Usage of buttress plate internal fixation associated with autografting of fibula and iliac bone for the treatment of distal femoral C_3 type fracture

To assess the effect of using buttress plate associated with antografting of fibula and iliac bone for the treatment of distal femoral C3 type fracture.Methods Seventeen cases of distal femoral C3 type fracture using buttress plate associated with antografting of fibula and iliac bone were analyzed retrospectively.Results All cases were followed up for an average of 24 months（8～55 months）.The average time of octets bridge forming were 4 months（3～5 months） while the average time for bone union were 8 months （6～14 months）.According to Shelbourne rating system,result of all 18 cases were excellent and no malunion,infection were found.Conclusion Buttress plate associated with antografting of fibula and iliac bone is an effective alternative for the treatment of distal femoral C3 type fracture.It can provide more stable fixation to the bone and earlier functional exercises can be achieved.5 refs,3 figs,1 tab.

Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss

BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.

First Metatarsophalangeal Joint Arthrodesis: Comparison of Mesenchymal Stem Cell Allograft versus Autogenous Bone Graft Fusion Rates

With patients undergoing first time 1st metatarsophalangeal joint arthrodesis using graft material when it was required to fill cystic bone voids, we retrospectively compared the time to fusion (clinical and radiographic), and non-union rate between the patient’s own bone autograft (n = 62) versus a mesenchymal stem cell impregnated allograft group (n = 51). A third control group (n = 52) was included in which an end-to-end arthrodesis was performed and no graft interposition was used or necessary. The non-union rate was 4% (n = 2) in the control group, 5.9% (n = 4) in the autograft group, and 9.5% (n = 5) in the mesenchymal stem cell allograft group. The time for radiographic fusion was 6.46 weeks for the control group, 6.52 weeks for the autograft group, and 6.53 weeks for the mesenchymal stem cell allograft group. The difference in time to clinical and radiographic union and the non-union rate were not found to be statistically significant among all 3 groups. Patient comorbidities and their possible effects on union rates were also analyzed within the populations. Some comorbidities had statistically significantly non-unions within the population, notably smoking (p = 0.024) and Rheumatoid arthritis (p = 0.001), however the populations were fairly small. The use of allogeneic bone graft impregnated with mesenchymal stem cells yields a similar fusion rate as with the use of autologous bone graft harvested from the surrounding area. The allograft impregnated with mesenchymal stem cells is a viable alternative yielding similar results when local autogenous bone graft is not available, not obtainable, or conditions warrant its use.

Challenges of bone tissue engineering in orthopaedic patients

Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked- with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator(RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine(or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.

Acellular allogeneic nerve grafting combined with bone marrow mesenchymal stem cell transplantation for the repair of long-segment sciatic nerve defects:biomechanics and validation of mathematical models

We hypothesized that a chemically extracted acellular allogeneic nerve graft used in combination with bone marrow mesenchymal stem cell transplantation would be an effective treatment for long-segment sciatic nerve defects.To test this,we established rabbit models of 30 mm sciatic nerve defects,and treated them using either an autograft or a chemically decellularized allogeneic nerve graft with or without simultaneous transplantation of bone marrow mesenchymal stem cells.We compared the tensile properties,electrophysiological function and morphology of the damaged nerve in each group.Sciatic nerves repaired by the allogeneic nerve graft combined with stem cell transplantation showed better recovery than those repaired by the acellular allogeneic nerve graft alone,and produced similar results to those observed with the autograft.These findings confirm that a chemically extracted acellular allogeneic nerve graft combined with transplantation of bone marrow mesenchymal stem cells is an effective method of repairing long-segment sciatic nerve defects.

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.

Reconstruction Using a Free Vascularized Fibular Graft after Frozen Autograft Reconstruction for Osteosarcoma of the Distal Tibia: A Case Report

Recently we have been performing biological reconstruction for malignant bone tumors of the extremities using frozen autografts. Here we present a case treated with free vascularized fibular graft (FVFG) after this method. A 23-year-old man developed osteosarcoma in his left distal tibia. There was nonunion after frozen autograft reconstruction, which we treated with FVFG. Twenty-four months later, bridging between the host bone and the frozen autograft was achieved. Our department has achieved bone union in almost all cases, but we sometimes encounter cases of nonunion after this method because of delayed blood supply. In these instances, reconstruction using FVFG may represent an attractive choice for salvage treatment.

林可钢板并植骨治疗胫骨平台骨折

[目的]探讨Link胫骨上段解剖钢板固定治疗胫骨平台骨折的手术方法及疗效评估.[方法]本院1996年1月～2004年7月住院患者128例,按胥少汀分类,Ⅱ型92例,Ⅲ型36例.均经手术治疗行单侧骨膜剥离,对平台骨折并塌陷者,在保持关节面平整基础上行坚强内固定并植骨,早期膝关节功能锻炼.[结果]所有病例均获6个月～18个月的随访,全部病例均骨性愈合,愈合时间最短为8周,最长为14周,平均为12周,膝关节功能评价,优108,占84.38%,良16例,占12.50%,可4例,占3.12%,优良率为96.88%.[结论]Link钢板加植骨治疗胫骨平台骨折,对加快骨折愈合,防止胫骨平台塌陷,便于膝关节早期功能锻炼,预防关节僵直和创伤性关节炎有显著疗效.

一期前路病灶清除植骨内固定治疗胸腰椎结核

目的:总结一期前路病灶清除、自体骨椎间植骨融合、前路或后路内固定治疗胸腰椎结核的临床效果。方法:2002年2月～2006年2月手术治疗胸、腰椎结核86例,均采用一期前路病灶清除、自体骨椎间植骨,侧前方内固定52例,后路内固定34例。根据术前、术后X线平片分析植骨融合及脊柱后凸畸形矫正效果。结果:随访8个月～4年,平均23个月。除1例术后2周出现切口皮下血肿、4例1年后仍存在髂骨供骨区疼痛外,无其他并发症;无复发。均获骨性愈合,愈合时间3～7个月,平均4.5个月,无内固定松动、脱出及断裂;术前Cobb角平均为33.6°,术后1周及末次随访时Cobb角分别为平均15.6°、18.6°。结论:对胸、腰椎结核患者行一期前路病灶清除、自体骨椎间植骨融合、前路或后路内固定治疗可有效矫正脊柱后凸畸形,重建脊柱稳定性,获得良好的骨性融合,临床效果良好。

医用硫酸钙人工骨在脊柱结核手术中的应用△

[目的]评价在脊柱结核病灶清除植骨融合并内固定术中，应用医用硫酸钙（Osteoset）人工骨与自体骨混合植骨的安全性和临床效果。[方法]自2004年4月～2006年5月间，对24例胸腰椎结核患者行一期前路病灶消除、Osteoset人工骨加自体骨植骨并内固定术。观察患者局部伤口情况，有无不良反应及脊髓神经功能恢复情况。定期影像学检查（脊柱X线片和CT扫描），对植骨融合和后凸畸形矫正的情况进行评定和分析。[结果]所有患者术后伤口均一期愈合，未见不良全身反应。随访6～24个月，平均15个月。影像学检查显示内固定位置良好，无松动；结核病灶均无复发，脊柱后凸畸形平均矫正15．2°±6．7°,末次随访畸形矫正角度未见明显丢失。术后3个月融合率达95．8％，术后6个月24例患者植骨部位均获骨性融合。[结论]Osteoset人工骨在脊柱结核手术治疗中可以补充植骨量，具有可靠的安全性和满意的临床效果，是一种优良的骨移植替代材料。

全髋关节置换术治疗髋臼骨折

目的:探讨全髋关节置换术治疗髋臼骨折的疗效与方法.方法:回顾全髋关节置换术治疗髋臼骨折患者17例,总结分析其手术入路的选择,异位骨化组织、内固定物以及髋臼骨缺损的处理方法.结果:17例病人中有14例得到随访,平均随访时间为3年7个月(1年2个月～9年8个月).出现感染1例,脱位1例,无菌松动2例.术后再次异位骨化者2例,其中1例引起坐骨神经症状,再次行神经松解术.所有随访病例,髋关节功能均有改善,Harris评分由术前平均51分,提高到术后89分.结论:选择正确的手术入路,适当处理异位骨化组织和内固定物,重建髋臼骨缺损,是全髋关节置换治疗髋臼骨折成功的关键.

钛质外科网和自体髂骨块在颈椎前路减压融合术中应用的对比性研究

目的:比较钛质外科网(简称'钛网')与自体髂骨块在颈椎前路减压融合术中恢复、维持颈椎曲度及椎间高度上的差异.方法:对59例确诊为脊髓型颈椎病的患者行颈椎前路减压融合术,其中22例行钛网植骨加AO纯钛带锁钢板内固定,37例行自体髂骨块植入加AO纯钛带锁钢板内固定.分别摄术前、术后即刻、术后随访时的颈椎标准侧位X线片,以Cobb角测量融合节段的前凸(或后凸),以D值评价颈椎的前凸(或后凸),同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB).对各参数不同时期间差值分别行组间配对t检验.结果:经9～18个月随访(平均10.8个月),所有病例均获骨性融合.术后3个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后即刻变化有显著性差异(P＜0.01);术后6个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后3个月变化有显著性关(P＜0.01).但两组的D值无显著性差异.结论:在维持融合节段椎体后缘高度和前凸上钛网优于自体髂骨块,但在维持颈椎曲度上无显著性差异.

关节镜下同种异体骨-髌腱-骨双束重建膝关节前交叉韧带的临床比较研究

目的探讨关节镜下同种异体骨-髌腱-骨(bone-patellar tendon-bone,BPTB)移植物双束重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的中期临床效果。方法 2003年7月～2007年7月,61例ACL断裂患者接受关节镜下BPTB重建ACL手术,按术式和移植物分为3组:异体BPTB双束组(20例),异体BPTB单束组(21例),自体BPTB单束组(20例)。3组平均随访时间分别为(41.6±3.0)、(42.3±3.9)、(42.5±2.7)月。通过膝关节查体、IKDC2000主观评分、Lysholm评分、Tegner评分、膝前痛、常规KT-2000、后推KT-2000及Biodex等速肌力测试系统评估手术效果。结果 3组间的IKDC2000、Lysholm、Tegner评分、大腿围度差值、肌力和常规KT-2000等指标差异无显著性(P>0.05)。异体双束组的Pivotshift阳性发生率(5%,1/20)是异体单束组的1/6(29%,6/21),自体单束组的1/4(20%,4/20)。异体双束组的后推KT-200030°位前移度(中位数15磅0.5 mm,20磅0.5 mm,30磅0.9 mm)明显低于其他两组(P<0.05)。异体双束组(15%,3/20)和异体单束组(10%,2/21)的膝前痛发生率明显低于自体单束组(75%,15/20)(χ2=24.201,P=0.000)。结论同种异体BPTB双束重建ACL能够更好地恢复膝关节整体前向及旋转稳定性,减少并发症,可以作为髁间窝较宽的患者ACL初次解剖重建的理想手术方法。

自体楔形骨块修复初次膝关节置换时严重膝内翻畸形的研究

目的:行初次膝关节置换术时,对严重膝内翻(内翻角>15°)的治疗方法较多,但疗效及费用差异较大,本研究介绍一种疗效满意、经济适用的方法:自体楔形骨块嵌入移植治疗严重膝内翻畸形。方法:回顾性分析本院2006年1月至2014年1月初次膝关节置换术患者687例,721膝,严重膝内翻畸形16例,21膝,全部为非包容性倾斜型骨缺损,平均体质指数31 kg/m2,年龄(63±5)岁,术前临床KSS评分18分,其中疼痛评分12分,活动度评分12分,内翻角平均为27°,功能KSS评分20分。手术的关键点是术中将胫骨内侧平台骨缺损修剪成阶梯状梯形骨缺损,将外侧平台截骨块修剪成与缺损面紧密匹配的骨块,完整嵌入缺损面,以增加植骨块与主体骨的接触面积、即刻稳定性,减少骨水泥渗漏。术后3个月完全负重。结果:平均随访5.3年,膝关节平均临床KSS评分由42分恢复到88分,平均功能KSS评分由57分恢复到92分。术后6个月后,X线片见植骨块骨小梁改建,未见植骨块塌陷、应力骨折、松动、骨不连发生。12个月后核素扫描可见植骨部核素浓聚,炎性指标未见异常。结论:初次膝关节置换中,自体楔形骨块嵌入修复骨缺内后侧骨缺损具有植骨愈合率高、功能恢复好、费用低的优势。

肌腱-骨块自体复合移植物嵌压固定法重建前交叉韧带的实验研究

[目的]研究肌腱-骨块自体移植物嵌压固定法重建前交叉韧带的组织形态学转归。[方法]以8只山羊膝关节为实验模型,用阶梯状联合钻1次成形建立股骨隧道呈倒置瓶颈状,以髌腱-胫骨结节骨块为移植物,在股骨隧道内行嵌压固定;在胫骨端骨桥打结固定。术后4、8、12和16周取材,分别进行放射学、大体形态和组织切片检查,观察隧道宽度变化及移植物的组织学转归。[结果]术后各时间点放射检查未见隧道扩大;HE染色检查显示12周后有明显的腱-骨连接形成,移植骨块与隧道形成骨性愈合。[结论]嵌压固定法重建前交叉韧带有利于移植物的愈合。

一期前路病灶清除椎间植骨联合内固定治疗脊柱结核

目的探讨病灶彻底清除后,自体髂骨块椎间植骨联合前路或后路内固定的效果。方法1999年6月～2004年4月期间一期手术治疗脊柱结核89例,其中前路病灶清除、自体髂骨椎间植骨,前方或侧前方内固定73例;前路病灶清除、自体髂骨椎间植骨,后路内固定16例。术后支具保护6个月,正规抗结核化疗12个月。根据术前、术后及最后一次随访的X线平片分析融合情况和畸形矫正的进展。结果随访1～5年,平均28个月;除2例复发、1例内固定松动、2例出现药物性肝炎、2例出现供骨区严重疼痛外,无其他并发症;88例获骨性愈合,愈合时间3～6个月。平均4个月;术前、术后、最后一次Cobb角分别为35.3°、16.3°、19.5°。结论对合适的病例,该法可有效稳定脊柱、维持其畸形的矫正;达到牢固地融合,临床效果明显。

胸腰椎结核的手术内固定治疗

[目的]探讨Z-plate-ⅡTM前路内固定技术治疗胸腰椎结核合并后凸畸形的疗效。[方法]总结行Z-plate-ⅡTM前路内固定技术治疗胸腰椎结核合并后凸畸形患者68例,随访时间2.2~6.3 a,平均3.3 a。内容包括植骨融合率、截瘫恢复情况和后凸畸形矫正状况。[结果]所有患者均显示骨性融合;45例合并截瘫的患者中,症状完全改善25例,部分改善15例;治愈率55.56%,好转率33.33%,合计恢复率为88.89%。术后后凸畸形平均矫正28.9°,随访2.2~6.3 a,平均3.3 a,后凸角度平均丢失2.7°。[结论]Z-plate-ⅡTM前路内固定技术可恢复脊柱的即刻稳定性,有利于骨融合,促进截瘫恢复和防止截瘫复发,矫正及预防后凸畸形。

自体骨髌腱骨和腘绳肌腱重建前交叉韧带疗效的Meta分析

目的通过Meta分析来比较自体骨髌腱骨和腘绳肌腱重建前交叉韧带的疗效。方法资料来源Medline,Cochrane图书馆和中国知网,检索1999年至2009年关于前交叉韧带断裂使用自体骨髌腱骨和腘绳肌腱治疗的文献,采用Meta分析的方法,运用RevMan4.2软件进行数据处理,对术后膝关节的体格检查和膝关节功能进行综合分析。结果 15篇文献入选本研究,轴移试验阳性的OR值为1.39[95%C(I0.82～2.36),P=0.23],Lachman试验阳性的OR值为1.30[95%C(I0.90～1.88),P=0.17],膝前疼痛的OR值为0.43[95%C(I0.30～0.61),P=0.000],伸膝受限(>5°)的OR值为0.44[95%CI(0.24～0.79),P=0.007]。结论腘绳肌腱重建前交叉韧带术后膝关节出现疼痛和伸膝受限的发病率低于骨髌腱骨,而膝关节稳定性方面二者没有显著的差别。

上肢骨肿瘤切除后的自体骨移植重建

目的探讨应用自体骨移植对上肢骨肿瘤切除后的骨缺损修复重建的效果。方法1998年8月～2004年3月，收治上肢骨肿瘤切除后的骨缺损16例。男8例，女8例。年龄7～45岁。经病理确诊，肱骨近端尤文肉瘤和骨肉瘤各1例；肱骨远端尤文肉瘤2例；桡骨远端骨巨细胞瘤8例，高分化软骨肉瘤2例，恶性纤维组织细胞瘤和骨肉瘤各1例。2例肱骨近端肿瘤行自体锁骨代肱骨；2例肱骨远端肿瘤行自体腓骨代肱骨；12例桡骨远端肿瘤中，1例行自体髂骨移植，11例行自体腓骨代桡骨进行重建。采用MSTS系统进行术后功能评价。结果2例肱骨近端自体锁骨移植患者分别随访36个月和12个月，术后保持部分肩关节前屈和后伸功能，但外展功能丧失；MSTS评分分别为23分和22分。2例肱骨远端自体腓骨移植患者分别随访4个月和6个月，肘关节功能良好，移植骨连接处已经出现骨愈合；MSTS功能评分分别为24分和19分。12例桡骨远端自体骨移植患者中11例随访6～75个月，功能良好，无明显并发症；1例髂骨植骨的桡骨远端骨巨细胞瘤术后3个月移植骨完全愈合，至今随访75个月，肿瘤无复发。MSTS功能评分18~27分，平均22．6分。结论自体骨移植在上肢骨肿瘤切除后骨缺损的重建，尤其是儿童的骨缺损重建中，是一种较好的方法。

瘤段切除灭活再植治疗儿童股骨恶性骨肿瘤

目的：探讨瘤段切除灭活再植术在儿童股骨恶性骨肿瘤治疗中的疗效。方法：回顾性研究2008年1月至2011年1月股骨恶性骨肿瘤行瘤段切除灭活再植术治疗的患者11例（男7例，女4例），年龄（11．0±2．5）岁。其中骨肉瘤10例，尤文氏肉瘤1例，按照Enneking方法分期，所有患者均为IIb期。结果：本组病例术后都得到随访，随访时间24-65（42±20）个月，骨折端都达到骨性愈合。术中瘤段骨切除长度（17．5±3．2）cm，手术时间为（180±35）min，出血量（1200±250）mL。术后48h内拔除引流管，引流量为（650±125）mL。1例（9．1％）出现局部皮肤坏死，通过伤口换药3周后伤口逐渐愈合。3处（27．3％）骨折断端骨愈合不良，予以骨折断端自体髂骨植骨后，骨折端愈合。1例（9．1％）发生肺转移，于术后35个月死亡。根据Enneking等肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准，功能评定优5例，良4例，中1例，差1例，优良率81．2％。结论：瘤段切除灭活再植术对于儿童股骨恶性骨肿瘤是一种可供选择的治疗方法。