantly as compared with theperpendicular cutting (P <0. 05). No significant changes were seen in femoral and burneral head grafts for the 2sectioning orientations. The grafts closer to the anterior superior iliac spine had significant higher failure loads andfailure strengths than those closer to the posterior superior iliac spine. After trimming off the lateral cortex, themean strength of the bicortical grafts decreased significantly as compared with the tricortical grafts (P <0. 05).Conclusion: The grafts from femoral head and distal tibia by perpendicular cutting have higher failure load than theload bearing in lumbar spine. The grafts cut close to the anterior superior iliac spine are recommended for cervicalinterbody fusion.

Knee Osteoarthritis Treated with Percutaneous Chondral-Bone Interface Optimization: A Pilot Trial

Objective: The objective is to evaluate the efficacy of using tibial bone marrow delivered to the chondral-bone interface (CBI) via percutaneous chondral bone interface optimization (PeCaBoo) as a therapy for knee osteoarthritis (OA). Study Design: A series of prospective cases were presented. Participants: Our study included 10 patients with medial or lateral compartment knee OA. Methods: With 1 cc of heparin pre-loaded in the syringe, 5 cc of tibial bone marrow was withdrawn from the proximal tibia. The resultant 6 cc of aspirate in the syringe was injected via PeCaBoo, 2 cc at a time, into the superior CBI and inferior CBI. The remaining 2 cc was injected via needle into the intra-articular joint space. Main Outcome Measurements: Patients had MRIs taken pre-procedure and 3 months post-procedure to measure bone edema and intra-articular matrix thickness. Patient-reported outcomes recorded included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Numeric Paint Rating Scale (NRS), which were both obtained pre-procedure and post-procedure at 3, 6, and 12 months. Use of non-steroidal anti-inflammatories (NSAIDs) was recorded pre- and post-procedure as well. Results: Our study included 4 males and 6 females, with an average age of 63.5 years. The average follow-up time was 14 months, with a range of 13 - 15 months. The mean WOMAC score was 58.2 points pre-procedure and 35.3 points post-procedure (p < 0.01). The mean NRS-Pain score was 8.6 points pre-procedure and 2.8 points post-procedure (p < 0.01). The matrix thickness increased by 14% on average at 3 months post-procedure (p < 0.01). The proportion of patients taking NSAIDs decreased by 60% after the PeCaBoo procedure. The subgroup of patients with tibial edema and knee OA had optimal outcomes. Conclusions: Tibial bone marrow stem cell delivered via PeCaBoo is a novel minimally-invasive treatment for knee OA, with potential to repair cartilage and improve knee pain and function.

The Use of Human Amniotic Allograft on Osteochondritis Dissecans of the Talar Dome: A Comparison with and without Allografts in Arthroscopically Treated Ankles

Arthroscopy of the ankle with micro-fracture technique is one way to initially treat symptomatic talar dome lesions. Human amniotic allograft has been used in similar bone, soft tissue and cartilage defects to aid in healing of tissue using graft cells that have not differentiated into a particular cell line. Patients were taken from the primary surgeon’s practice to include those who had undergone arthroscopy with micro-fracture technique for treatment of a talar dome lesion less than 2 cm2. 101 patient surgeries were completed arthroscopically without additional major procedures. 54 surgeries were completed with human amniotic allograft;47 were completed without (control group). Modified ACFAS ankle scores were taken pre-operatively, 3, 12 and 24 months post-operatively. Visual analog pain scores were taken pre-operatively and 24 months post-operatively. Results comparing pre-operative modified ACFAS scores between the control and graft groups were not significantly different (p = 0.14). There was a significant improvement in both groups’ scores following ankle arthroscopy with micro-fracture as expected. However, the amniotic tissue group did significantly better when comparing the post-operative scores between the control and graft group. Pain scores comparing control and amniotic patient groups were significant (p < 0.001) with amniotic allograft patients achieving a greater improvement in pain reduction than the control both early and at 24 months. There were no complications, wound dehiscence or infections recorded. Combining ankle arthroscopy/micro-fracture technique with human amniotic allograft on talar dome lesions, less than 2 cm2, significantly improves the patients’ pain and ACFAS scores.

自体髂骨和同种异体骨植入治疗SchatzkerⅡ型胫骨平台骨折的疗效比较

目的 比较SchatzkerⅡ型胫骨平台骨折应用自体髂骨和同种异体骨植入治疗的临床疗效。方法 74例SchatzkerⅡ型胫骨平台骨折患者,按手术植骨治疗方法不同分为自体髂骨组和异体骨组,各37例。两组均采用胫骨近端外侧锁定钢板内固定,自体髂骨组胫骨平台塌陷处植入自体髂骨,异体骨组胫骨平台塌陷处植入异体骨。比较两组手术相关指标,术后3、6个月的美国特种外科医院(HSS)评分及膝关节屈曲活动度,并发症发生情况。结果 自体髂骨组术中出血量(62.70±3.34)ml多于异体骨组的(44.50±3.03)ml,手术时间(86.50±5.87)min、骨折愈合时间(18.40±3.20)周长于异体骨组的(77.30±2.98)min、(14.80±2.29)周,差异有统计学意义(P<0.05)。两组术后3、6个月的HSS评分比较,差异无统计学意义(P>0.05)。两组术后3、6个月的膝关节屈曲活动度比较,差异无统计学意义(P>0.05)。异体骨组并发症发生率为5.4%(2/37),与自体髂骨组的8.1(3/37)比较,差异无统计学意义(P>0.05)。结论 同种异体骨较自体髂骨在骨折愈合时间、手术时间、出血量方面相对具有优势,但在术后膝关节功能、膝关节活动度方面效果相当,说明同种异体骨与自体髂骨植骨治疗schatkzerⅡ型胫骨平台骨折各有优势,可根据患者具体情况进行手术的选择。

血小板源性生长因子联合同种异体骨移植治疗脊柱结核疗效观察

目的探讨血小板源性生长因子(PDGF)联合同种异体骨移植治疗脊柱结核的疗效及安全性。方法选择2018年8月至2023年8月青海省第四人民医院收治的177例腰椎结核患者为研究对象。根据移植骨来源将患者分为对照组(n=49)和观察组(n=128)。患者术前均进行至少2周的正规四联抗结核化学治疗。对照组患者给予PDGF联合自体骨移植,观察组患者给予PDGF联合同种异体骨移植。记录2组患者的手术时间、术中出血量、住院时间;比较2组患者术前及术后1、3、6个月的全血红细胞沉降率(ESR)、血清C-反应蛋白(CRP)水平;术前进行CT及核磁共振成像(MRI)检查,术后待骨融合完成后复查CT及MRI,比较术前与术后Cobb角变化;术前及术后1、3、6个月,采用视觉模拟评分法(VAS)评估腰椎区域的疼痛程度,比较2组患者术前、术后VAS评分,并比较2组男性患者术前、术后VAS评分以及2组女性患者术前、术后VAS评分。结果观察组与对照组患者手术时间、住院时间比较差异无统计学意义(P>0.05)。观察组患者术中出血量显著少于对照组(P<0.05)。观察组与对照组患者术前、术后Cobb角比较差异均无统计学意义(P>0.05)。2组患者术后Cobb角与术前比较均显著降低(P<0.05)。2组患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组男性患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组女性患者术前及术后1、3、6个月的VAS评分均依次降低,组内两两比较差异均有统计学意义(P<0.05)。术前及术后1、6个月时,观察组与对照组患者VAS评分比较差异无统计学意义(P>0.05);术后3个月,观察组患者VAS评分显著低于对照组(P<0.05)。观察组男性患者术前及术后1、6个月的VAS评分与对照组男性患者比较差异无统计学意义(P>0.05);观察组男性患者术后3个月的VAS评分显著低于对照组男性患者(P<0.05)。观察组女性患者术前及术后1、6个月的VAS评分与对照组女性患者比较差异无统计学意义(P>0.05);观察组女性患者术后3个月的VAS评分显著低于对照组女性患者(P<0.05)。2组患者术前及术后1、3、6个月的ESR均依次降低,组内两两比较差异均有统计学意义(P<0.05)。2组患者术前及术后1、3、6个月的血清CRP水平均依次降低,组内两两比较差异均有统计学意义(P<0.05)。术前及术后1、3、6个月,观察组与对照组患者ESR比较差异均无统计学意义(P>0.05)。术前及术后1、6个月,观察组与对照组患者血清CRP水平比较差异无统计学意义(P>0.05);观察组患者术后3个月的血清CRP水平显著高于对照组(P<0.05)。结论PDGF联合同种异体骨移植治疗脊柱结核的效果与自体骨移植相当,但PDGF联合同种异体骨移植可显著减轻患者术后疼痛程度,提高患者的舒适度,避免自体骨移植带来的额外损伤,减轻患者的身体负担,可作为腰椎结核手术植骨一种安全、可靠的手术方式。

大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎的疗效评价

目的通过对大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌关节炎的随访和研究,用以评价该术式的治疗效果。方法2017年1月-2022年6月,本科采用大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎(EatonⅢ期及Ⅳ期)患者25例,术前根据影像学Eaton分期:Ⅲ期4例,Ⅳ期21例。术后评价治疗效果,客观评价包括患肢捏力、握力、拇指外展角度(掌侧、桡侧)、拇指对掌功能评分(Kapandj评分)和第1掌沉降率;主观评价包括视觉模拟评分(VAS)及上肢功能障碍评分(DASH)。结果术后25例平均随访16个月,末次随访时,所有患者疼痛明显减轻,力量明显提高,关节活动范围及功能明显改善,第1掌骨的高度得到了较好的维持,第1腕掌关节的功能恢复良好,并且能回到之前的工作岗位,按照Robbins腕关节评分标准综合评定:优12例,良11例,可2例,优良率达92.0%。结论大多角骨切除联合韧带重建异体肌腱填塞治疗第1腕掌骨关节炎可明显缓解疼痛,改善第1腕掌关节功能,并能在术后维持第1掌骨的高度,疗效确实值得推广应用。

综合骨库在现代矫形外科中的作用

[目的]介绍并分享综合骨库建立20年来的成功经验;探讨骨库在现代矫形外科中的地位和作用。[方法]提供并总结分析综合骨库自1988～2007年间有关同种异体骨,系列异种骨生产、使用的数据。[结果]同种骨:得到死亡供体69具,存活供体88例;收获半关节540件,骨板237件,松质骨粒2632份;以上同种骨共使用于1390例病人;系列异种骨:重组合异种骨2495份,抗感染重组合异种骨208份,注射型BMP542份,系列异种骨共使用于2771例病人;20年来,共培训骨库技术人员18名,培养博士48名,硕士36名。[结论]临床植骨材料需求量大,在细胞型组织工程尚无满意的产品问世前,综合骨库所提供的异种骨和同种骨根据不同的植骨需要,取长补短,相互补充,使之成为最理想的选择。综合骨库这种集加工生产,科研开发及教学培训于一体的运行模式必将在中国的组织库事业中发挥愈加重要的作用。

改良前方入路结核病灶清除、同种异体骨移植、内固定治疗颈胸段脊柱结核

目的:探讨通过改良前方入路进行颈胸段脊柱结核病灶清除、同种异体骨移植、内固定治疗的疗效。方法:对6例C7～T3椎体结核患者采用标准颈椎前方入路联合胸骨柄正中劈开暴露病灶,彻底清除结核肉芽组织、脓液、死骨等进行脊髓减压,次全切除相应椎体,植入同种异体髂骨块重建前柱、前方钉板内固定,术后佩戴头颈胸支具6个月,正规抗痨12个月。结果:随访18～39个月,平均28个月,6例患者均获骨性愈合,结核病变无复发,后凸角无明显丢失。结论:颈胸段改良前方入路暴露C7～T3病灶充分、安全,病灶清除后植入异体髂骨块修复骨缺损、牢固内固定,重建颈胸段的稳定性、矫正后凸畸形可靠。

吻合血管腓骨与异体骨复合移植修复四肢长段骨缺损

目的探讨同期吻合血管的自体腓骨与长段异体骨捆绑或开槽嵌套式复合移植修复四肢长段骨缺损的临床效果. 方法 2001年1月～2003年12月,对19例四肢长段骨缺损患者进行修复.其中男11例,女8例.年龄6～35岁.骨缺损为肱骨1例,股骨9例,胫骨9例.骨缺损长度12～25 cm,平均16.6 cm.采用自体腓骨15～28 cm,平均18.3 cm,其中腓骨干16例,腓骨近段3例,均携带监测皮岛;异体骨11～24 cm,平均16.1 cm.捆绑式复合骨移植3例, 嵌套式16例;单用螺钉固定12例,桥式钢板螺钉内固定7例. 结果所有患者经5～36个月,平均18.2个月随访,供、受区创口均Ⅰ期愈合,监测皮岛成活并与周围组织正常愈合,无明显排斥反应,无供区肢体功能障碍.X线片示术后3个月异体骨与自体骨骨愈合15例,术后8个月愈合3例,另1例左股骨下段滑膜肉瘤术后2个半月局部复发而行截肢.术后超过1年拆除内固定者5例,术中均证实异体骨与自体骨间已骨性愈合,无一例出现异体骨吸收或塌陷. 结论吻合血管的自体腓骨与长段异体骨复合移植修复四肢长段骨缺损,能加速异体骨活化,促进骨愈合,是修复四肢长段骨缺损一种较好的方法,但应严格掌握适应证.