【Abstract】 Objective To evaluate the effects of allogeneic bone graft for reconstructing bone defect of clavicle aftertumor resection. Methods Nine patients received the surgical procedures for repairing and reconstructing bone defect afterresection of clavicle tumor from January 2000 to January 2006. There were 4 males and 5 females aged 12 to 68 years. Two patientswere diagnosed as having benign tumor and tumor-like lesion(stage Ⅲ according to Campanacci grading), and 7 as having primarymalignant tumor and metastatic cancer. Three lesions were located in acromial end, 2 in sternal end and 4 in shaft of clavicle. Twocases was accompanied by pathological fracture. According to Enneking’s functional evalutation, the results were excellent in 3 cases,good in 3 cases, fair in 1 case and poor in 2 cases. Based on the visual analogue scale (VAS), pain was rated as medium rest-pain in4 cases, as medium move-pain in 3 cases and heavy pain in 2 cases preoperatively. The tumor was resected with en bloc. Defectedclavicles were reconstructed by a part of allograft clavicle and plate. The patients with malignant tumor received neo-adjuvant chemotherapyand radiotherapy postoperatively. The results were evaluated according to control of tumor, rel ief of pain, bone healingand shoulder joint function. Results These patients were followed up 12 to 70 months (mean 34.6 months). There were no localrecurrence and metastases in all patients during the follow-up. No complications of immune rejection and deep infection wereseen. The normal shape of the shoulders was restored. Eight of all patients showed primary bone healing between allograft boneand host bone. The mean healing time was 5.4 months (3.2-6.8 months). Loosening of the plate and nonunion were seen in 1 case;and bone grafting was given again. Fracture of allograft occurred in 1 case after removing internal fixation. According to Enneking’s functional evulation, the results were excellent in 6 cases and good in 3 cases at 3 months after operation; excellent in 4 cases, goodin 1 case and fair in 1 case among 6 patients who were followed up for 24 months. The VAS results of postoperation showed l ightmove-pain in 2 cases at 3 months, l ight move-pain and medium move-pain in 1 case respectively and no pain in 7 cases 12 months after operation. Conclusion Allogeneic clavicle is a useful and rel iable reconstructive material for clavicle defect due to tumor resection. The satisfactory shape and favorable function of the shoulder may be recovered after this procedure.
To investigate the operative treatment of displaced intra-articular calcaneal fractures (DIACFs) using a combination of small lateral incision approach and internal fixation and allograft bone transplantation. Methods From January 2005 to December 2007, 28 patients with 34 DIACFs were treated with open reduction, allograft bone transplantationand internal fixation through a small lateral incision approach. Of them, there were 18 males and 10 females, aged 16-65 years. The disease course was 2 hours to 18 days. According to Sanders classification, there were 18 cases of type II fractures, 10 cases of type III fractures and 6 cases of type IV fractures. Results 22 patients with 28 DIACFs were followed up 18.5 months (13-28 months). The wound of 26 feet achieved primary heal ing, the acute rejection was found in 2 patients and developed wound compl ications. Both patients underwent further surgery prior wound heal ing. After the internal fixation were removed, factures was fixed with external fixator, closed continuous irrigation and drainage was employed. In the meantime, both patients received antibiotics and incisional dressing change. As a result, one achieved primary heal ing, the other developed delayed heal ing. Thepreoperative X-ray film showed that Bouml;hler angle was (6.19 ± 9.66)° and Gissane angle was (103.04 ± 15.03)°; the postoperative X-ray film demonstrated that Bouml;hler angle was (34.51 ± 5.89)° and Gissane angle was (112.18 ± 10.50)°; showing statistically significant differences (P lt; 0.05). The internal fixation of 12 patients (14 DIACFs) were removed at 6 -10 months after operation, Bouml;hler angle was (32.81 ± 5.10)° and Gissane angle was (110.81 ± 9.98)°. When compared with preoperative X-ray film, statistically significantdifferences (P lt; 0.05) was found, but there was no statistically significant differences (P gt; 0.05) when compared with normal X-ray film. According to the American Orthopedic Foot and Ankle Society evaluation system for ankle-hind foot, 3 feet scored 60-70 points, 10 feet 70-80 points, 12 feet 80-90 points and 3 feet 90-100 points. Conclusion Allograft bone transplantation is an option for management of DIACFs, because it enables satisfactory reconstruction of bone defects, allows met anatomic reduction and functional recovery, maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.
Objective To investigate the clinical result of treatment of bonecyst by transplantation of the autologous bone marrow combined with the allograft bone. Methods From February 2004 to March 2006, 13 patients withbone cyst were treated by transplantation of the autologous bone marrow combined the the allograft bone. Among the 13 patients, 6 were males and 7 were females, ranging in age from 5 to 16 years, averaged 11.5 years. In the patients, 5 lesions were located inthe proximal humerus, 2 in the femoral neck, 3 in the femoral shaft, 2 in the proximal tibia, and 1 in the distal tibia. Among the patients, 5 had a complication of pathologic fracture. All the patients underwent an erasion of the bone cyst, and then the transplantation of the autologous bone marrow combined with the allograft bone, and 8 of them were also given an instrument fixation. Results The follow-up for 6 months to 2 years after operation revealed that 5 of the patients had an incision healing by the first intention, 5 had an effusion in the incision site, and 3 had a delayed healing of the incision. According to the Capanne criteria, the postoperative X-ray findings indicated that 10 patients had Grade Ⅰ healing, and 3 had Grade Ⅱ healing. The complete healing took 3.5-8 months,averaged 5.2 months. There was no recurrence. When the fixation instrument was removed, no pathologic fracture occurred. The function of the upper and lower limbs recovered. Conclusion Transplantation of the autologous bone marrow combined with the allograft bone is an effective and safe procedure for treatment of bone cyst.
Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
ObjectiveTo review the research progress and clinical application of allograft bone spacer in cervical and lumbar interbody fusion. MethodsLiterature about allograft bone spacer in cervical and lumbar degenerative disease was reviewed and analyzed, including the advantages and disadvantages of allograft material, fusion rate, effectiveness, and complications. ResultsFusion rate and effectiveness of allograft bone spacers were similar to those of autograft and polyetheretherketone spacers, and they were recommended by many orthopedists. However, indications, long-term effectiveness, and complications were not clear. ConclusionFurther study on allograft bone spacer in cervical and lumbar interbody fusion should be focused on optimal indications and long-term effectiveness.
ObjectiveTo analyze the effectiveness of a new type of decellularized allogeneic bone in the application of anterior cervical discectomy and fusion (ACDF). MethodsA retrospective analysis was made on the clinical data of 73 patients with single segmental cervical spondylosis treated with ACDF between January 2009 and December 2013. Of 73 cases, autologous iliac bone was used in 22 cases (group A), new decellularized allogeneic bone transplantation (Bio-Gene) in 22 cases (group B), and normal allogeneic bone (Xin Kang Chen) in 24 cases (group C). There was no significant difference in gender, age, type of cervical spondylosis, course of disease, and involved segment among 3 groups (P>0.05). The operation time, intraoperative blood loss, and complications were compared between groups; X-ray films and CT images were taken to observe the bone fusion, and Japanese Orthopaedic Association (JOA) score was used to assess the clinical efficacy. ResultsThe operation time and intraoperative blood loss of group A were significantly more than those of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Pain and numbness at donor site occurred in 12 cases, and poor healing in 1 case of group A; red swelling and exudate were observed in 1 case of group B and in 6 cases of group C; and there was significant difference in complications among 3 groups (χ2=18.82, P=0.00). All patients were followed up 6-54 months (mean, 30 months). The graft fusion rate was 100% in groups A and B, and was 95.8% in group C, showing no significant difference (χ2=2.04, P=0.36). The JOA score at 6 months after operation were significantly improved when compared with preoperative score in 3 groups (P<0.05), but no significant difference was found among the 3 groups at preoperation and 6 months after operation (P>0.05). The excellent and good rates of groups A, B, and C were 90.9%, 88.9%, and 87.5% respectively, showing no significant difference (χ2=0.14, P=0.93). ConclusionNew type of decellularized allogeneic bone in ACDF has the advantages of shorter operation time, less blood loss, and better early effectiveness. But whether there is a chronic rejection or delayed rejection needs further studies.
ObjectiveTo explore whether FTY-720P could enhance the effect of allograft bone for bone defect repair by suppressing osteoclast formation and function. MethodAnimal experiment:Forty-eight New Zealand white rabbits were selected to establish the tibia defect model (1.5 cm in length) and were divided into 4 groups (n=12) . Defect was not repaired in group A, defect was repaired with allograft bone in group B, with autogenous fibula in group C, and with allograft bone and FTY-720P in group D. Lane-Sandhu scoring system and bone density examination were used to evaluate the effect at 2, 4, 8, and 12 weeks after operation. Cell experiment:Bone marrow-derived mononuclear phagocytes (BMMs) were harvested from 1-month-old Sprague Dawley rats and induced into osteoclasts with macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL), then were identified with tartrate-resistant acid phosphatas (TRAP). According to different concentrations of FTY-720P before induction, experiment was divided into 0, 500, 600, 700, 800, 900, 1 000, and 1 500 ng/mL groups. The effect of FTY-720P was studied by counting the number of osteoclasts and the number of bone resorption lacunae made by osteoclasts. ResultsAnimal experiment:Lane-Sandhu score showed no significant difference between groups at 2 weeks after operation (P>0.05) , but the score was significantly better in groups C and D than groups A and B, and in group B than group A (P<0.05) . The bone density of group C was significantly greater than that of groups A, B, and D at 2 weeks after operation (P<0.05) , but no significant difference was found among groups A, B, and D (P>0.05) ; the bone density of groups B, C, and D was significantly greater than that of group A at 4, 8, and 12 weeks (P<0.05) , but no significant difference was shown among groups B, C, and D (P>0.05) . Cell experiment:BMMs could be induced into osteoclasts by the addition of M-CSF and RANKL, which could be proved by counting the number of the nuclear and TRAP staining. The osteoclasts were significantly more in 0, 500, 600, 700, 800, 900 ng/mL groups than 1 000 and 1 500 ng/mL groups (P<0.05) , in 0, 500, 600, and 700 ng/mL groups than 800 and 900 ng/mL groups (P<0.05) , in 0, 500, 600 ng/mL groups than 700 ng/mL group (P<0.05) ; and there was no significant difference between the other groups (P>0.05) . The number of bone resorption lacunae in 0, 500, 600, and 700 ng/mL groups was significantly higher than that in 800, 900, 1 000, and 1 500 ng/mL groups (P<0.05) , and it was significantly higher in 0, 500 and 600 ng/mL groups than 700 ng/mL group (P<0.05) , but difference was not significant between the other groups (P>0.05) . ConclusionsFTY-720P combined with allograft bone for bone defect repair can have the same effect to autogenous bone by means of inhibiting osteoclast formation and function, which reduces bone loss.