Autogenous Ilium Research Articles

Bioabsorbable high-purity magnesium interbody cage: degradation, interbody fusion, and biocompatibility from a goat cervical spine model.

BackgroundBioabsorbable Mg-based implants have been a focus of orthopedic researches due to their intrinsic advantages in orthopedics surgeries. This study aimed to investigate the performance of bioabsorbable high-purity magnesium (HP Mg, 99.98 wt.%) interbody cages in anterior cervical discectomy and fusion (ACDF) and to evaluate the degradation of HP Mg cages under an interbody microenvironment.MethodsACDF was performed at C2–3 and C4–5, and a HP Mg cage or autologous iliac bone was randomly implanted. At 3, 6, 12 and 24 weeks after surgery, the cervical specimens were harvested to evaluate the fusion status, degradation and biocompatibility by CT, micro-CT, histological examinations and blood tests.ResultsThere was no significant difference in the CT fusion score between cage group and autogenous ilium group at 3 and 6 weeks. At 12 and 24 weeks, the mean CT fusion score in the cage group was markedly lower than in the autogenous ilium group. CT and histological examinations showed bony junctions formed through the middle hole of the cage between upper and lower vertebral bodies in the cage group, but the total fusion area was less than 30%. The degradation rate of cages was relatively rapid within the first 3 weeks and thereafter became stable and slow gradually. The HP Mg cage had good biosecurity and biomechanical characteristics.ConclusionsImplantation of Mg-based interbody cage achieves successful histological fusion, while the total fusion area needs to be improved. More studies are needed to improve the bone-cage interface.

Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients.

ObjectiveTo investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates.MethodsThis retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients.ResultsThe study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8–28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients.ConclusionStructural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.

Anterolateral Radical Debridement and Interbody Bone Grafting Combined With Transpedicle Fixation in the Treatment of Thoracolumbar Spinal Tuberculosis

This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis.Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial.There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up.The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes.

SURGICAL TREATMENT FOR INFECTED LONG BONE DEFECTS AFTER LIMB-THREATENING TRAUMA: APPLICATION OF LOCKED PLATE AND AUTOGENOUS CANCELLOUS BONE GRAFT.

Treatment strategies for bone defects include free bone grafting, distraction osteogenesis, and vascularized bone grafting. Because bone defect morphology is often irregular, selecting treatment strategies may be difficult. With the Masquelet technique, a fracture site is bridged and fixed with a locking plate after treating deep infection with antibiotic-containing cement, and a free cancellous bone-graft is concomitantly placed into the defects. This procedure avoids excessive bone resection. We studied 6 patients who underwent surgical treatment for deep infection occurring after extremity trauma (2004 through 2009). Ages at surgery ranged from 29 to 59 years (largest age group: 30 s). Mean follow-up was 50.7 months (minimum/maximum: 36/72 months). One patient had complete amputation of the upper extremity, 3 open forearm fractures, 1 closed supracondylar femur fracture, and 1 open tibia fracture. In all patients, bone defects were filled with antibiotic-containing cement beads after infected site debridement. If bacterial culture of infected sites during curettage was positive, surgery was repeated to refill bone defects with antibiotic-containing cement beads. After confirmation of negative bacterial culture, osteosynthesis was performed, in which bone defects were bridged and fixed with locking plates. Concomitantly, crushed cancellous bone grafts harvested from the autogenous ilium was placed in the bone defects. Time from bone grafting and plate fixation to bone union was at least 3 and at most 6 months, 4 months on average. Infection relapsed in one patient with methicillin-resistant Staphylococcus aureus, necessitating vascularized fibular grafting which achieved bone union. No patients showed implant loosening or breakage or infection relapse after the last surgery during follow-up. The advantage of cancellous bone grafting include applicability to relatively large bone defects, simple surgical procedure, bone graft adjustability to bone defect morphology, rapid bone graft revascularization resulting in high resistance to infection, and excellent osteogenesis.

Autologous Ilium Grafts: Long‐Term Results on Immediate or Staged Functional Rehabilitation of Mandibular Segmental Defects Using Dental Implants after Tumor Resection

It is a challenge for clinicians to restore oral function in patients with segmental defects of the mandible because of tumor extirpation. Dental implant therapy following vascularized autologous ilium grafts is an effective method to restore oral function in patients with mandibular segmental defects. The aim of this retrospective study was to investigate the long-term clinical outcomes of ilium grafts combined with immediate or staged mandibular dental implant therapy to restore craniofacial defects resulting from tumor resection. Over a 5-year period (2000-2004), 32 patients who underwent mandibular segmental resection for tumors were treated with vascularized ilium grafts to augment bone volume. Seventeen patients received phase I therapy (immediate placement of implants), and 15 patients underwent phase II therapy (delayed placement of implants). A total of 110 dental implants were placed in these patients for mandibular restoration of the defective areas. Information regarding implant success and survival rates, marginal bone loss, soft tissue inflammation, complications of prosthesis, and patient satisfaction for the 8 to 12 years following oral reconstruction was obtained from patient records. Although there was mild evidence of bone graft resorption, the vascularized autogenous ilium bone grafts were successful in all patients. The cumulative patient survival and success rate of the implants were 96.4% and 91.8%, respectively. The mean peri-implant bone resorption ranged from 1.0 to 1.2 mm over the 8- to 12-year follow-up period. The annual mean number of complications/repairs was from 0.11 to 0.07 per patient during the 8- to 12-year follow-up. Over 80% of the patients were fully satisfied with their restoration of oral function. This study demonstrates that reconstruction of mandibular segmental defects because of resection of mandibular tumors using dental implants therapy combined with vascularized autogenous ilium grafts is an effective method to restore oral function.

Spinal fusion of lumbar intertransverse process in rabbits by using bone marrow stromal stem cells in conjunction with bone morphogenetic protein with freeze-dried demineralized bone matrix as scaffold

Objective To discuss spinal fusion effect of lumbar intertransverse process in rabbits by using bone marrow stromal stem cells(MSCs)in conjunction with bone morphogenetic protein(BMP)and freeze-dried demineralized bone matrix(FDBM)as scaffold.Methods To separate and cultivate MSCs in vitro,with FDBM as scaffold,osteogenesis was induced by BMP.Sixty Japan white rabbits were randomly divided into three groups.Group A was MSCs+FDBM+BMP,group B was FDBM,group C was autogenous ilium cancellous bone(AIB).Lumbar intertransverse process was fused in lumbar five to six.Rabbits were killed at 8 weeks after operation.The general observation and imageology were used to assess the fusion condition.To estimate the implantation using DR image.Gray scale analysis of DR image caculated the osteogenic density and acreage.The CT scan and three-dimensional reconstruction was used to observe the fusion configuration of lumbar intertransverse process.Results The fusion mass character in group A and C was hard,the morphology was not regulation.The fusion mass was almost absorbed in group B beside little tissue approach transverse process.There were high density image between intertransverse processes,osteogenic density were nonuniform in group A and C.There were nonunion in group B.Consistent callus were existed between intertransverse process in group A and C.There were not consistent callus in group B.Group A was similar to group C in osteogenesis density and acreage.Group B was the worst.There were cartilage and newly born bone trabecular formation in group A and group C.Between transverse process were mainly fiber tissue in group B.Conclusion MSCs in conjunction with BMP and FDBM has the similar osteogenic capability to the AIB and better osteogenic capability than that of FDBM alone when spinal fusion of lumbar intertransverse process is performed in rabbits. Key words: Mesenchymal stem cells; Bone matrix; Bone morphogenetic proteins; Tissue engineering

Operative treatment of complex posterior tibial plateau fractures via posterior approach

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization. Key words: Tibial fractures; Fracture fixation, internal; Treatment outcome

The surgical technique and follow-up of the treatment with locking internal fixation on long bone nonunion of extremities

To report the outcome of long bone nonunion of humerus, femur and tibia treated with locking internal fixation and bone graft. From February 2003 to October 2006, locking internal fixation and bone grafting were employed to treat 5 cases at humerus, 33 cases at femur, 23 cases at tibia. Forty-four of the patients were men, and 17 were women. The mean age was 38 years (range 7-70 years). The nonunion had resulted from failure of internal fixation in 47 cases, failure of external fixation in 5 cases, infection in 9 cases. The history of nonunion lasted from 10 to 156 months (mean 19 months). There were 42 patients treated with locking compression plate (LCP), and 19 patients with less invasive stabilization system (LISS). For bone grafting, autogenous ilium was used in 55 patients, autogenous ilium and allograft bone was used in 3 patients, allograft bone and Wright DBM artificial bone was used in 3 patients. All the 61 patients were followed up for an average 12 months (range 6-24 months) only to reveal solid bone union in all the fracture, with a mean healing time of 4.8 months (ranged from 4 to 6 months). No loosening or breakage of the implants occurred in this series. The Knee Society Scores (KSS) was used to evaluate knee function in 47 patients with peri-knee joint nonunion, excellent result were seen in 35 patients, good in 7 patients, fare in 1 patients, poor in 4 patients. Locking internal fixation can be used to treat effectively bone nonunion at the humerus, femur and tibia.

Management of acetabular comminuted fractures combined with compressive defects

目的 探讨治疗髋臼粉碎性骨折合并压缩性缺损的手术方法.方法1997年7月～2005年2月,收治髋臼粉碎性骨折合并压缩性缺损43例,其中陈旧性骨折25例,新鲜骨折16例,畸形(大于90 d)2例;复杂骨折与缺损34例,简单骨折与缺损9例.缺损体积3～9 cm3,平均4.5cm3.采用改良髋臼入路,应用髋臼三维记忆内固定系统(ATMFS)三维记忆锁定碎骨;髋臼碎骨关节面整复法;自体髂骨髋臼后壁解剖性重建法;自体骨+人工骨填塞及骨腊隔离法等术后相关措施.结果所有患者随访5～86个月,平均15.7个月.粉碎骨折关节面粉碎+填补压缩体积至头臼解剖复位31例;自体髂骨后壁解剖性重建头臼解剖复位12例;40例患者经过平均5.3个月患侧髋关节功能达到健侧水平,1例股骨头缺血性坏死,2例异位骨化+股骨头缺血性坏死导致髋关节骨融合.结论本文介绍了治疗髋臼粉碎性骨折合并压缩性缺损的新方法与措施,有效地提高了股骨头与髋臼解剖对应率,为髋关节功能的恢复提供了新的思路。

Causes and treatment of humerus bone nonunion

Objective To explore the causes of humerus bone nonunion and the c linic effects of different fixators and bone grafts in treatment of humerus bone nonunion. Methods 51 cases of humerus bone nonunion, 36 males and 15 females, w ere analyzed retrospectively. Different fixations were applied for the patients: plates in 30 cases, interlocking medullary nails in 12 cases, external fixators in 8 cases and allograft-bone plate with screws in 1 case. For bone graft, Rec onstructed Bone Xenograft (RBX) was used in 12 cases, autogenous ilium in 16 cas es, autogenous ilium plus RBX in 17 cases, allograft-bone in 2 cases and allogr aft-bone plus RBX in 2 cases. Results Of the 51 cases, 2 were out of follow-up , 49 cases were followed up for 8 months to 9 years, with 4 years and 7 months o n average. The total union-rate was 89.8%. The union-rate in patients with pl ate fixation was 83.3%, with external fixator 100%, and with interlocking medu llary nails 100%. The union-rate in patients with RBX was 100%, with autogeno us ilium 87.5%, and with autogenous plus RBX 88.2%. Conclusions The treatment of humerus bone nonunion with interlocking medullary nails or external fixators is superior to that with plates in that it is less invasive, and provides effect ive fixation and satisfactory functional recovery as well. Since RBX has good bi ocompatibility and does not result in immunological rejections, it can be safely used in the treatment of bone nonunion and has reliable effects on promoting bo ne healing.

良性セメント芽細胞腫の１例

Benign cementoblastoma is a mesoblastic-odontogenic tumor which shows increased cementum. This tumor has been called “true cementoma” by many workers and is a very rare odontogenic tumor. We recently encountered a case of benign cementoblastoma at the 65 root in a 50-year-old male.Enucleation of the tumor was performed and the bone defect was repaired by an autogenous ilium graft.