Seven cases with bone tumor in upper limb were reported. Five cases were treated by using free vascularized fibular graft, 2 cases by using fusion between humorus and clavicle. A follow-up study of six patients showed that the graft bone was united within 3 months in 5 cases, in 6 months in one case. Partial function of upper limb in 6 patients have been restored.
Since 1979, vascularized iliac bone graft based on the deep circumflex iliac vessels (DCIV) or the deep superior branches of superior gluteal vassels (SGV) was used to the treatment of bone defect, non-union of fracture, and aseptic necrosis of the femoral head in Ⅱ4 cases. Of these Ⅱ4 graftings, 68 were pedicled, 46 were microvascular free transfer. Early callus formation developed 6 weeks after surgery. Solid bony union was obtained in 3 months. Among 32 patients with aseptic necrosis of femoral head followed more tha 1 years, dior relief of pain and omprovement of X-ray findings were obtained in 31. The advantages of using vascularized iliac bone graft, especially based on the DCIV and SGV, are discussed. The author has a good opinion of vascularized iliac bone graft based on the SGV.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
In order to observe stereological correlation between new vessels and surrounding tissue, 6 rabbits were used for the following experiments. The mandible defect model was made by cutting 1 cm x 0.5 cm bone from both right and left side of mandible. Then, the left defect was repaired by the bone segment from the right side, and the right defect was repaired by frozen allogenic bone segment. One month later, the metabolism of the bone segments was observed by nuclein scintiphotography. The revascularization of the bone segments was observed by vascular corrosion cast method. It was shown that new vessels from host soft tissue could penetrate the periosteum of allogenic transplanted bone, along the absorbing path, ingrowth into the bone. The metabolism of the bone was active. It was suggested that the vessel growth from host to the graft is one of the main patterns of revascularization.
OBJECTIVE To compare the osteogenesis of recombination artificial bones, which are bovine deproteined bone (bDPB) and bovine bone morphogenetic protein (bBMP), combined with tumor necrosis factor alpha (TNF alpha), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) respectively. METHODS One hundred trephined skull bone defects in fifty rabbits were divided into four groups, which implanted with bDPB/bBMP/TNF alpha, bDPB/bBMP/bFGF, bDPB/bBMP/EGF, and bDPB/bBMP respectively. X-ray and histological changes were observed in the 1st, 2nd, 4th, 6th, 8th weeks after implantation. The content of 35S and 45Ca and ash weight were measured at 10 and 42 days after operation. RESULTS The osteogenesis of bDPB/bBMP/TNF alpha group was ber than that of bDPB/bBMP/bFGF group(P lt; 0.01), while bDPB/bBMP/bFGF group was ber than that of bDPB/bBMP/EGF(P lt; 0.01). No significant statistical difference were found between bDPB/bBMP/EGF and bDPB/bBMP(P gt; 0.05). CONCLUSION TNF alpha combined with bBMP and carrier can stimulate bone formation and increase the volume of new bone in vivo. It suggests that bDPB/bBMP/TNF alpha is a valuable biomaterial of bone graft.
Six cases of maxillary tumors after being resccted radically, a primary repair of the maxillary defects were carried out by grafting of the pedicled buccal fat pad as the oral linning combined with bone graft. The cases were followed from 8 to 14 months. The function of the maxillary sinuses was normal and the facial contour was restored symmetrical. The applied anatomy and the method of operation were introduced in details. The advantages of the method were discussed.
Since 1979, 13 different types of vascularized bone or periosteal flaps were used to repair bone defects following resection of skeletal neoplasms in 109 cases. The result was satisfactory. In this article, the main points in discussion werethe operative indication, how to design the flap and the technique used to repair the defect.
Objective To compare the long-term results of vascularised fibulargraft and simple autologous fibular graft for reconstruction of wrist after distal bone tumor resection.Methods From January 1979 to September2002, 15 patients with wrist defects due to distal bone tumor resection were treated with vascularised fibular graft or simple autologous fibular graft and followed up 1 year. The results were graded with Enneking’s system and evaluated radiographicallyaccording to the “International Symposium on Limb Salvage”. The grade system included limb function, radiological examination and the function of ankle. Results The limb function of 8 patients with vascularised fibular graft restored to 80% of normal function and the bone union was achieved within 6 months. The limbfunction of 6 patients with simple autologous fibular graft restored to 67% of normal function. The bony union was achieved within 6 months in 4 cases with thebone graft less than 5 cm and in the 13th and 16th months in 2 cases with the bone graft more than 12 cm. Conclusion It is suitable to use the headof fibular boneas a substitute for the distal radius. The healing of vascularised fibular graft is very quick and haven’t the bone resorption. So in the procedure for reconstruction and limb salvage after bone tumor resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.