Regardless of the advancement of synthetic bone substitutes,allograft-derived bone substitutes still dominate in the orthopaedic circle in the treatments of bone diseases.Nevertheless,the stringent devitalization proc...Regardless of the advancement of synthetic bone substitutes,allograft-derived bone substitutes still dominate in the orthopaedic circle in the treatments of bone diseases.Nevertheless,the stringent devitalization process jeopardizes their osseointegration with host bone and therefore prone to long-term failure.Hence,improving osseointegration and transplantation efficiency remains important.The alteration of bone tissue microenvironment(TME)to facilitate osseointegration has been generally recognized.However,the concept of exerting metal ionic cue in bone TME without compromising the mechanical properties of bone allograft is challenging.To address this concern,an interfacial tissue microenvironment with magnesium cationc cue was tailored onto the gamma-irradiated allograft bone using a customized magnesium-plasma surface treatment.The formation of the Mg cationic cue enriched interfacial tissue microenvironment on allograft bone was verified by the scanning ion-selective electrode technique.The cellular activities of human TERT-immortalized mesenchymal stem cells on the Mg-enriched grafts were notably upregulated.In the animal test,superior osseointegration between Mg-enriched graft and host bone was found,whereas poor integration was observed in the gamma-irradiated controls at 28 days post-operation.Furthermore,the bony in-growth appeared on magnesium-enriched allograft bone was significant higher.The mechanism possibly correlates to the up-regulation of integrin receptors in mesenchymal stem cells under modified bone TME that directly orchestrate the initial cell attachment and osteogenic differentiation of mesenchymal stem cells.Lastly,our findings demonstrate the significance of magnesium cation modified bone allograft that can potentially translate to various orthopaedic procedures requiring bone augmentation.展开更多
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 resul...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.展开更多
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 aceta...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.展开更多
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 s...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.展开更多
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 ...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.展开更多
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 reliev...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.展开更多
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 a...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.展开更多
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 freshfroze...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.展开更多
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 ost...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.展开更多
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,...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.展开更多
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 ...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.展开更多
基金supported by the National Natural Science Foundation of China(NSFC)(Nos.81902189,81772354,82002303,31570980)Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory(2018GZR0201001)+6 种基金National Key Research and Development Plan(2018YFC1105103)Research Grant Council General Research Funds(RGC GRF)(17214516)Shenzhen Science and Technology Innovation Funding(JCYJ20160429190821781 and JCYJ2016429185449249)Science Technology Project of Guangzhou City(201804010185)Science and Technology Innovation Project of Foshan City(1920001000025)Scientific Research Foundation of PEKING UNIVERSITY SHENZHEN HOSPITAL KYQD(2021064)National Young Thousand-Talent Scheme to Zhang Zhi-Yong.
文摘Regardless of the advancement of synthetic bone substitutes,allograft-derived bone substitutes still dominate in the orthopaedic circle in the treatments of bone diseases.Nevertheless,the stringent devitalization process jeopardizes their osseointegration with host bone and therefore prone to long-term failure.Hence,improving osseointegration and transplantation efficiency remains important.The alteration of bone tissue microenvironment(TME)to facilitate osseointegration has been generally recognized.However,the concept of exerting metal ionic cue in bone TME without compromising the mechanical properties of bone allograft is challenging.To address this concern,an interfacial tissue microenvironment with magnesium cationc cue was tailored onto the gamma-irradiated allograft bone using a customized magnesium-plasma surface treatment.The formation of the Mg cationic cue enriched interfacial tissue microenvironment on allograft bone was verified by the scanning ion-selective electrode technique.The cellular activities of human TERT-immortalized mesenchymal stem cells on the Mg-enriched grafts were notably upregulated.In the animal test,superior osseointegration between Mg-enriched graft and host bone was found,whereas poor integration was observed in the gamma-irradiated controls at 28 days post-operation.Furthermore,the bony in-growth appeared on magnesium-enriched allograft bone was significant higher.The mechanism possibly correlates to the up-regulation of integrin receptors in mesenchymal stem cells under modified bone TME that directly orchestrate the initial cell attachment and osteogenic differentiation of mesenchymal stem cells.Lastly,our findings demonstrate the significance of magnesium cation modified bone allograft that can potentially translate to various orthopaedic procedures requiring bone augmentation.
基金by PLA General Logistics Department,No.CWS14J067.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
