Objective To study the past, present and future of bone grafting. Methods Related l iterature on bone grafting in recent years was extensively reviewed. Results Bone grafting had a history over 300 years, a variety of bone grafting candidates including autografting, allografting, xenografting, synthetic and composite bone grafting had been util ized in cl inical orthopedics at present. But bone autografting and allografting represented the preferred alternatives for bone grafting.It would be important trend in bone grafting to fulfill the optimizing design of biomaterials and constructing composite bone substitutes with cells, factors and scaffolds. Conclusion The future bone grafting might be focused on how to achieve the goal of the rapid osseointegration as well as the physiological bone reconstruction.
Objective To explore the feasibility of combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation for correction of secondary midface deformities in cleft patients. Methods From January 2002 to January 2005, 10 patients suffering from secondary midface deformities were treated. There were 4 males and 6 females, aged from 16 to 32 years. The unilateral cleft was involved in 8 patients and the bilateral cleft in2 patients. All patients received combining high level Le Fort Ⅰ osteotomy with bone grafting in the same operation. The horizontal corticotomy of high level Le Fort Ⅰosteotomy on anterior wall of maxillary bone is higher than that of traditionalLe Fort Ⅰ osteotomy, it is only 5 mm close to infraorbital foramen. Results All 10 patients were satisfied with their appearances after operation. Dental articulation was improved greatly in 9 patients. With an X-ray re-examination, maxillary was returned to normal position in all patients. After a follow up from 6months to 2 years, dental arch had good appearance. The X-ray films showed no obvious bone absorption. The density of grafting bone was approximation to the normal bone.Conclusion High level Le Fort Ⅰ osteotomy can make notonly maxillary advance, but also regions of lateral and floor of nose and partial infraorbital region advance. Combining with bone grafting in the same operation can decrease the frequency of operation, save the treatment expense and obtain an ideal effect. So it is an effective method for correction of the secondary midface deformities in cleft patients.
Objective To evaluate the cl inical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. Methods From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35° (average 26.7°). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score: 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. Results The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms rel ived 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21° (average 15.2°) 12 months after operation without aggravation. The Frankel gradingsystem was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in l iver and kidney function. There was no recurrence of tuberculosis. Conclusion It seems that the systemic drug treatment of antituberculosis before and after operation, the thorough debridement of focus during operation, and the effective and rel iable wayto reconstruct for the spinal stabil ity are the key points for the treatment of spinal tuberculosis.
ObjectiveTo study the effectiveness of posterior laminotomy decompression and bone grafting via the injured vertebrae for treatment of thoracolumbar burst fractures. MethodsBetween November 2010 and November 2012, 58 patients with thoracolumbar burst fractures were treated by posterior fixation combined with posterior laminotomy decompression and intervertebral bone graft in the injured vertebrae. There were 40 males and 18 females with a mean age of 48 years (range, 25-58 years). According to Denis classification, 58 cases had burst fractures (Denis type B); based on neurological classification of spinal cord injury by American Spinal Injury Association (ASIA) classifications, 5 cases were rated as grade A, 18 cases as grade B, 20 cases as grade C, 14 cases as grade D, and 1 case as grade E. Based on thoracolumbar burst fractures CT classifications there were 5 cases of type A, 20 cases of type B1, 10 cases of type B2, and 23 cases of type C. The time between injury and operation was 10 hours to 9 days (mean, 7.2 days). The CT was taken to measure the space occupying of vertebral canal. The X-ray film was taken to measure the relative height of fractured vertebrae for evaluating the vertebral height restoration, Cobb angle for evaluating the correction of kyphosis, and ASIA classification was conducted to evaluate the function recovery of the spinal cord. ResultsThe operations were performed successfully, and incisions healed primarily. All the patients were followed up 12-18 months (mean, 15 months). CT showed good bone graft healing except partial absorption of vertebral body grafted bone; no loosening or breakage of screws and rods occurred. The stenosis rates of fractured vertebral canale were 47.56%±14.61% at preoperation and 1.26%±0.62% at 1 year after operation, showing significant difference (t=24.46, P=0.00). The Cobb angles were (16.98±3.67)° at preoperation, (3.42±1.45)° at 1 week after operation, (3.82±1.60)° at 1 year after operation, and (4.84±1.70)° at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). The relative heights of fractured vertebrae were 57.10%±6.52% at preoperation, 96.26%±1.94% at 1 week after operation, 96.11%±1.97% at 1 year after operation, and 96.03%±1.96% at 3 months after removal of internal fixation, showing significant differences between at pre-and post-operation (P < 0.05). At 1 year after operation, the neural function was improved 1-3 grades in 56 cases. Based on ASIA classifications, 1 case was rated as grade A, 4 cases as grade B, 10 cases as grade C, 23 cases as grade D, and 20 cases as grade E. ConclusionTreatment of thoracic and lumbar vertebrae burst fractures by posterior laminotomy decompression and bone grafting via the injured vertebrae has satisfactory effectiveness, which can reconstruct vertebral body shape and height with spinal cord decompression and good vertebral healing. It is a kind of effective solution for thoracolumbar burst fracture.
Objective To investigate the amount of bone grafting, bone defect gap residual rates, and biomechanical stability of the injured vertebral body after reduction of thoracolumbar burst fractures, pedicle screw-rods fixation, and bone graft by bilateral pedicle or unilateral spinal canal. Methods Eighteen fresh lumbar spine (L1-5) specimens of calves (aged 4-6 months) were collected to establish the burst fracture model at L3 and divided into 3 groups randomly. After reduction and fixation with pedicle screws, no bone graft was given in group A (n=6), and bone graft was performed by bilateral pedicles in group B (n=6) and by unilateral spinal canal in group C (n=6). The amount of bone grafting in groups B and C was recorded. The general situation of bone defect gaps was observed by the DR films and CT scanning, and the defect gap residual rates of the injured vertebrae were calculated with counting of grids. The compression stiffness was measured by ElectreForce-3510 high precision biological material testing machines. Results The amount of bone grafting was (4.58 ± 0.66) g and (5.72 ± 0.78) g in groups B and C respectively, showing signficant difference (t=2.707, P=0.022). DR films and CT scanning observation showed large bone defect gap was seen in injured vertebrae specimens of group A; however, the grafting bone grains was seen in the “eggshell” gap of the injured vertebral body, which were mainly located in the posterior part of the vertebral body, but insufficient filling of bone graft in the anterior part of the vertebral body in group B; better filling of the grafting bone grains was seen in injured vertebral body of group C, with uniform distribution. The bone defect gap residual rates were 52.0% ± 5.5%, 39.7% ± 2.5%, and 19.5% ± 2.5% respectively in groups A, B, and C; group C was significantly lower than groups A and B (P lt; 0.05), and group B was significantly lower than group A (P lt; 0.05). Flexion compressive stiffness of group C was significantly higher than that of groups A and B (P lt; 0.05), but no significant difference was found between groups A and B (P gt; 0.05). Extension compressive stiffness in group C was significantly higher than that in group A (P lt; 0.05), but no significant difference was found between groups A and B, and between groups B and C (P gt; 0.05). The compression stiffness of left bending and right bending had no significant difference among 3 groups (P gt; 0.05). Conclusion Thoracolumbar burst fracture pedicle screws fixation with bone grafting by unilateral spinal canal can implant more bone grains, has smaller bone defect gap residual rate, and better recovery of flexion compression stiffness than by bilateral pedicles.
Objective To investigate the clinical effect of medical grade calcium sulfate(Osteoset) as a bone graft substitute. Methods From December 2004 to May 2005, 9 cases of bone defect(limb group)were repaired with Osteoset pellets; bone defect was caused by benign tumor inlimbs, including 3 cases of fibroma xanthomas in humerus(1 case) and acetabulum (2 cases), 2 cases of bone cysts in humerus(1) and radius(1), 1 case of nonossifying fibroma, 1 case of ossifying fibroma and 2 cases of osteofibrous dysplasia in femurs. Five cases of lumbar posterolateral fusion (spine group) were treated with Osteoset pellets as autograft volume expander, including 2 cases of lumbar spinal stenosis, 2 cases of lumbar spondylolisthesis and 1 case of lumbar spondylolysis. Radiological method was used to evaluate the repair effect of Osteoset pellets. Results The mean follow-up time was 6.2 months (3to 9 months). Osteoset pellets began to be absorbed after 1 to 3 months of operation, and were totally absorbed and replaced by osseous tissue after 4 to 6months. No local recurrence was detected in limb group and the function of limbs was normal. At 6 months after operation, all patients in spine group got bony fusion. Conclusion Medical grade calcium sulfate (Osteoset) isan ideal bone graft substitute with excellent bone repair effect.
【Abstract】 Objective To study a new method of alveolar cleft bone graft repair. Methods From April 2005to August 2006, 26 cases (30 sides) of alveolar cleft were treated with trabecular substance of self-il ium combined with the decalcified dentinal matrix of human (DDM). There were 16 males and 10 females, aged 6-12 years. Unilateral alveolar cleft was involved in 22 cases, bilateral alveolar cleft in 4 cases. All cases were accompanied by nasal wing collapse, 5 by deciduous tooth retention, 3 by malposed teeth and 1 by tooth deformity. Anterior occlusal radiographs and panoramic oral radiographs were taken to observe union and bone absorption before and after operation. Results Twenty-three patients achieved heal ing by first intention, oronasal fistulas were closed successfully. Infection occurred in one bilateral alveolar cleft case and bone tissue exposure in 2 cases. Wound healed by rinse or dressing change and inunction with MEBO. The X-ray films after operation showed bone bridge formation in the alveolar cleft. The stabil ity and continuity of body of maxilla were resumed. Four cases (6-9years old) were observed 6.5 months, 22 cases (9-12 years old ) were observed 8.6 months. According to Bergland for evaluation,the X-ray films after 3 months of operation showed 16 cases (16 sides) in class I (53.3%), 7 cases (8 sides) in class II (26.7%),2 cases (4 sides) in class III (13.3%), and 1 case(2 sides) in class IV (6.7%). The overall survival ratio of alveolar bone grafting was 93.3%, and the cl inical success ratio was 80%. Conclusion The DDM is good in alveolar cleft bone graft repair. It is better than using self-il ium only cl inically.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
OBJECTIVE: To present a surgical choice for nonunion and bone defect. METHODS: From November 1994 to October 1997, 17 cases of nonunion of fracture and massive bone defect were treated by autogenous iliac bone and fibular bone with vascular anastomosis. Of 17 cases, there were 10 cases of nonunion of bone fracture, 7 cases of bone defect following tumor resection (4 cases of benign and 3 cases of malignant). Autogenous fibular bone grafting with vascular anastomosis, ranging from 12 cm to 29 cm in length, were employed in 12 cases; autogenous iliac bone grafting, ranging from 7 cm x 3 cm to 9 cm x 5 cm in size, were utilized in the other 5 cases. All of 17 cases were followed up for 10 months to 5 years, 3 years and 7 months in average, and were evaluated from clinical manifestation. RESULTS: Bone union was achieved in 10 cases of nonunion of fracture after bone grafting, bony refilling of the bone defect was observed in 4 cases due to benign tumor and 1 case due to malignant tumor. The other 2 cases of malignant tumor died from lung metastasis of the tumor 10 months and 12 months after bone grafting, respectively. CONCLUSION: Bone grafting is an effective surgical option in treatment of nonunion of fracture and bone defect.
Objective To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Methods Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.