The paper introduced bone graft nourished by venous blood, compared with vascularized and conventional bone graft in the animal experiment. B、h(?)ological, radiological methods and tatracycline labeling, the results confirmed that the bone gra(?) nourished by venous blood is inferior to the vascularized bone graft, but is significantly superior to the conventional bone graft in the survival amount, vitality of osteocytes and bone union. The survival mechanism and practicality of bone graft nourished by venous blood were preliminarily discussed in the paper.
Objective To investigate the effect of transplantation of the cutaneous iliac flap on repairing bone and soft tissue defect of metatarsal. Methods From October 1999 to December 2003, the cutaneous iliac flap was designed for the repair of bone and soft tissue defect of metatarsal in 4 male patients, whose ages ranged from 26 to 47, with skin graft for the coverage of the iliac flap. The duration of injury ranged from 1 to 5 months. The length of the defect ranged from 4 to 7 cm and the defect area ranged from 5 cm×3 cm to 9 cm×5 cm. Results One week after transplantation, complete survival of iliac flap was observed in 3 cases and partial survival in 1 case (but later proved survived). Callus was seen 1 month after transplantation and Kwires were removed 4months after transplantation. Patients were followed up for 5 to 24 months. There were no ulcers. The ability of walking and bearing was satisfying as well asthe function and shape. Conclusion With satisfying restoration of function and shape, transplantation of the cutaneous iliac flap with skin graft is an alternative to treat bone and soft tissue defect of metatarsal with one stage surgery.
OBJECTIVE: To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. METHODS: From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. RESULTS: The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. CONCLUSION: Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.
Objective To study the effect of core decompression combining with autologous cortical sustaining bone and cancellous bone graft in treating osteonecrosis of the femoral head (ONFH). Methods From February 2004 to May 2008, 64 patients (77 hi ps) with ONFH were treated with core decompression combining with autologous cortical sustaining bone and cancellous bone graft, including 45 males and 19 females and aging 23 to 60 years with an average age of 43 years. There were 51 cases of unilateral ONFH and 13 cases of bilateral ONFH. ONFH was caused by alcohol in 39 cases(47 hi ps), by steroid in 21 cases (26 hi ps), and by trauma in 4 cases (4 hi ps). The disease course was 1-12 years. The pain time was 2-14 months (average 7 months). All the cases underwent imageology and postoperation pathology examination to confirm the diagnosis of ONFH. According to Association Research Circulation Osseous (ARCO) international classification of osteonecrosis, 17 cases (23 hips) were classified as stage I A, 2 cases (3 hips) as stage I B, 21 cases (24 hips) as stage II A, 2 cases (2 hips) as stage II B, 4 cases (4 hips) as stage II C, and 18 cases (21 hips) as stage III A. The outcome was evaluated both cl inically by Harris score and radiologically by imageology. Results A total of 59 cases (69 hips) were followed up for 12-62 months with an average of 32.1 months. The Harris score was 87.12 ± 8.68 at 12 months after operation, showing significant difference (P lt; 0.05) when compared with the preoperative one (68.38 ± 14.49). The results were excellent in 39 hips, good in 18 hips, fair in 6 hips, and poor in 6 hip; and the excellent and good rate was 82.6%. Radiographic evaluation was 21 hips (30.4%) of grade I, 42 hips (60.9%) of grade II, and 6 hips (8.7%) of grade III. One case had the compl ication of il ium bone donor site, 21 cases had l ittle pain or numbness, and the other cases had no uncomfortable compl ication. Conclusion The method of core decompression combining with autologous cortical sustaining bone and cancellous bone graft can improve the means of bone grafts, prevent the collapse of the femoral head, and is less traumatic than common procedures. Cl inical effects are obvious and effective.
Objective To analyze the effectiveness of free vascularized fibula grafts (FVFG) for extensive bone defects after resection of lower limb malignant bone tumors. Methods Between November 2015 and July 2018, 15 cases of lower limb malignant bone tumors were treated. There were 12 males and 3 females with an average age of 12.3 years (range, 9-21 years). There were 11 cases of osteosarcoma and 4 cases of Ewing’s sarcoma. The tumor located at middle femur in 8 cases, lower femur in 4 cases, and middle tibia in 3 cases. The disease duration was 2-6 months (mean, 3.2 months). The tumor was completely removed, and the length of the bone defect was 8-23 cm (mean, 17.7 cm). The bone defect was repaired by FVFG, and combined inactivated tumor bone was used in 8 cases of femoral bone defect. Results The average operation time was 280 minutes (range, 180-390 minutes). The average blood loss was 310 mL (range, 200-480 mL). All incisions healed by first intention. All patients were followed up 2-24 months with an average of 14.5 months. Bone healing achieved in all patients at 9-18 months (mean, 12.3 months) after operation except 1 patient which was followed up only 2 months. The fibula grafts had active metabolism and the average bone metabolism score was 184 (range, 111-257) in effected side and 193 (range, 127-259) in contralateral side. There was no difference between bilateral sides. The average Enneking score was 24.6 (range, 20-30) at last follow-up. No ankle instability or paralysis of common peroneal nerve occurred. Conclusion FVFG appeared very efficient in repair of extensive bone defect after resection of lower limb malignant bone tumor.
In this experiment, bone grafts with or without perios-teum were taken from both ilium, usually a small amont ofmuscle was attached. These two types of grafts were trans-ferred respectively to the subcutaneous layer of the feet andto the defects of the metacarpus. After the operation , thespeciments were under gross and histologic examinations, andvolumetric measurment of the grafts pericdically. Vascularregeneration was found one week after operation, and thosegrafts with periosteum showed vascular regeneration and less absoption more than those with no periosteum. The vascular regeneration of the abundant iliac grafts transfered to the dcfects was more than to the subcutaneous layer.
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.
Objective To summarize the progress of Masquelet technique to repair bone defect. Methods The recent literature concerning the application of Masquelet technique to repair bone defect was extensively reviewed and summarized. Results Masquelet technique involves a two-step procedure. First, bone cement is used to fill the bone defect after a thorough debridement, and an induced membrane structure surrounding the spacer formed; then the bone cement is removed after 6-8 weeks, and rich cancellous bone is implanted into the induced membrane. Massive cortical bone defect is repaired by new bone forming and consolidation. Experiments show that the induced membrane has vascular system and is also rich in vascular endothelial growth factor, transforming growth factor β1, bone morphogenetic protein 2, and bone progenitor cells, so it has osteoinductive property; satisfactory results have been achieved in clinical application of almost all parts of defects, various types of bone defect and massive defect up to 25 cm long. Compared with other repair methods, Masquelet technique has the advantages of reliable effect, easy to operate, few complications, low requirements for recipient site, and wide application. Conclusion Masquelet technique is an effective method to repair bone defect and is suitable for various types of bone defect, especially for bone defects caused by infection and tumor resection.