Objective To investigate the effectiveness of shortening-lengthening method using Ilizarov technique for repairing large tibial bone and soft tissue defects. Methods Between January 2006 and December 2011, 12 patients with large tibial bone and soft tissue defects were treated by shortening-lengthening method using Ilizarov technique. There were 8 males and 4 females with an average age of 39.3 years (range, 18-65 years). The causes were injury in 8 cases and chronic infection in 4 cases. The area of soft tissue defect was 5 cm × 4 cm to 20 cm × 16 cm, and the length of tibial bone defect was 4.5-8.0 cm with an average of 6.2 cm. Results Incision in the lengthening area healed by first intention; healing of wounds by first intention was achieved in 6 cases, delayed healing in 2 cases, and secondary healing in 4 cases, with no common peroneal nerve injury. All patients were followed up 18-54 months with an average of 29 months. In the lengthening area, the bone healing time was 180-365 days (mean, 267 days), and the healing index was 3.8-4.3 days/mm (mean, 4.1 days/mm). In the shortening area, the bone healing time was 195-380 days (mean, 297 days) in the others except 1 case who was repaired with bone grafting. Mild pin-related infection and loosening were observed in all cases, but no infection occurred in the lengthening or shortening area. At last follow-up, weight bearing of the leg was fully recovered in 12 cases. According to Mazur’s criteria, the function of ankle was excellent in 2 cases, good in 6 cases, and fair in 4 cases. Nine patients had equal limb length, and 3 patients had shortened length less than 2 cm. Conclusion Shortening-lengthening method using Ilizarov technique has the advantages of simple surgery, less complications, easy to close the wound, and good effectiveness in repairing of large tibial bone and soft tissue defects．
Objective To investigate the early-term effectiveness of extra-large uncemented acetabular components for hip revision in the treatment of extensive acetabular bone defect. Methods Between September 2008 and May 2012, 13 patients (13 hips) with extensive acetabular bone defect underwent first hip revision using extra-large uncemented acetabular components (Jumbo cup). The diameter of Jumbo cup was larger than or equal to 64 mm for male and 60 mm for female. There were 4 males and 9 females with an average age of 64.7 years (range, 58-84 years). The period from primary arthroplasty to revision was 3-16 years (mean, 9.6 years). According to Paprosky classification, acetabular bone defect was rated as stage IIA in 2 cases, as stage IIB in 5 cases, as stage IIC in 4 cases, and as stage IIIA in 2 cases. The preoperative vertical distance from the center of involved femoral head to interteardrop line was (21.2 ± 6.1) mm longer than that of normal side. The Harris score and the rotation center of hip were evaluated preoperatively and postoperatively. Results Healing of incision by first intention was obtained in all patients, and no complication of dislocation, infection, and injury of sciatic nerve or femoral nerve occurred. The duration of follow-up ranged from 13 to 40 months (mean, 23.5 months). Partial or complete pain relief was achieved in all patients. The other patients could walk independently and restored to their routine jobs except for 1 case of hemiplegia caused by acute cerebral infarction at 3 months after surgery. In 5 patients with bone implantation, with the prolonging follow-up, the allograft could integrate with the host bone without absorption, and the bone fusion time was 9-35 months (mean, 14.5 months). At last follow-up, the X-ray films revealed that the vertical distance from the center of involved femoral head to interteardrop line was (6.0 ± 3.1) mm longer than that of normal side, which was significantly reduced when compared with preoperative value (t=11.13, P=0.00). No periprosthetic transparent region, prosthesis displacement, or screw breakage occurred. The Harris score was significantly increased from 30.4 ± 8.8 preoperatively to 85.1 ± 3.2 at last follow-up (t=22.11, P=0.00). Conclusion The application of extra-large uncemented acetabular components could be an effective technique for the reconstruction of extensive acetabular bone defect, and gain a good early-term effectiveness. The long-term survival rate of prostheses needs to be followed up.
Objective To investigate the effectiveness of tissue transplantation combined with bone transmission in treatment of large defects of tibial bone and soft tissue. Methods Between February 2006 and February 2011, 15 cases of traumatic tibia bone and soft tissue defects were treated. There were 12 males and 3 females, aged from 16 to 54 years (mean, 32 years). After internal and external fixations of fracture, 11 patients with open fracture (Gustilo type III) had skin necrosis, bone exposure, and infection; after open reduction and internal fixation, 2 patients with closed fracture had skin necrosis and infection; and after limb replantation, 2 patients had skin necrosis and bone exposure. The area of soft tissue defect ranged from 5 cm × 5 cm to 22 cm × 17 cm. Eight cases had limb shortening with an average of 3.5 cm (range, 2-5 cm) and angular deformity. The lenghth of bone defect ranged from 4 to 18 cm (mean, 8 cm). The flap transplantation and skin graft were used in 9 and 6 cases, respectively; bone transmission and limb lengthening orthomorphia were performed in all cases at 3 months after wound healing; of them, 2 cases received double osteotomy bone transmission, and 14 cases received autologous bone graft and reset after apposition of fracture ends. Results All flaps and skin grafts survived; the wound healed at 3.5 months on average (range, 3 weeks-18 months). The length of bone lengthening was 6-22 cm (mean, 8 cm). The time of bone healing and removal of external fixation was 9.5-39.0 months (mean, 15 months). The healing index was 40-65 days/cm (mean, 55 days/cm). All patients were followed up 1-5 years (mean, 4 years). The wounds of all the cases healed well without infection or ulceration. The functions of weight-bearing and walking were recovered; 6 cases had normal gait and 9 cases had claudication. The knee range of motion was 0° in extention, 120-160° in flexion (mean, 150°). According to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system for ankle function, the results were excellent in 7 cases, good in 4 cases, and fair in 4 cases, with an excellent and good rate of 73.3%. Conclusion Tissue transplantation combined with bone transmission is an effective method to treat large defects of soft tissue and tibial bone, which can increase strength of bone connection and reduce damage to the donor site.
【Abstract】 Objective To evaluate the feasibility and effectiveness of reconstruction of mandibular bone defects using three-dimensional skull model and individualized titanium prosthetics from computer assisted design. Methods Between July 2002 and November 2009, 9 patients with mandibular defects accepted restorative operation using individualized bone prosthetics. Among 9 cases, 4 were male and 5 were female, aged 19-55 years. The causes of mandibulectomy were benign lesions in 8 patients and carcinoma of gingival in 1 patient. Mandibular defects exceeded midline in 2 cases, involved condylar in 4 cases, and was limited in one side without involvement of temporo-mandibular joint in 3 cases. The range of bone defects was 9.0 cm × 2.5 cm-17.0 cm × 2.5 cm. The preoperative spiral CT scan was performed and three-diamensional skull model was obtained. Titanium prosthetics of mandibular defects were designed and fabricated through multi-step procedure of reverse engineering and rapid prototyping. Titanium prosthetics were used for one-stage repair of mandibular bone defects, then two-stage implant denture was performed after 6 months. Results The individualized titanium prosthetics were inserted smoothly with one-stage operative time of 10-23 minutes. All the cases achieved incision healing by first intention and the oblique mandibular movement was corrected. They all got satisfactory face, had satisfactory contour and good occlusion. In two-stage operation, no loosening of the implants was observed and the abutments were in good position with corresponding teeth which were designed ideally before operation. All cases got satisfactory results after 1-9 years of follow-up. At last follow-up, X-ray examinations showed no loosening of implants with symmetry contour. Conclusion Computer assisted design and three-dimensional skull model techniques could accomplish the design and manufacture of individualized prosthetic for the repair of mandibular bone defects.
【Abstract】 Objective To investigate the anti-infection and bone repair effects of cationic l i posome-encapsulatedvancomycin combined with the nano-hydroxyapatite/chitosan/konjac glucomannan (n-HA/CS/KGM) composite scaffold invivo. Methods Fifty-one 6-month-old New Zealand white rabbits, weighing 1.5-3.0 kg, were selected to prepare chronicinfectious tibia bone defect model by using Staphylococcus aureus. After 4 weeks, 48 survival rabbits were randomly divided into 4 groups (n=12). After debridement, defect was treated with nothing in group A, with n-HA/CS/KGM composite scaffold in group B, with vancomycin and n-HA/CS/KGM composite scaffold in group C, and with cationic l i posome-encapsulated vancomycin and n-HA/CS/KGM composite scaffold in group D. After 8 weeks of treatment, general observation, X-ray, HE staining, the bacterial culture, and the measurement of the longest diameter of bone defect were done. Results At 4 weeks after modeling, 48 rabbits were diagnosed as having osteomyelitis, including periosteal new bone formation, destruction of bone, and soft tissue swell ing. The Norden score was 3.83 ± 0.52. At 8 weeks after treatment, sinus healed in groups C and D, but sinus was observed in groups A and B; the gross bone pathologieal scores of group D were significantly better than those of groups A and B (P lt; 0.05). Bone defects were repaired completely in group D, the results of the longest diameter of bone defects in group D was significantly better than those in the other 3 groups (P lt; 0.05). New bone formation was observed in groups C and D, but periosteal reactionand marrow low-density shadow were observed in groups A and B; Norden score in group D was significantly better than those in groups A, B, and C (P lt; 0.05). HE staining showed that there were a large number of trabecular bone formation and fibrosis, with no obvious signs of infection in groups C and D, but neutrophil accumulation was observed in groups A and B; Smeltzer scores in groups C and D were significantly better than those in groups A and B (P lt; 0.05). Bacteriological results showed higher negative rate in groups C and D than in groups A and B (P lt; 0.05). Conclusion Cationic l iposome-encapsulated vancomycin and n-HA/CS/KGM composite scaffold can be a good treatment for infectious bone defects in rabbits, providing a new strategy for the therapy of bone defects in chronic infection.
Objective To evaluate the effectiveness of acetabulum reinforcement ring (Cage) with allograft bone for reconstructing acetabular defects in hip revision. Methods Between February 2006 and August 2010, 14 patients (14 hips) with serious acetabular bone defects after total hip arthroplasty underwent acetabular reconstruction by using Cage with allograft bone. There were 6 males and 8 females with a mean age of 59.2 years (range, 45-76 years). The mean time between first replacement and revision was 7.2 years (range, 5-12 years). The revision causes included infection in 8 cases, osteolysis and aseptic loosening in 6 cases. The hip function Harris score was 37.7 ± 5.3. According to America Association of Orthopedic Surgeon (AAOS) standard, the acetabular defect was classified as type III in 8 cases and as type IV in 6 cases. Results All incisions healed by first intention, and no complication occurred. The patients were followed up 14-62 months (mean, 44 months). The pain was relieved or disappeared. At last follow-up, the Harris score was 89.7 ± 3.2, showing significant difference when compared with preoperative score (t= — 44.40, P=0.04). No loosening of the acetabular component or osteolysis was found in 14 hips. No absorption or collapse of the allograft was observed in all patients. Conclusion Cage with allograft bone is a useful method of reconstructing acetabular bone defects in hip revision. Further follow-up is needed to assess the long-term effectiveness.
Objective To investigate the expression levels and significance of vascular endothel ial growth factor (VEGF) and microvessel density (MVD) in rabbit radius defects repaired with allogeneic and autogenic bone. Methods Forty adult New Zealand rabbits were chosen, and 10 mm bone defect model was created in the bilateral radii of 28 experimental rabbits. The other 12 rabbits provided allogeneic bone under the standard of American Association of Tissue Bank. In the left side, allogeneic bone were used to repair bone defect (experimental group), equal capacity autogenous il iac bone was used in the right side (control group). Animals were sacrificed at 2, 4, 8, and 12 weeks postoperatively. Immunohistochemical method was used to determine the expression of VEGF, CD34 protein and MVD counting. Bone histomorphometric parameters, including percent trabecular area (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp) were measured by von Kossa staining undecalcified sl ices. The relation was analyzed between VEGF and MVD, histomorphometric parameters. Results The positive signals of VEGF protein were detected in cytoplasm of vascular endothel ial cells, chondrocytes, osteoblasts, fibroblasts and osteoclasts. At 2 weeks, there was no significant difference in VEGF protein expression between experimental group and control group (P gt; 0.05); at 4 and 8 weeks, the expression of VEGF in control group was significantly higher than that in experimental group (P lt; 0.05); and at 12 weeks, there was no significant difference between two groups (P gt; 0.05). There was a positive correlation (P lt; 0.01) between VEGF expression and MVD value in two groups at 2, 4, 8, and 12 weeks postoperatively. There was no significant difference in bone histomorphometric parameters (BV/TV, Tb.Th, Tb.N, Tb.Sp) between two groups at 12 weeks postoperatively (P gt; 0.05), but there was a positive correlation between VEGF expression and parameters of BV/TV, Tb.Th, and Tb.N (P lt; 0.01); and a negative correlation between VEGF and Tb.Sp (P lt; 0.01). Conclusion VEGF can express diversity at different time and positions, and the different expressions indicated various biology significances in the process of the bone heal ing. It can coordinate growth of cartilage and bone and profit vascular reconstruction of allogeneic bone. VEGF may participate in promoting osteogenesis in the course of allogeneic bone transplantation.
Objective To study the operative methods and therapeutic effects of acetabulum reinforcement ring in the reconstruction of acetabular defects in primary and revisional artificial hip replacement. Methods From November 2000 to July 2005, 14 cases (15 hips) of severe acetabular defects in artificial hip replacement were treated with acetabulum reinforcement ring combined autogenous or allogenic bone transplantation, including 7 males and 8 females aged 34-72 years with an average of 55 years. Among them, 9 cases (9 hips) underwent artificial hip joint revision, which was 3-22 years (average8.9 years) far away from their primary replacement, and 5 cases (6 hi ps) received primary replacement, including 1 case of rheumatoid arthritis of both hips, 1 osteoarthritis caused by acetabular dysplasia, 1 femoral head resection due to debridement of hi p infection, 1 nonunion of acetabulum old fracture with the center dislocation of femoral head and 1 old acetabulum fracture. The disease course was 2-25 years (average 11.6 years). According to the American Academy of Orthopaedic Surgeons (AAOS) classification, the acetabulum defects of 7 hips were categorized into Type II, 6 hips were Type III and 2 hips were Type IV. Harris score was (59.1 ± 15.4) points preoperatively. Results All wounds were healed by first intention. The symptom of sciatic nerve simulation was occurred in 1 case and was rel ieved after taking neuroprotective drug for 5 months. All the cases were followed up for 33-90 months (average 51.3 months). Harris score at the final follow-up was (81.9 ± 10.4) points, indicating there was a significant difference between before and after operation (P lt; 0.01). X-ray film demonstrated that the displacement of acetabulum reinforcement ring and acetabular cup was less than 5 mm, the rotation was less than 5°, and there was no progressive radiolucent zone around acetabulum and screw. Conclusion Acetabulum reinforcement ring is beneficial to reconstruct severe acetabular defects, improve hip joints’ function and provide primary stabil ity for putting acetabular cup into an ideal biomechanical position.
Objective To evaluate the potential of bioresorbable collagen membrane in a combination with bone marrow stromal cells (BMSCs) or platelet rich plasma (PRP) in repairing alveolar bone defects. Methods The first and second premolars were extracted from the bilateral maxillary and mandibular bone and fouralveolar intrabone defects (8 mm in height, 5 mm in width,15 mm in length) werecreated in 3 male mongrel dogs. The experiment included 4 groups: group A (nothing was used as control group), group B (only Bio-Gide® group C (Bio-Gide® BMSCs) and group D (Bio-Gide®／PRP). The macroscopic, radiographic and histological observations were performed at 4, 8 and 12 weeks after surgery. Results The cells were circle or short spindleshape after 1 day of coculture; and the cellswere polygon and long spindleshape with process after 3 days. The macroscopic observation: after 4 weeks in the defect region, obvious excavation and organization of hematoma were seen in group A; and new bone formation and little organization of hematoma were seen in groups B, C, D. After 8 weeks, excavation was not obvious, fibrous tissue was seen at the top of defect, organized hematoma wasgradually replace by new bone in group A; the edge of membrane broke and adhered to deep tissue and needle could pierce the surface ofdefect in groups B, C, D. After12 weeks,excavation disappeared in 4 groups and fibrous tissue at top of alveolar ridge in group A was thicker than that in groups B, C, D. The radiographic observation: defect was full of new bone. In groups A, B, C and D, the grey values were 68, 50, 56 and 49 after 4 weeks; 46, 30, 24 and 30 after 8 weeks; and 24, 17, 15 and 20 after 12 weeks respectively. The histological observation:after 4 weeks, a lot of fibrous connective tissues granulation tissues were seen no obvious new bone formed in group A; and the collagen structure of membrane remained and new bone formed in medial surface in groups B, C, D. After 8 weeks, new bone trabecula displayed clump and web in group A; the collagen structureof membrane were not of integrity, and many bone islands and few fibrous connective tissue formed in groups B, C, D. After 12 weeks, defect was filled with newbone in 4 groups. Conclusion Guided bone regeneration (GBR) treatment with collagen membranes may significantly enhance bone regeneration within 8 weeks. Theinfluence of GBR in combination with BMSCs or PRP in accelerating the repair of alveolar bone defects shoud be further investigated.
Objective To investigate the effect of astragalus polysaccharides(AP) on chitosan／polylactic acid(AP／C／PLA)scaffolds and marrow stromal cells(MSCs)tissue engineering on periodontal regeneration of horizontal alveolar bone defects in dogs． Methods MSCs were isolatedfrom the bone marrow and then cultured in conditioned medium to be induced to become osteogenic．The MSCs were harvested and implanted into AP／C／PLA and C／PLA scaffolds．A horizontal alveolar bone defect(5 mm depth, 2 mm width)were produced surgically in the buccal side of the mandibular premolar 3 and 4 of 10 dogs．The defects were randomly divided into 4 groups(n=10)：Group A, root planning only(blank contro1); group B, AP／C／PLA with conditioned medium(medium contro1);group C, C／PLA with MSCs(scaffolds contro1); and group D, AP／C／PLA with MSCs(experimental group)．Eight weeks after surgery， block sections of the defects were collected for gross, histological and X-ray analysis. Results MSCs induced in vitro exhibited an osteogenic phenotype with expressingcollagen I and alkaline phosphatase． X-ray film observation showed that the bone density and height had no changes in group A; in group B, the bone density was increased to a certain extent and furcation area reached a few height, but no height was increased in interdental septum; in group C，the bone density was increased and furcation area nearly reached the native height,but interdental septum reached a few height;in group D,the bone density was increased significantly and furcation area and interdental septum reached the native height. Histological evaluation showed that there was greater tissue formation in group D than that in groups A, B and C, in which new alveolar bone, new cementum, periodontal ligament with Sharpey’s fibers, and new bone tissue was similar to native periodontal tissues. Ingroup A，B, C and D respectively, the amount of new alveolar bone regeneration was 0.83±0.30, 1.46±0.55, 2.67±0.26 and 2.90±0.41 mm; new cementum regeneration was 0.78±0.45，1.30±0.60，2.29±0.18 and 2.57±0.22 mm; the amount of connective tissue adhesion was 0.80±0.22，1.33±0.34，2.23±0.42 and 2.64±0.27 mm; all showing significant differenecs between group D and groups A, Band C (Plt;0.05)．Conclusion The technology of tissue engineering with AP／C／PLAscaffolds and induced MSCs may contribute to periodontal regeneration．