ObjectiveTo review the current research and application progress of three-dimentional (3D) printed porous titanium alloy after tumor resection, and provide direction and reference for the follow-up clinical application and basic research of 3D printed porous titanium alloy. MethodsThe related literature on research and application of 3D printed porous titanium alloy after tumor resection in recent years was reviewed from three aspects: performance of simple 3D printed porous titanium alloy, application analysis of simple 3D printed porous titanium alloy after tumor resection, and research progress of anti-tumor 3D printed porous titanium alloy. Results3D printing technology can adjust the pore parameters of porous titanium alloy, so that it has the same biomechanical properties as bone. Appropriate pore parameters are conducive to inducing bone growth, promoting the recovery of skeletal system and related functions, and improving the quality of life of patients after operation. Simple 3D printed porous titanium alloy can more accurately match the bone defect after tumor resection through preoperative personalized design, so that it can closely fit the surgical margin after tumor resection, and improve the accuracy and efficiency of the operation. The early and mid-term follow-up results show that its application reduces the postoperative complications such as implant loosening, subsidence, fracture and so on, and enhances the bone stability. The anti-tumor performance of 3D printed porous titanium alloy mainly includes coating and drug-loading treatment of pure 3D printed porous titanium alloy, and some progress has been made in the basic research stage. ConclusionSimple 3D printed porous titanium alloy is suitable for patients with large and complex bone defects after tumor resection, and the anti-tumor effect of 3D printed porous titanium alloy can be achieved through coating and drug delivery.
ObjectiveTo review antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants, so as to provide reference for subsequent research. MethodsThe related research literature on antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants in recent years was reviewed, and the research progress was summarized based on different kinds of antibacterial substances and osteogenic active substances. ResultsAt present, the antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants includes: ① Combined coating strategy of antibiotics and osteogenic active substances. It is characterized in that antibiotics can be directly released around titanium-based implants, which can improve the bioavailability of drugs and reduce systemic toxicity. ② Combined coating strategy of antimicrobial peptides and osteogenic active substances. The antibacterial peptides have a wide antibacterial spectrum, and bacteria are not easy to produce drug resistance to them. ③ Combined coating strategy of inorganic antibacterial agent and osteogenic active substances. Metal ions or metal nanoparticles antibacterial agents have broad-spectrum antibacterial properties and various antibacterial mechanisms, but their high-dose application usually has cytotoxicity, so they are often combined with substances that osteogenic activity to reduce or eliminate cytotoxicity. In addition, inorganic coatings such as silicon nitride, calcium silicate, and graphene also have good antibacterial and osteogenic properties. ④ Combined coating strategy of metal organic frameworks/osteogenic active substances. The high specific surface area and porosity of metal organic frameworks can effectively package and transport antibacterial substances and bioactive molecules. ⑤ Combined coating strategy of organic substances/osteogenic active substancecs. Quaternary ammonium compounds, polyethylene glycol, N-haloamine, and other organic compounds have good antibacterial properties, and are often combined with hydroxyapatite and other substances that osteogenic activity. ConclusionThe factors that affect the antibacterial and osteogenesis properties of titanium-based implants mainly include the structure and types of antibacterial substances, the structure and types of osteogenesis substances, and the coating process. At present, there is a lack of clinical verification of various strategies for antibacterial/osteogenesis dual-functional surface modification of titanium-based implants. The optimal combination, ratio, dose-effect mechanism, and corresponding coating preparation process of antibacterial substances and bone-active substances are needed to be constantly studied and improved.
Objective To investigate the effectiveness on the re-fracture of the femur with occult infection by using non-contact locking plate which was placed under the deep fascia. Methods Clinical data of 12 cases of occult infective re-fracture after femoral fracture operation were retrospectively analysed between January 2010 and December 2014. There were 8 males and 4 females with an age of 28-69 years (mean, 42.8 years). Femur re-fractured in 5 cases after 3 days to 4 weeks (mean, 10.6 days) of removal of internal fixation, including 4 cases of plate fixation and 1 case of intramedullary nail fixation; femur in 7 cases re-fractured because of breakage of internal fixator after 7-16 months (mean, 9.3 months) of internal fixation, including 5 cases of plate fixation and 2 cases of intramedullary nail fixation. The tissues near the fracture were collected for bacteria culturing and pathological examining. All the patients were treated by debriding the site of the fracture, bridging with the non-contact locking plate, and transplanting with granulated cancellous bone autograft. Intravenous infusion of antibiotics were used for 2-3 weeks after operation and oral administration for 4 weeks. The X-ray films were taken regularly and the function of the knees were evaluated by the Hospital for Special Surgery (HSS) score system. Results The results of bacteria culturing were positive in 8 patients and negative in 4 patients, and the pathological results of all the patients were confirmed to be chronic bone infection. All the fractures healed with no signs of exudation and ulceration of the incisions. The 12 patients were followed up 18-36 months (mean, 29.6 months). The fracture healed well and no re-fracture occurred. The fracture healing time was 14-22 weeks (mean, 18 weeks). At last follow-up, the function of the knee joint was excellent in 9 cases and good in 3 cases according to HSS score system. Conclusion The treatment of re-fractures after femur fracture operation needs to determine whether there is an occult infection, and non-contact locking plate placed under the deep fascia is an effective way for the re-fracture.
ObjectiveTo investigate the effectiveness on the distal radius deformity and bone defect after trauma by using Ilizarov external fixator.MethodsThe clinical data of 9 patients of post-traumatic distal radius deformity with bone defect treated by Ilizarov technique between January 2012 and December 2016 were retrospectively analyzed. There were 7 males and 2 females with an average age of 25.6 years (range, 11-46 years). Of the 9 cases, 4 were radial baseball hand deformity with large bone defect, 4 were short deformity of distal radius, 1 was distal radius deformity with radial deflection and pronation deformity, all with distal dislocation of the distant radial-ulnar joint. The time from injury to operation was 6 months to 6.2 years (mean, 1.5 years). The bone defect was 1.4-6.8 cm (mean, 3.6 cm). After complete debridement, the forearm was fixed with Ilizarov external fixator. At 7 days after operation, bone transport or bone lengthening was performed at the rate of 0.8-1 mm/d, 4 times a day, the deformity was slowly corrected and the bone defect was repaired. According to the loss of palmar tilt angle and ulnar tilt angle measured before operation, the position of distal radial articular surface was gradually adjusted in the course of moving or prolonging, so as to restore palmar tilt angle and ulnar tilt angle as far as possible.ResultsAll wounds healed by first intention and no leakage or rupture occurred. All the 9 patients were followed up 15-36 months (mean, 23 months). All the radius defects healed and the distal deformity was corrected, the healing time was 92.4-138.6 days (mean, 104.7 days); the external fixation index was 32.6-51.1 days/cm (mean, 40.2 days/cm). After 2 months of external fixator removal, the wrist joint flexion was (42.6±3.1)°, the wrist dorsum extension was (48.5±4.7)°, the palm inclination angle was (11.5±1.3)°, and the ulnar deviation angle was (21.2±3.7)°; the elbow flexion was (128.2±6.4)°, the elbow extension was (3.2±2.1)°, the forearm pronation was (71.5±4.3)°, and the forearm rotation was (38.2±6.5)°; the wrist and elbow joint extension and forearm rotation were significantly improved when compared with preoperative values (P<0.05). At last follow-up, wrist function was assessed according to Gartland-Werley standard, the results were excellent in 3 cases, good in 5 cases, and fair in 1 case. Four cases had pinhole infection, and were cured after anti inflammatory dressing change or replacement of needles; 3 cases did not heal at the bone junction, and were healed after bone grafting; 4 cases deviated from the radial force line, and the deformity was corrected after adjusting the needle.ConclusionIlizarov technique can correct deformity and reconstruct bone defect of the post-traumatic distal radius simultaneously, so it is a good method to treat this kind of disease.
ObjectiveTo investigate the effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of the soft tissue defect of forefoot.MethodsBetween March 2011 and March 2017, 18 cases with severe soft tissue defects of forefeet were repaired with the wide fascial and doubly vascularized pedicle posterior cnemis flaps. There were 13 males and 5 females with an average age of 33 years (range, 11-49 years). Of 18 cases, the defects were caused by trauma in 16 cases with an average disease duration of 15 hours (range, 3-72 hours), by infection after correction of spastic clubfoot in 1 case, and by infection after open fracture fixation in 1 case. The defects were on the planta of forefoot in 11 cases and on the dorsum of forefoot in 7 cases. The size of soft tissue defects ranged from 6 cm×4 cm to 15 cm×9 cm. All defects combined with the bone, joint, and tendon exposures and 4 defects combined with fractures. The size of flaps ranged from 8 cm×5 cm to 17 cm×10 cm. All wounds of donor sites were repaired by skin grafting.ResultsThe operation time was 100-190 minutes (mean, 140 minutes). Seventeen flaps survived and wounds healed by first intention. One flap had partial necrosis and cured after dressing change. Seventeen cases were followed up 5-24 months (mean, 16 months). Both the color and texture of the flaps were satisfactory. But the pedicles of flaps were swollen. The functions of foot and ankle returned to normal.ConclusionThe wide fascial and doubly vascularized pedicle posterior cnemis flap has reliable blood supply and sufficient venous reflux to ensure its survive, which can be used to repair severe soft tissue defect of forefoot.
Objective To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening. Methods The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded. ResultsAfter the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation (P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case. ConclusionUlnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness.