Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the l...Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.展开更多
Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial...Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were展开更多
This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandi...This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandibular deficiency underwent intraoral or extraoral inverted-L osteotomy of ramus and lilac crest bone grafting. Data were collected from the patients＇ records, photographs and radiographs. The height and width of the ramus were successfully expanded by inverted-L osteotomy and lilac crest bone grafting with minimal complications in all patients, resulting in significant improvement in occlusion and facial appearance. Our early results showed that the inverted-L osteotomy of ramus and lilac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular deficiency.展开更多
To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae...To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A （n=20） were rein-forced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B （n=50） did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B （group A： 6.4 degree; group B： 5.4 degree）/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B （P=0.0001）. Postoperatively, greater anterior height was achieved in group A than in group B （P〈0.01）. During follow-up study, anterior vertebral height was maintained only in Group A （P〈0.001）. Both group A and group B showed good Denis pain scores （P1 and P2） but group A outdid group B in terms of control of severe and constant pain （P4 and P5）. By Frankel criteria, the changes in neurological functions in group A was better than those of group B （P〈0.001）. It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.展开更多
To evaluate the treatment results of bilateral alveolar bone grafting (BABG) in patients with bilateral complete clefts of lip and palate. [WT5”BX] Methods.[WT5”BZ] A retrospective study was performed in 66 bilatera...To evaluate the treatment results of bilateral alveolar bone grafting (BABG) in patients with bilateral complete clefts of lip and palate. [WT5”BX] Methods.[WT5”BZ] A retrospective study was performed in 66 bilateral complete cleft lip and palate patients who received the procedure of BABG, among them 15 were primary BABG and 51 were secondary BABG. The patients were further divided into three groups according to age and eruption stage of the canine at the time of surgery. The result of BABG was evaluated on the radiographs. [WT5”BX] Results.[WT5”BZ] (1)The overall success rate of BABG was 75 0%, with 83 3% and 72 5% for primary and secondary BABG respectively; (2)The marginal bone level was found to be significantly higher in the youngest age group than in the other groups both for primary and secondary BABG; (3)For both primary and secondary BABG, Group C (patients’ age more than 16 years) had the least optimal success rate, with 66 7% and 65 4% respectively. [WT5”BX] Conclusion.[WT5”BZ] Simultaneous primary palate repair and BABG is safe and feasible procedure for treating unoperated bilateral complete cleft lip and cleft palate patients. For both primary and secondary BABG, significantly better results can be achieved if the operation is performed before eruption of the canine.展开更多
Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substi...Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substitute in comparison to empty controls. Materials and Methods: Vital roots of the second, third and fourth mandibular premolars in six healthy mongrel dogs were apectomized. The root canals were prepared and sealed with IRM following a standardized surgical procedure. The resection bone defects were either filled with autogenous bone (PB) or one of the bone graft substitutes;CERAMENTTM|BONE VOID FILLER, ChronOS?, TigranTM PTG, Easygraft? CLASSIC or left empty. After 120 days the animals were sacrificed and the specimens were analyzed radiologically and histologically. Kruskal-Wallis and Mann-Whitney tests were performed for statistical evaluation. Results: 34 sections were analyzed histologically. The evaluation revealed a variation in the outcome amongst the tested options, regarding reestablishment of the periapical bone healing and inflammatory infiltration in the sections. According to the tested variables, there was no statistical significant difference between the materials when comparing all groups as a whole. When comparing individual materials to each other there was statistical differences among some of the tested materials. Conclusion: The healing outcome after periapical surgery of a five-wall resection defect could not be increased by infill with autogenous bone or bone graft substitutes. The most important factor for the healing outcome in periapical surgery is the quality of the root-end sealing. The healing outcome after some of the tested bone substitutes, might be improved by longer healing time.展开更多
BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical ...BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.展开更多
Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-co...Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.展开更多
Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subc...Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subchondral bone,surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis.In this study,we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis.Methods We retrospectively analyzed 76 patients with GCT around the knee.The mean age at first diagnosis was 31.1 years.Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone.Patient follow-up was a median duration of 35 months,ranging from 18 to 113 months.Results The local recurrence rate was 5.3％ （4/76）.Secondary degenerative changes occurred in 30.3％ （23/76） of the patients.Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients （P ＜0.001）.Of these 57 patients,56.5％ （13/23） treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting,the rate decreased to 29.4％（10/34）,with a statistically significant difference （P=0.041）.Conclusions GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage.Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.展开更多
Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtaine...Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtained from articles listed in PubMed that were published from January 1993 to July 2009. The search terms were ＂impaction bone grafting＂, ＂particle size＂, ＂mechanical property＂and ＂biological behavior＂.Study selection Articles relevant to the choices of allografts and their results for bone defect reconstruction on the acetabular side were selected.Results Different choices of allografts, including the particle size, process of irradiation or fat reduction, composition and particle grade, are made to improve the survival rate of a prosthesis in acetabular revision surgery. This review,which compares both mechanical and biological factors, summarizes the experimental and clinical results for different techniques.Conclusions Fresh frozen cancellous allografts with particle sizes ranging from 7 to 10 mm are a favorable choice for reconstruction of bone defects of American Academy of Orthopedic Surgeons （AAOS） types Ⅱ （cavitary defect） and Ⅲ（combined cavitary and segmental defect） on the acetabular side. A fat-reducing procedure with saline or solvent/detergent is controversial. Adding autologous marrow into irradiated allografts, which provides reliable mechanical stability and biological safety, may be a substitute for fresh frozen allografts. Cortical bone can be a supplementary material in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade, and randomized controlled trials in clinical practice are required to obtain more information about the selection of allografts.展开更多
Curettage of benign bone tumor is a common cause for bone defect.For such bone defect repair,autogenous bone,allogeneic bone and traditional artificial bone graft substitutes have many disadvantages.In recent years,a ...Curettage of benign bone tumor is a common cause for bone defect.For such bone defect repair,autogenous bone,allogeneic bone and traditional artificial bone graft substitutes have many disadvantages.In recent years,a biomimetic mineralized collagen(MC)with similar composition and microstructures to the natural bone matrix was developed and used for treating various bone defects.In this work,a retrospective study analyzed clinical outcomes of patients treated with curettage of benign bone tumors and bone grafting with MC,in comparison to another group treated with the same surgical method and autogenous bone.Lane-Sandhu X-ray score of the autogenous bone group was superior to the MC group at 1 month after the operation,but the two groups had no statistical difference at 6 and 12 months.The MC group was better in Musculoskeletal Tumor Society scoring at 1 and 6 months after the operation,and the two groups had no statistical difference at 12 month.Therefore,the MC performed not as good as autogenous bone in early stage of bone healing but achieved comparable outcomes in long-term follow-ups.Moreover,the MC has advantages in function recovery and avoided potential complications induced by harvesting autogenous bone.展开更多
The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was ...The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.展开更多
Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June...Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient’s radius. The average volar tilt was 6° to 15° and the average ulnar tilt was 18° to 25°. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.展开更多
This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate,showing a left alveolar cleft,lateral deviation of the major segment of...This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate,showing a left alveolar cleft,lateral deviation of the major segment of the maxilla,and palatal transposition of the lateral incisor.Preoperatively,the midline of the upper central incisors was shifted by 7.0 mm to the right,the right lateral incisor showed palatal transposition,and the residual alveolar cleft was 6.5 mm.Segmental Le Fort I osteotomy of the major segment,and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age.Thus,midline correction,alignment of the right lateral incisor,and cleft closure were achieved;no further prosthetic treatment was required.展开更多
Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are t...Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures,with the former demonstrating superior cost-effectiveness and reduced comorbidity rates,particularly in cases involving donor zones.However,a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens,with existing tools often yielding coarse particles at a high cost.Consequently,commercial bone xenograft solutions are frequently favored despite lower standards.This technical note introduces a novel technique for swiftly,safely,and efficiently obtaining autologous particulate bone specimens.The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles.The continuous irrigation with saline maintains a clear surgical field during the milling process.The collected bone particles are then transferred to a metal capsule for further use.This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods,providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.展开更多
Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling...Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.展开更多
To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital ...To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.展开更多
Tissue engineering aims to offer large-scale replacement of damaged organs using implants with the com-bination of cells,growth factors and scaffolds.However,the intra/peri-implant region is exposed to se-vere hypoxic...Tissue engineering aims to offer large-scale replacement of damaged organs using implants with the com-bination of cells,growth factors and scaffolds.However,the intra/peri-implant region is exposed to se-vere hypoxic stress and oxidative stress during the early stage of implantation with bone graft materials,which endangers the survival,proliferation and differentiation of seed cells within the implants as well as the host cells surrounding the implants.If the bone graft material could spontaneously and intelligently regulate the hypoxic stress and oxidative stress to a moderate level,it will facilitate the vascularization of the implants and the rapid regeneration of the bone tissue.In this review,we will first introduce the signaling pathways of cellular response under hypoxic stress and oxidative stress,then present the clas-sical material designs and examples in response to hypoxic stress and oxidative stress.And finally,we will address the important role of epigenetic mechanisms in the regulation of hypoxic stress and oxida-tive stress and describe the potential applications and prospective smart bone graft materials based on novel epigenetic factors against hypoxic stress and oxidative stress in bone repair.The main content of this review is summarized in the following graphical abstract.展开更多
Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,...Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,the treatment for aseptic femoral shaft nonunion is controversial.The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure.Methods:A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019.All patients were treated by leaving the nail in situ,debridement of nonunionsites,decortication,autogenous iliac bone grafting,and augmentative antirotational plating fixation.The time to fracture union and complications were recorded.Results:All patients were followed up for 12–18 months.The union rate after revision surgery was 100%.The average union time was 5.5months(range,4-10).Subjective pain symptoms had disappeared in all patients.There were no incision infections or internal fixator fatigue fractures.Average scores of the physical function and bodily pain components of the SF-36 were 95.5(range,91-98)and 94.1(range,90-97),respectively.No other obvious complications occurred postoperatively.Conclusion:Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing;this approach has an overall high union rate and few complications.展开更多
Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ridges.Thus,the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB(lyophilize...Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ridges.Thus,the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB(lyophilized)graft and verify its reliability.Eight individuals were included from 2014 to 2018.The first surgery was performed to install homologous bone blocks in the maxilla.The period of the second intervention varied between 5 months and 15 days to 11 months(≈7.93 months).The biopsies were taken from the central region of the matured graft during the surgery for implant placement.All patients presented clinical and radiographic conditions for the installation of dental implants.There was a 100%of survival rate.The histological assessment showed that the homologous block bone graft was an osteoconductive biomaterial,with connective tissue present,and newly formed bone juxtaposed on its surface.There were bone trabeculae with osteocytes and active osteoblasts with connective tissue in the mineralization process;the remodeling process can be found through the reverse lines.A limited focus of necrosis with fibrosis was detected,with small resorption and areas of inflammatory infiltrate,but without clinical significance.The homologous block bone graft can be considered a feasible option to substitute the autogenous bone graft(gold standard),with predictable clinical and favorable histological results.The patients had a shorter surgical period,low morbidity,and an unlimited amount of biomaterial available at an accessible cost.展开更多
基金2018 Hebei health technology research and achievement transformation key project(No.zh2018014)2018 Hebei Medical applicable technology tracking project(No.gl2018074)+1 种基金2017 Zhangjiakou city level plan(No.17120010d)2018 Hebei North University School level scientific research project(No.yb2018010)
文摘Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.
文摘Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were
文摘This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandibular deficiency underwent intraoral or extraoral inverted-L osteotomy of ramus and lilac crest bone grafting. Data were collected from the patients＇ records, photographs and radiographs. The height and width of the ramus were successfully expanded by inverted-L osteotomy and lilac crest bone grafting with minimal complications in all patients, resulting in significant improvement in occlusion and facial appearance. Our early results showed that the inverted-L osteotomy of ramus and lilac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular deficiency.
文摘To enhance the fusion of graft bone in thoracolumbar vertebrae and minimize the postoperative loss of correction, short-segment pedicle screw fixation was reinforced with posterior moselizee bone grafting in vertebrae for spinal fusion in patients with thoracrolumbar vertebrate fractures. Seventy patients with thoracrolumbar vertebrate fractures were treated by short-segment pedicle screw fixation and were randomly divided into two groups. Fractures in group A （n=20） were rein-forced with posterior morselized bone grafting in vertebrae for spinal fusion, while patients group B （n=50） did not receive the morselized bone grafting for bone fusion. The two groups were compared in terms of kyphotic deformity, anterior vertebral height, instrument failure and neurological functions after the treatment. Frankel grading system was used for the evaluation of neurological evaluation and Denis scoring scale was employed for pain assessment. The results showed that the kyphosis correction was achieved in both group A and group B （group A： 6.4 degree; group B： 5.4 degree）/At the end of follow-up, kyphosis correction was maintained in group A but lost in group B （P=0.0001）. Postoperatively, greater anterior height was achieved in group A than in group B （P〈0.01）. During follow-up study, anterior vertebral height was maintained only in Group A （P〈0.001）. Both group A and group B showed good Denis pain scores （P1 and P2） but group A outdid group B in terms of control of severe and constant pain （P4 and P5）. By Frankel criteria, the changes in neurological functions in group A was better than those of group B （P〈0.001）. It is concluded that reinforcement of short-segment pedicle fixation with morselized bone grafting for the treatment of patients with thoracolumbar vertebrae fracture could achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Morselized bone grafting in vertebrae offers immediate spinal stability in patients with thoracolumbar vertebrate fractures, decreases the instrument failure and provides better postoperative pain control than without the morselized bone grafting.
文摘To evaluate the treatment results of bilateral alveolar bone grafting (BABG) in patients with bilateral complete clefts of lip and palate. [WT5”BX] Methods.[WT5”BZ] A retrospective study was performed in 66 bilateral complete cleft lip and palate patients who received the procedure of BABG, among them 15 were primary BABG and 51 were secondary BABG. The patients were further divided into three groups according to age and eruption stage of the canine at the time of surgery. The result of BABG was evaluated on the radiographs. [WT5”BX] Results.[WT5”BZ] (1)The overall success rate of BABG was 75 0%, with 83 3% and 72 5% for primary and secondary BABG respectively; (2)The marginal bone level was found to be significantly higher in the youngest age group than in the other groups both for primary and secondary BABG; (3)For both primary and secondary BABG, Group C (patients’ age more than 16 years) had the least optimal success rate, with 66 7% and 65 4% respectively. [WT5”BX] Conclusion.[WT5”BZ] Simultaneous primary palate repair and BABG is safe and feasible procedure for treating unoperated bilateral complete cleft lip and cleft palate patients. For both primary and secondary BABG, significantly better results can be achieved if the operation is performed before eruption of the canine.
文摘Purpose: To investigate the periapical tissue response after root end filling with intermediate restorative material (IRM) and filling of the root-end resection bone defects with autogenous bone or a bone graft substitute in comparison to empty controls. Materials and Methods: Vital roots of the second, third and fourth mandibular premolars in six healthy mongrel dogs were apectomized. The root canals were prepared and sealed with IRM following a standardized surgical procedure. The resection bone defects were either filled with autogenous bone (PB) or one of the bone graft substitutes;CERAMENTTM|BONE VOID FILLER, ChronOS?, TigranTM PTG, Easygraft? CLASSIC or left empty. After 120 days the animals were sacrificed and the specimens were analyzed radiologically and histologically. Kruskal-Wallis and Mann-Whitney tests were performed for statistical evaluation. Results: 34 sections were analyzed histologically. The evaluation revealed a variation in the outcome amongst the tested options, regarding reestablishment of the periapical bone healing and inflammatory infiltration in the sections. According to the tested variables, there was no statistical significant difference between the materials when comparing all groups as a whole. When comparing individual materials to each other there was statistical differences among some of the tested materials. Conclusion: The healing outcome after periapical surgery of a five-wall resection defect could not be increased by infill with autogenous bone or bone graft substitutes. The most important factor for the healing outcome in periapical surgery is the quality of the root-end sealing. The healing outcome after some of the tested bone substitutes, might be improved by longer healing time.
文摘BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.
文摘Background Quadratus femoris pedicled bone grafting has yielded satisfactory long-term clinical outcome for osteonecrosis of the femoral head （ONFH） in pre-collapse ONFH without extensive lesion. However, for pre-collapse ONFH with extensive necrotic area, it is still challenging to preserve the femoral head. The current study aimed to introduce a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus and to evaluate its short-term outcomes.Methods From January 2008 to December 2008, 10 ONFH patients （12 hips） underwent operations by a new technique of deliquesce strut with titanium mesh containing bone grafting pedicled with the femoral quadratus （group A）.According to the ARCO classification system, there were two hips in stage Ⅱ B and 10 hips in stage Ⅱ C. Also in the same period, 12 ONFH patients （16 hips） underwent operations by the conventional procedure of quadratus femoris pedicled bone grafting （group B）. There were 6 hips in stage Ⅱ B and 10 hips in stage Ⅱ C. All patients were males and suffered from alcohol induced ONFH. For the new technique, the necrotic area was evaluated, and a titanium mesh piece of the same size （range from 2.5 cm×2.8 cm to 2.8 cm×3.4 cm） was obtained and shaped to match the contour of the head. The cancellous bone was first placed underneath the subchondral bone and was densely impacted （about 1 to 2 mm thick）.Then the titanium mesh piece was inserted. The length of the decompressive trough was measured. A titanium cylinder mesh cage with a diameter of 1.6 cm of the same length was obtained, with a ＂U＂ shaped window in the wall being created to make room for the muscle pedicle. The muscle pedicle bone was inserted into the titanium mesh cage to form a bone graft-titanium cage complex and, then the complex was inserted. The hundred percent score method was used for outcome evaluation. Clinical and radiographic outcomes were compared between group A and group B.Results The average operative time was 150 minutes （130 to 185 minutes） in group A, with an average of 130 minutes （120 to 180 minutes） in group B. The mean blood loss was 400 ml （300 to 500 ml） in group Aand 350 ml （250 to 500 ml）in group B. Group A patients were followed up for an average of 19.2 months （14 to 24 months）, with an average of 18.5 months （12 to 24 months） for Group B. Full weight bearing was allowed 5 to 7 months postoperatively. Pain and function were obviously improved. For group A, pain score improved from a mean of 9.8 points preoperatively to an average of 24.6 points postoperatively, and function score improved from a mean of 9.0 points preoperatively to an average of 17.4 points postoperatively. In group B, pain score improved from a mean of 9.5 points preoperatively to an average of 24.2 points postoperatively and function score improved from a mean of 9.2 points preoperatively to an average of 17.2 points postoperatively. The range of motion changed the least, with score improvement from a preoperative mean of 13.9 points to postoperative 16.8 points for group A and from a preoperative mean of 13.7 points to postoperative 16.5 points for group B. Radiographic score improved from preoperative 31 points to postoperative 38 points for group A, in comparison with an improvement from preoperative 31 points to postoperative 37 points for group B. At the latest follow up, 11 hips were rated as excellent and 1 hip was better for group A, with 14 hips being rated as excellent and 2 hips being better in group B. There was no statistically significant difference between groups A and B in clinical and radiographic outcomes.Conclusion For ONFH in stage ARCO llC, satisfactory clinical outcome can be achieved by the new technique in the short-term period while the long-term clinical outcome has yet to be determined.
文摘Background Giant cell tumors （GCTs） most commonly occur around the knee.The most beneficial procedure for this disease has been extensive curettage with reconstruction.However,since many GCTs may compromise the subchondral bone,surgery can further jeopardize the articular cartilage and result in secondary osteoarthritis.In this study,we aimed to determine the factors associated with the development of degenerative arthritis and the effect of bone grafting on the prevention of secondary osteoarthritis.Methods We retrospectively analyzed 76 patients with GCT around the knee.The mean age at first diagnosis was 31.1 years.Surgical treatments included extensive curettage and cementation with or without bone grafting in the subchondral bone.Patient follow-up was a median duration of 35 months,ranging from 18 to 113 months.Results The local recurrence rate was 5.3％ （4/76）.Secondary degenerative changes occurred in 30.3％ （23/76） of the patients.Less than 10 mm of the residual thickness of the remaining subchondral bone was correlated with secondary degenerative changes in 57 patients （P ＜0.001）.Of these 57 patients,56.5％ （13/23） treated with bone cement reconstruction alone developed secondary degenerative changes; following bone grafting,the rate decreased to 29.4％（10/34）,with a statistically significant difference （P=0.041）.Conclusions GCT patients with less residual thickness of the subchondral bone are more likely to develop degenerative arthritis after curettage.Bone grafting in the subchondral bone area is recommended when the residual thickness of the subchondral bone is less than 10 mm.
文摘Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtained from articles listed in PubMed that were published from January 1993 to July 2009. The search terms were ＂impaction bone grafting＂, ＂particle size＂, ＂mechanical property＂and ＂biological behavior＂.Study selection Articles relevant to the choices of allografts and their results for bone defect reconstruction on the acetabular side were selected.Results Different choices of allografts, including the particle size, process of irradiation or fat reduction, composition and particle grade, are made to improve the survival rate of a prosthesis in acetabular revision surgery. This review,which compares both mechanical and biological factors, summarizes the experimental and clinical results for different techniques.Conclusions Fresh frozen cancellous allografts with particle sizes ranging from 7 to 10 mm are a favorable choice for reconstruction of bone defects of American Academy of Orthopedic Surgeons （AAOS） types Ⅱ （cavitary defect） and Ⅲ（combined cavitary and segmental defect） on the acetabular side. A fat-reducing procedure with saline or solvent/detergent is controversial. Adding autologous marrow into irradiated allografts, which provides reliable mechanical stability and biological safety, may be a substitute for fresh frozen allografts. Cortical bone can be a supplementary material in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade, and randomized controlled trials in clinical practice are required to obtain more information about the selection of allografts.
基金part supported by Research Fund for Jiangsu Provincial Commission of Health and Family Planning(H201559)Science and Technology Development Project of Lianyungang City(SH1412)the National Key R&D Program of China(2020YFC1107600).
文摘Curettage of benign bone tumor is a common cause for bone defect.For such bone defect repair,autogenous bone,allogeneic bone and traditional artificial bone graft substitutes have many disadvantages.In recent years,a biomimetic mineralized collagen(MC)with similar composition and microstructures to the natural bone matrix was developed and used for treating various bone defects.In this work,a retrospective study analyzed clinical outcomes of patients treated with curettage of benign bone tumors and bone grafting with MC,in comparison to another group treated with the same surgical method and autogenous bone.Lane-Sandhu X-ray score of the autogenous bone group was superior to the MC group at 1 month after the operation,but the two groups had no statistical difference at 6 and 12 months.The MC group was better in Musculoskeletal Tumor Society scoring at 1 and 6 months after the operation,and the two groups had no statistical difference at 12 month.Therefore,the MC performed not as good as autogenous bone in early stage of bone healing but achieved comparable outcomes in long-term follow-ups.Moreover,the MC has advantages in function recovery and avoided potential complications induced by harvesting autogenous bone.
基金supported and funded by the following grants:National Natural Science Foundation of China[Grant Numbers 82072456 and 81802174]National Key R&D Program of China[Grant Number.2018YFB1105100]+7 种基金Bethune plan of Jilin University[Grant Number 419161900014]Wu Jieping Medical Foundation[3R119C073429]Department of Science and Technology of Jilin Province,P.R.C.[Grant Numbers 20200404202YY and 20200201453JC]Department of Finance in Jilin province[Grant Numbers 2019SCZT046,2020SCZT037]undergraduate teaching reform research project of Jilin University[Grant Number 4Z2000610852]key training plan for outstanding young teachers of Jilin University[Grant Number 419080520253]Jilin Province Development and Reform Commission,P.R.C.[Grant Number 2018C010]Natural Science Foundation of Jilin Province[Grant Number 20200201345JC].
文摘The study aimed to develop efficient techniques with different novel graft structures to enhance the treatment of acetabular bone deficiency.The inhomogeneous material properties Finite Element Analysis(FEA)model was reconstructed according to computed tomography images based on a healthy patient without any peri-acetabular bony defect according to the American Academy of Orthopedic Surgeons(AAOS).The FEA model of acetabular bone deficiency was performed to simulate and evaluate the mechanical performances of the grafts in different geometric structures,with the use of fixation implants(screws),along with the stress distribution and the relative micromotion of graft models.The stress distribution mainly concentrated on the region of contact of the screws and superolateral bone.Among the different structures,the mortise-tenone structure provided better relative micromotion,with suitable biomechanical property even without the use of screws.The novel grafting structures could provide sufficient biomechanical stability and bone remodeling,and the mortise-tenone structure is the optimal treatment option for acetabulum reconstruction.
文摘Objective: To study the therapeutic effect of collapsed and comminuted distal radius fracture. Methods: Twenty-six patients with collapsed and comminuted distal radius fracture were hospitalized from July 1998 to June 2003. All fractures were treated by the methods of open reduction, sustained bone grafting and passing joint external fixator to restore the anatomic shape of distal radius. Results: All 26 cases were followed up, and the results showed that the fractures have been united radiographically. The joint surfaces were intact and there was no length discrepancy occurred in patient’s radius. The average volar tilt was 6° to 15° and the average ulnar tilt was 18° to 25°. According to the Dieust criterion, 19 cases were rated as excellent and 7 as good. Conclusions: The method that applying passing joint external fixator and bone grafting for the treatment of collapsed and comminuted distal radius fracture could maintain the stability of fracture and restore the length of radius and the intact of joint surface.
基金supported by the JSPS KAKENHI(grant number JP19K10399)Grant-in-Aid for Scientific Research from the Ministry of Education,Culture,Sports,Science and Technology,Japan.
文摘This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate,showing a left alveolar cleft,lateral deviation of the major segment of the maxilla,and palatal transposition of the lateral incisor.Preoperatively,the midline of the upper central incisors was shifted by 7.0 mm to the right,the right lateral incisor showed palatal transposition,and the residual alveolar cleft was 6.5 mm.Segmental Le Fort I osteotomy of the major segment,and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age.Thus,midline correction,alignment of the right lateral incisor,and cleft closure were achieved;no further prosthetic treatment was required.
文摘Particulate bone plays a crucial role in various oral and maxillofacial surgical procedures,including reconstruction,implantation,and craniofacial surgery.Autologous bone and deproteinized bovine bone xenografts are the two primary resources used for such procedures,with the former demonstrating superior cost-effectiveness and reduced comorbidity rates,particularly in cases involving donor zones.However,a significant challenge lies in acquiring uniformly sized autologous particulate bone specimens,with existing tools often yielding coarse particles at a high cost.Consequently,commercial bone xenograft solutions are frequently favored despite lower standards.This technical note introduces a novel technique for swiftly,safely,and efficiently obtaining autologous particulate bone specimens.The procedure involves the use of a motor handpiece fitted with a micro drill and surgical spoon to collect the bone particles.The continuous irrigation with saline maintains a clear surgical field during the milling process.The collected bone particles are then transferred to a metal capsule for further use.This technique offers a promising solution to the challenge of inconsistent particle size associated with harvesting using traditional methods,providing surgeons with a reliable and efficient method of obtaining autologous particulate bone samples.
文摘Introduction: Osteonecrosis of the femoral head (ONTF) is a debilitating condition. Several treatments have been proposed with controversial results. The aim of our study was to evaluate treatment by surgical drilling coupled with in situ cancellous grafting. Materials and methods: Our study was a case-control study conducted at Brazzaville University Hospital from 1st January 2018 to 31 December 2023. It compared two groups of patients with ONTF: non-operated (13 patients, 20 hips) and operated (22 patients, 35 hips). We used the visual digital scale (VDS) for pain assessment, the Merle D’Aubigne-Postel (MDP) scoring system for clinical and functional assessment, and the evolution of necrosis. Results: The group of non-operated patients had a mean age of 35.69 ± 3.4 years, no improvement in pain with an EVN above seven at the last recoil and a mean global MDP score falling from 12.7 before offloading to 10.13 at one year. The group of patients operated on had a mean age of 37.86 ± 7.02 years, a significant reduction in pain (p = 0.00004) and a significantly increased MDP score (p = 0.0034). A comparison of the two groups of patients showed significant stabilization of the necrotic lesions in the operated patients (p = 0.00067), with better satisfaction in the same group. Conclusion: Surgical drilling combined with grafting in the treatment of early-stage ONTF has improved progress in our series. The technique is reproducible and less invasive. It has made it possible to delay unfavorable progression and, consequently, hip replacement surgery.
文摘To analyse the effectiveness of performing a transverse tibial bone graft in the treatment of patients with diabetic foot. We retrospectively analysed the clinical details of 51 diabetic foot patients in our hospital from February 2023 to February 2024 and divided them into two groups according to the different treatment modalities, in which the control group received open debridement and the treatment group received transverse tibial bone transfer and compared the differences between the two groups. There were large differences in VAS score, Toronto Clinical Symptom Score, quality of life score, internal lumen diameter, blood flow velocity in the affected limb, perfusion volume, vascular endothelial growth factor, epidermal growth factor and CRP between the two groups after surgery (P < 0.05). Patients with diabetic foot should be treated with transverse tibial bone grafting, which is safer and more effective and can have a significant impact on improving the status of the affected limb, the inflammation and the patient’s quality of life.
基金financially supported by the National Nat-ural Science Foundation of China(Nos.32071341,82202741,52003302,31430030,51973021,32201111,and 52202358)the Chinese Postdoctoral Science Foundation(Nos.2021M703710 and 2021M691464)+1 种基金the Guangdong Basic and Applied Basic Re-search Foundation(Nos.2021A1515111040,2019A1515110841 and 2019A1515011935)the Beijing Municipal Health Commis-sion(Nos.BMHC-20216 and PXM 2020_026275_000002)。
文摘Tissue engineering aims to offer large-scale replacement of damaged organs using implants with the com-bination of cells,growth factors and scaffolds.However,the intra/peri-implant region is exposed to se-vere hypoxic stress and oxidative stress during the early stage of implantation with bone graft materials,which endangers the survival,proliferation and differentiation of seed cells within the implants as well as the host cells surrounding the implants.If the bone graft material could spontaneously and intelligently regulate the hypoxic stress and oxidative stress to a moderate level,it will facilitate the vascularization of the implants and the rapid regeneration of the bone tissue.In this review,we will first introduce the signaling pathways of cellular response under hypoxic stress and oxidative stress,then present the clas-sical material designs and examples in response to hypoxic stress and oxidative stress.And finally,we will address the important role of epigenetic mechanisms in the regulation of hypoxic stress and oxida-tive stress and describe the potential applications and prospective smart bone graft materials based on novel epigenetic factors against hypoxic stress and oxidative stress in bone repair.The main content of this review is summarized in the following graphical abstract.
文摘Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,the treatment for aseptic femoral shaft nonunion is controversial.The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure.Methods:A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019.All patients were treated by leaving the nail in situ,debridement of nonunionsites,decortication,autogenous iliac bone grafting,and augmentative antirotational plating fixation.The time to fracture union and complications were recorded.Results:All patients were followed up for 12–18 months.The union rate after revision surgery was 100%.The average union time was 5.5months(range,4-10).Subjective pain symptoms had disappeared in all patients.There were no incision infections or internal fixator fatigue fractures.Average scores of the physical function and bodily pain components of the SF-36 were 95.5(range,91-98)and 94.1(range,90-97),respectively.No other obvious complications occurred postoperatively.Conclusion:Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing;this approach has an overall high union rate and few complications.
文摘Bone biomaterials have been increasingly used to reconstruct maxillary atrophic ridges.Thus,the aim of this study was to evaluate bone reconstruction in the maxilla using a homologous cortico-cancellous FFB(lyophilized)graft and verify its reliability.Eight individuals were included from 2014 to 2018.The first surgery was performed to install homologous bone blocks in the maxilla.The period of the second intervention varied between 5 months and 15 days to 11 months(≈7.93 months).The biopsies were taken from the central region of the matured graft during the surgery for implant placement.All patients presented clinical and radiographic conditions for the installation of dental implants.There was a 100%of survival rate.The histological assessment showed that the homologous block bone graft was an osteoconductive biomaterial,with connective tissue present,and newly formed bone juxtaposed on its surface.There were bone trabeculae with osteocytes and active osteoblasts with connective tissue in the mineralization process;the remodeling process can be found through the reverse lines.A limited focus of necrosis with fibrosis was detected,with small resorption and areas of inflammatory infiltrate,but without clinical significance.The homologous block bone graft can be considered a feasible option to substitute the autogenous bone graft(gold standard),with predictable clinical and favorable histological results.The patients had a shorter surgical period,low morbidity,and an unlimited amount of biomaterial available at an accessible cost.
