Autologous Iliac Bone Graft Research Articles

Late Diagnosed Cervical Spine TBC Spondylitis: Case Report

SUMMARY Cervical tuberculosis is a rare disease with a high complication rate. Tuberculosis of the cervical spine is reported in about 6-9% of all cases of spinal tuberculosis. Early diagnosis and treatment of spinal tuberculosis is essential in order to prevent neural deficit. Management strategies for spinal tuberculosis range from ambulatory chemotherapy to radical surgical debridement with fusion. The paper presents a case of an 18-year-old patient with TBC spondylitis C3- C5. Eleven months passed from the onset of the disease until surgery and final diagnosis. When hospitalized, the patient suffered from the overall weakness, a 15- kg weight loss, dysphagia, neck pain, neck rigidity, febrility, cervical radiculopathy and paresthesia of both upper extremities. MR image showed a complete destruction of C3, abscess perforation in the anterior epidural space with the spinal cord compression and abscess extension to prevertebral space from C2 to C5. After the radical surgical debridement of C3-C5 and anterior decompression, a tricorticate autologous bone graft obtained from the iliac crest was placed and a plate fixation was done. Tuberculostatics were included for 12 months after surgery. Complete recovery occurred six months after surgery. Anterior decompression with autologous iliac bone graft led to a good clinical and radiological outcome in patients with cervical spine tuberculosis.

Autologous Iliac Bone Graft With Anterior Plating Is Advantageous Over the Stand-Alone Cage for Segmental Lordosis in Single-Level Cervical Disc Disease

Anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft and plating has been a standard surgical method for single-level cervical disc disease. The stand-alone cage was introduced to reduce graft-related morbidity. However, problems due to focal kyphosis at the operated level have been on the rise. It has been difficult to derive a conclusive answer from previous studies for the indications of each method. An interim analysis of a prospective randomized study was performed to compare the sagittal alignment between a stand-alone cage (ACDF cage) and autologous iliac bone graft and plating (ACDF plate). Twenty-nine patients were allocated to the ACDF-cage group (M:F = 17:12) and 23 to the ACDF-plate group (M:F = 14:9). Cobb angles at the operated segment (segmental angle, SA; lordosis vs kyphosis) were compared at postoperative 12 months and the other confounding factors were explored. Demographic features were not different between groups. The fusion method significantly affected segmental alignment at 12 months (P = .03; odds ratio, 5.52). Preoperatively, the SA was not different between the groups (P = .18) and was similar (P = .22) immediately following the operation. However, the SA was significantly more lordotic (P < .05) in the ACDF-plate group at postoperative 12 months in comparison with the ACDF-cage group. There was no other significant risk factor for segmental kyphosis. The stand-alone cage and autologous bone graft with plating had similar clinical outcomes, but stand-alone cage fusion may be disadvantageous from a radiological viewpoint.

Long-term outcomes of one-stage anterior debridement, bone grafting, and internal fixation for the treatment of lower cervical tuberculosis with kyphosis

Background. Patients with spinal deformities and nerve compression due to spinal tuberculosis often require surgical intervention. The objective of this study was to assess the long-term therapeutic effectiveness of one-stage anterior debridement, bone grafting, and internal fixation for lower cervical tuberculosis with kyphosis. Methods. Twenty-one patients with lower cervical tuberculosis and cervical kyphosis received one-stage anterior debridement, autologous iliac bone grafting, and internal plate fixation. Patients were followed-up postoperatively for at least 5 years. Outcome measures included neck pain using Visual Analogue Scale (VAS) scores, Frankel classification of spinal cord injury, and Cobb angle of cervical kyphosis. Results. Eighteen patients had lesions in 2 vertebrae and 3 had lesions in 3 vertebrae. Cervical tuberculosis was cured in all patients. The mean preoperative VAS score for neck pain was 8 (range: 6–10), whereas the mean best postoperative VAS score was 0.6 (range: 0–3). Mean final VAS score was significantly higher than the best VAS score (2.14 vs. 0.62). Of the 13 patients with symptoms of spinal cord compression, 9 improved by 1 grade and 4 improved by 2 grades according to Frankel classification at final follow-up. The mean preoperative Cobb angle of cervical kyphosis was 29° (range: 15°–50°), whereas the mean postoperative Cobb angle at final follow-up was −1.8° (range: 2–7°). Conclusions. One-stage anterior debridement, bone grafting, and internal fixation can effectively remove lesions, decompress the nerve, reduce pain, and correct kyphosis in patients with cervical tuberculosis and associated kyphosis. Long-term postoperative outcomes were satisfactory.

Paper 66: Tibial Slope and Patellar Height After Opening Wedge High Tibia Osteotomy Using Autologous Tricortical Iliac Bone Graft

Our aim was to evaluate the alteration in angle of posterior slope of the tibia and the degree of patellar height following medial opening wedge high tibia osteotomy(HTO) using autologous tricortical iliac bone graft in 32 consecutive patients.

A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee

Background:Medial opening wedge high tibial osteotomy (MOWHTO) has proven to be an effective treatment for varus osteoarthritic knees. Various methods of fixation with different implant types and using either bone grafts or bone substitutes have been reported. We performed non-locking T-buttress plate fixation with autologous iliac bone graft augmentation, which is defined here as the traditional method, and locking compression plate fixation without any bone graft or bone substitute. We aimed to compare bone union and complications of these two MOWHTO techniques.Materials and Methods:Between June 2005 and December 2007, 50 patients who underwent MOWHTO (a total of 60 knees) were retrospectively reviewed and classified into two groups: group A, which consisted of 26 patients (30 knees) was treated using T-buttress plate fixation with autologous iliac bone graft augmentation and group B, which consisted of 24 patients (30 knees) was operated upon using a medial high tibial locking compression plate without any augmentation. Demographic characteristics and radiographic outcomes, including union rate, time to union, medial osteotomy defects, and complications, were collected and compared between the two groups. The progress of all patients was followed for at least 2 years.Results:All osteotomies united within 12 weeks after surgery. Group B had slightly longer time to union than group A (10.3 weeks and 9.5 weeks, respectively; P = 0.125). A significantly higher incidence of medial defects after osteotomy was reported in the locking compression plate group (P = 0.001). A total of 5 (8.3%) knees had complications. In group A, one knee had a superficial wound infection and another knee had a lateral tibial plateau fracture without significant loss of correction. In group B, one knee had screw penetration into the knee joint and two knees had local irritation that required the removal of the hardware.Conclusion:Locking compression plate fixation without the use of bone grafts or bone substitutes provides a satisfactory union rate and an acceptable complication rate when compared to the traditional MOWHTO technique. Thus, we recommend using this technique for treating unicompartmental medial knee osteoarthritis.

Peri-Navicular Arthrodesis for the Stage III Müller-Weiss Disease

We aimed to report our results of peri-navicular arthrodesis with autologous iliac bone graft for Stage III Müller-Weiss disease. Nine cases of Stage III Müller-Weiss disease according to the Maceira classification (four male and five female) with average age of 48.2 (range, 41 to 58) years, had mild or severe midfoot pain with the longitudinal arch collapse. The patients, all of whom had failed conservative treatment for more than 6 months, underwent peri-navicular arthrodesis. All patients were followed up at 3, 6, 9, and 12 months, and then every 6 months with AOFAS ankle-hindfoot scores and radiographic measurements. Mean followup time for radiological and clinical evaluation was 22.4 (rangem 12 to 52) months. All patients were satisfied with their clinical results without pain 12 months after surgery. The mean AOFAS ankle-hindfoot scores improved from 40.1±8.3 preoperatively to 90.9±2.1 at the last followup (p<0.05). A solid fusion was found in all cases at 3 months after surgery by radiographic and clinical evaluation. The average longitudinal arch height increased from 46.1±2.1 mm preoperatively to 53.5±2.3 mm at the last followup (p<0.05) on the lateral weightbearing radiograph. The peri-navicular arthrodesis with autologous iliac bone graft resulted in a good outcome for Stage III Müller-Weiss disease with good clinical outcomes, high fusion rate, and obvious improvement of the longitudinal arch height.

Calcitonin Enhanced Lumbar Spinal Fusion in a New Zealand Rabbit Model

In this study, the effect of calcitonin on lumbar spinal fusion was studied in a New Zealand rabbit model. To investigate whether calcitonin can enhance lumbar spinal fusion in a New Zealand rabbit model and whether calcitonin can enhance expression genes involved in osteogenesis and angiogenesis. Calcitonin is used to treat osteoporosis and diseases involving accelerated bone turnover. Studies have shown that calcitonin might also promote bone cell proliferation and bone formation, suggesting its possible role in promoting spinal fusion, but few data are available. The effect of calcitonin on lumbar spinal fusion was analyzed in 32 New Zealand rabbits. Each rabbit received 2 autologous iliac bone grafts (one between L4-L5 without fixation, one between L6-L7 with fixation). Sixteen rabbits received calcitonin (calcitonin group, 1 U/kg daily from day 1 to the day of sacrifice), whereas the other 16 did not (control). At weeks 1, 2, 4, and 8, after examination for spinal fusion with radiography, 4 rabbits from each group were sacrificed. Each graft was histologically scored under light microscopy. In addition, we analyzed the messenger RNA (mRNA) levels of collagen I (Col I), bone morphometric protein 2 (BMP-2), insulinlike growth factor-1 (IGF-1), and vascular endothelial growth factor (VEGF), genes known to be involved in osteogenesis and angiogenesis, in each graft. With both fixation and without fixation, the bone grafts in rabbits receiving calcitonin showed a higher spinal fusion rate and higher histologic scores from week 2 to week 8, and had higher mRNA levels of Col I, BMP-2, IGF-1, and VEGF at all time points except BMP-2 and IGF-1 at week 1, than grafts in rabbits without receiving calcitonin. Calcitonin can enhance lumbar spinal fusion. One mechanism might be through upregulating genes involved in osteogenesis and angiogenesis.

Bone Morphogenetic Protein-2 Compared to Autologous Iliac Crest Bone Graft in the Treatment of Long Bone Nonunion

This retrospective study investigated the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) mixed with cancellous allograft on fracture healing compared to iliac crest autograft in the treatment of long bone nonunion. Eighty-nine patients with 93 established long bone nonunions treated between January 2002 and June 2004 at a single academic Level I trauma center were evaluated. Patients with clinical and radiographic evidence of failed fracture union underwent nonunion debridement, revision of fixation, and implantation at the nonunion site of either rhBMP-2 or the standard treatment autologous iliac crest bone graft. Union rate, operative time, estimated intraoperative blood loss, hospital length of stay, and postoperative infections were recorded. Nineteen nonunions received rhBMP-2 on a specialized carrier matrix (an absorbable collagen sponge) mixed with cancellous allograft, and 74 nonunions were treated with autologous iliac crest bone graft. There was no statistical difference in the rate of healing between treatment groups (68.4% vs 85.1%, respectively; P=.09). Incidence of postoperative infection was 16.2% after autologous iliac crest bone graft and 5.3% after rhBMP-2/absorbable collagen sponge (P=.22). Iliac crest autograft was associated with longer operative procedures (257.9±93.0 vs 168.9±86.5 minutes; P=.0007) and greater intraoperative blood loss (554.6±447.8 vs 331.6±357.2 mL; P=.01). These outcomes suggest that rhBMP-2 may provide a suitable alternative to autologous iliac bone graft, with the possible advantages of shorter operative time and reduced intraoperative blood loss, and may be considered as part of the orthopedic surgeon's treatment options.

One-Stage Anterolateral Surgical Treatment for Lumbosacral Segment Tuberculosis

The purpose of this study was to evaluate clinical outcomes following one-stage anterior radical debridement, interbody fusion, and sacral rod fixation for the treatment of lumbosacral segment tuberculosis. From March 2004 to November 2008, 11 patients diagnosed with spinal tuberculosis received antituberculosis medications for two to three weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to 37.2 ± 9.6 mm/h (25-54 mm/h). Lumbosacral angle, visual analogue scale (VAS) pain, ESR, and neurological performance were assessed before and after surgery. All surgical procedures were performed successfully without intra or postoperative complication. There were no instances of spinal tuberculosis recurrence. Patients were followed-up for a mean of 19.6 months. The mean lumbosacral angle was significantly increased from the mean preoperative angle (12.9 ± 5.0°) both postoperatively (21.5 ± 6.1°) and at final follow-up (20.1 ± 5.2°) (both P <0.001). The mean VAS scores and ESR were significantly decreased from preoperative levels (7.3 ± 1.2 and 37.2 ± 9.6 mm/h, respectively) both postoperatively (1.5 ± 0.5 at month six and 10.4 ± 4.5 mm/h at month three, respectively) and at final follow-up (0.6 ± 0.5 and 10.5 ± 2.3 mm/h, respectively) (all P <0.001). Bone fusion occurred in all patients at a mean of nine months (range six to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery. Our findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.

Effect of zoledronate acid treatment on osseointegration and fixation of implants in autologous iliac bone grafts in ovariectomized rabbits

One main problem associated with alveolar bone augmentation in implant dentistry is resorption of grafted bone, which may be further compromised by systemic skeletal disorders such as osteoporosis. Zoledronate acid (ZOL) is the most potent bisphosphonate to treat osteoporosis and therefore it is hypothesized to be able to invert the negative effect of osteoporosis on osseointegration and fixation of dental implants in autologous bone grafts. In this study, 56 rabbits received bilateral ovariectomy (OVX) (40 rabbits) or sham operation (16 rabbits). Three months later, 8 animals from each group were sacrificed for bone mineral density (BMD) examination. Then the remaining animals underwent bilateral autologous iliac bone grafting with simultaneous implantation of titanium implants in tibiae and were divided into 5 groups (n=8): Sham, OVX, Loc-ZOL (local treatment), Sys-ZOL (systemic treatment) and Loc+Sys-ZOL (local plus systemic) group. At 3 months after implantation, all animals were sacrificed and specimens were harvested for examinations. Both BMD and histological examinations of femurs showed osteoporotic changes after ovariectomy, while systemic treatment with ZOL restored mineralized bone. Micro-CT examination demonstrated that OVX group showed significant decrease of mineralized bone and implant-bone contact when compared with sham control, whereas both systemic and local treatments of ZOL significantly increased mineralized bone and implant-bone contact in ovariectomized animals. However, the best effects were observed in Loc+Sys-ZOL group (combined use of ZOL) and most of bone indices were similar to (IBCR, p>0.05) or higher than (BV/TV, Conn.D and Tb.N) (p<0.01) those of the sham group, except Tb.Th, which was still significantly lower (p<0.01), and Tb.Sp, which was further decreased (p<0.01). The aforementioned effects were also confirmed by histomorphometric analysis of bone indices on implant-bone contact and mineralized bone. In addition, biomechanical testing further supported the beneficial effect of ZOL treatment and maximal removal torque of titanium implants was observed in Loc+Sys-ZOL group. In conclusion, our study suggests that both systemic and local treatments with ZOL can invert negative effect of osteoporosis and promote osseointegration and fixation of dental implants in autologous bone grafts under osteoporotic condition. Combined systemic and local use of ZOL exerts best effects when compared to their single use.

Treatment of bone nonunion and bone defects associated with unsuccessful humeral condylar fracture repair with autogenous iliac bone reconstruction

Our preliminary study retrospectively assessed outcomes after the use of autogenous iliac bone grafts combined with internal fixation to repair refractory bone nonunions and bone defects associated with supracondylar or intracondylar humeral fractures, or both. We identified 22 patients (14 men and 8 women) with a mean age of 33.8 years (range, 17-60 years) with bone nonunion and severe bone defects associated with supracondylar or intercondylar humerus fractures, or both. The humeral condyle in each patient was anatomically reconstructed using autologous iliac bone grafts and internal fixation. Active functional exercise was initiated 3 to 4 weeks after surgery. The following variables were assessed: preoperative and postoperative elbow range of motion, Mayo Elbow Performance Score (MEPS), and postoperative complications. Mean follow-up was 38.6 months. Mean duration until bone union was 5.6 months. Preoperatively, 16 patients had a fair or poor MEPS (<75). At final follow-up MEPS was excellent (>90) in 8, good (75-90) in 9, fair (60-74) in 4, and poor (<60) in 1 patient. Postoperative heterotopic ossification anterior to the elbow joint occurred in 2 patients. Our preliminary results suggest that anatomic reconstruction of the humeral condyle using autogenous iliac bone grafting with internal fixation can improve elbow joint function in patients with bone nonunion and bone defects associated with supracondylar or intracondylar humeral fractures, or both. Larger scale studies are warranted to confirm our findings and compare the efficacy of this vs other surgical approaches.

Autologous Bone Marrow Grafting Combined with Demineralized Bone Matrix Improves Consolidation of Docking Site After Distraction Osteogenesis

Distraction osteogenesis is used for the reconstruction of extensive osseous defects. Delay in docking site consolidation results in significant prolongation of this surgical procedure. The primary aim of the present study was to retrospectively compare three different treatment options, all aimed at improving and accelerating docking site consolidation. We further sought to clarify whether the application of autologous bone marrow cells combined with demineralized bone matrix would substantially improve docking site consolidation. Between 1995 and 2008, forty-three patients (mean age, 38.28 years) were managed with bone transport for the treatment of a tibial bone defect (mean length, 9.49 cm). The patients were divided into three groups according to the "docking site procedure" used: closed compression (Group A), surgical debridement of the docking site and application of autologous iliac bone graft (Group B), or surgical debridement and local application of bone marrow concentrate and demineralized bone matrix (Group C). Docking site consolidation was assessed both radiographically and clinically, and the results were statistically analyzed. The median "healing time" required for docking site consolidation was significantly longer in the compression group as compared with the demineralized bone matrix plus bone marrow group (p = 0.021), whereas there was no difference between the other groups. There was no significant difference among the groups in terms of complication rates (p = 0.702). Docking site consolidation was completed prior to regenerate consolidation in nine of the ten patients in Group C and in 13.6% of the patients in Group B, whereas in all of the remaining patients, completion of regenerate healing always preceded docking site consolidation. The application of demineralized bone matrix and autologous bone marrow is at least equivalent to autologous cancellous bone graft in terms of substantially reducing docking site healing time compared with closed compression alone. The application of demineralized bone matrix and autologous bone marrow is an effective treatment option, with minimal donor site morbidity, for reducing consolidation time of the docking site in tibial defects treated with distraction osteogenesis.

Low-Intensity Pulsed Ultrasound Enhances Healing of Laminectomy Chip Bone Grafts on Spinal Fusion: A Model of Posterolateral Intertransverse Fusion in Rabbits

Laminectomy-derived chip bone graft was usually used in spinal fusion; however, the result of this kind of local bone used in lumbar posterolateral fusion is uncertain. This study tested the hypotheses that low-intensity pulsed ultrasound (LIPU) can accelerate the healing process of laminectomy bone chips in a spinal fusion and enhance the union rate. Forty-eight rabbits were randomly divided into three groups for the spinal unilateral uninstrumented posterolateral fusion of L5-L6: autologous iliac bone graft (AIBG), laminectomy chip bone graft (LCBG), LCBG plus LIPU (LCBG + LIPU). Each group was subdivided into 6-week and 12-week subgroups. All rabbits were subjected to radiographic examination and manual testing. All successful spinal fusion specimens received biomechanical testing and a histologic examination. The LCBG + LIPU group had the highest successful fusion rate at 6-week and 12-week examination (75% and 100%, respectively). At 6 weeks, the average maximum toque at failure values of the fusion masses for the LCBG + LIPU group was significantly higher than that for the LCBG group (p = 0.034). The average maximum torque of the 12-week LCBG + LIPU group was significantly higher than those of the 12-week AIBG and 12-week LCBG groups (p = 0.040 and p = 0.026, respectively). This study suggested that LIPU can enhance bone healing. With augmentation by LIPU, laminectomy chip bone used in lumbar posterolateral fusion can achieve a similar fusion rate and stronger fusion mass than those of an AIBG.

Humeral diaphyseal nonunions treated by interlocking or expandable intrameduilary nailing plus iliac bone grafting

Objective To discuss the efficacy of interlocking or expandable intramedullary nailing plus iliac bone grafting for treatment of humeral diaphyseal nonunion.Methods From June 1999 to May 2008, 27 cases of humeral diaphyseal nonunion, 14 males and 13 females, were treated in our department.The nonunions occurred at the upper-middle humerus in 6 cases, at the middle humerus in 16 cases and at the middle-lower humerus in 5 Cases. The patients had previously undergone operations for 1 to 4 times (average,2.3 times). Interlocking nailing was applied in 16 cases (including one case of close nailing and 5 cases of cable tension band osteosynthesis after replacement of the original nailing); expandable nailing was applied in 11 cases. Autologous iliac bone grafting was performed in 26 cases except the one case of close nailing.Results Twenty-six cases were followed up for an average of 4 years and 2 months. Bony healing was obtained in 5.4 months on average. By Neer scoring, the shoulder functions were evaluated as excellent in 12,good in 8 and fair in 6 cases, with a good to excellent rate of 76. 9％. By Mayo clinic performance scoring,the elbow functions were excellent in 23 and good in 3 cases, with a good to excellent rate of 100％. One case of radial nerve palsy recovered 6 months after operation.ConclusionInterlocking or expandable intramedullary nailing plus iliac bone grafting is an effective method to treat nonunion of humeral diaphysis. Key words: Humeral fractures; Fractures, ununited; Bone nails; Fracture fixation, internal

Internal fixation with locking plates and bone grafting for femoral nonunion and/or bone defects

Objective To evaluate the clinical effects of internal fixation with locking plates and bone grafting for femoral nonunion and /or bone defects.MethodsFrom June 2005 to June 2010, 80 cases of nonunion of femoral fractures and/or bone defects were treated with internal locking plating and bone grafting. There were 60 males and 20 females, with a mean age of 38.2 years (range, 8 to 68 years) and a mean nonunion history of 16.5 months (range, 6 to 150 months) . The causes for nonunion were failure of internal fixation in 60 cases, failure of external fixation in 5 cases and infection in 15 cases. There were 15 hypertrophic, 10 malnourished, 40 atrophic (including 20 bone defects) and 15 infective nonunions.Fifty-eight cases were treated with less invasive stabilization system and 22 cases with locking compression plate. Bone grafting was performed for all cases, including 35 cases of autologous iliac bone grafting, 10 cases of local sliding plus bony callus grafting, 8 cases of autologous iliac bone plus allograft bone grafting, 7 cases of allograft bone plus Wright DBM artificial bone grafting and 20 cases of free vascularized fibular grafting.ResultsAll cases were followed up for a mean period of 13.8 months (range, 6 to 36 months). All cases healed after a mean duration of 5.3 months (range, 4 to 8 months) without wound infection or fixator failure.By the Sanders scale, of the 16 cases of proximal femoral nonunion, the hip functions were rated as excellent in 10, good in 5 and fair in one, with an excellent to good rate of 93.8％. By the American Knee Society Score (KSS), of the 40 cases of distal femoral nonunion, the knee function was rated as excellent in 25, good in 12 and fair in 3, with an excellent to good rate of 92. 5％. By the Sanders and KSS systems, of the 24 cases of femoral shaft nonunion, the hip and knee functions were rated as excellent in 21, good in 2 and fair in one,with an excellent to good rate of 95. 8％.ConclusionAs internal fixation with locking plates and bone grafting can significantly promote fracture union, it is an effective treatment for nonunion of femoral fractures. Key words: Femoral fracutres; Fracture, ununited; Bone plates; Fracture fixation, internal

Biological evaluation of recombinant human bone morphogenetic protein-2 artificial bone in lumbar intertransverse process fusion

Objective To evaluate rhBMP-2/20%β-TCP/PDLLA complex biological properties.Methods Preparation of casting salting was carried out using three-dimensional porous 20% rhBMP-2/β-TCP/PDLLA. 24 4-month-old healthy male New Zealand rabbits were randomly divided into A,B groups of 12,according to the method described in Boden production L4,5 intertransverse process fusion model. A group was embedding rhBMP-2/20%β-TCP/PDLLA complex,and B group was implanted autogenous iliac bone block. Animals were killed according to postoperative time(3 weeks,6 weeks, 12 weeks) ,for gross observation, X-ray observation of the formation of new bone, artificial bone degradation, and early histological manifestations. Results Composite artificial bone and autologous iliac bone graft were able to achieve good spinal fusion,artificial bone graft where there is no inflammatory response,but also in new bone formation,while reshaping the gradual degradation of carrier material. Conclusions 20%β-TCP/PDLLA showed good biocompatibility. Its structure and micro-environment created by its degradation were conducive to play a role for the rhBMP-2. β-TCP/PDLLA had strong activity in inducing bone and good bone fusion ability,and it was a promising bone graft substitutes, which fusion power was stronger than that in autologous iliac bone graft. Key words: Bone morphogenetic porteins; Bone substitutes; Spinal fractures; Biomechanics

Surgical Correction of a Median Cleft of the Mandible

We report a rare case of a boy with median clefts of the lower lip and mandible. In addition, there was a fibrous band extending from the symphysis of the mandible to the suprasternal notch. We repaired the mandibular cleft using autologous iliac bone grafts. The separated mandibular bones were reconnected by rigid fixation with titanium miniplates. Z-plasty with cervical skin was also performed. The fibrous band extending from the mandibular symphysis to the suprasternal notch was dissected. The suprasternal notch end of the band was cut off, and a fibrous soft-tissue pedicled superior flap was formed. The flap was turned over and transferred to the mental region subcutaneously to correct the microgenia. The appearance of this child was greatly improved by this procedure.

Subsidence and Nonunion after Anterior Cervical Interbody Fusion Using a Stand-Alone Polyetheretherketone (PEEK) Cage

BackgroundThe purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications.MethodsThirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs.ResultsThe anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001).ConclusionsAnterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

Opening‐Wedge High Tibial Osteotomy With and Without Bone Graft

Medial opening-wedge has gained popularity in comparison to other techniques of high tibial osteotomy. This technique involves the creation of a gap in the tibia. Filling the gap with autologous iliac bone graft was recommended in the classic description, to prevent complications such as correction loss or delayed bone union. No previous reports have compared grafted and nongrafted osteotomies. This study hypothesized that the use of autologous bone graft in medial opening-wedge high tibial osteotomy (MOWHTO) less than 12.5 mm is unnecessary. A prospective randomized clinical trial was conducted. Forty-six opening-wedge high tibial osteotomies were carried out between April 2007 and December 2008. All had fixation with a type of Puddu stainless steel plate and screws. Patients were randomly divided by software analysis into two groups: group A had osteotomies that were filled with autologous bone graft and group B had osteotomies that were unfilled. Autologous iliac bone graft was harvested in both groups. Clinical and radiographic evaluations were performed twice monthly by blinded investigators. The rates of complications were compared between the groups. There was no difference in demographic data. Mean time to clinical bone union in group A was 12.4 weeks (confidence interval [CI] 11.2-13.6) and in group B was 13.7 weeks (CI 12.5-14.9), but this difference was not significant (P = 0.13). Signals of correction loss occurred in one patient (4.35%) in group A, and in two patients (8.70%) in group B. All osteotomies had achieved bone union. It was concluded that time to bone union was not statistically different between the group with bone graft and the group without graft.

Bone Union Rate With Autologous Iliac Bone Versus Local Bone Graft in Posterior Lumbar Interbody Fusion

A retrospective clinical study with a long-term follow-up in a single facility. The purpose of this study is to compare bone union rate between autologous iliac crest bone graft and local bone graft in patients treated by posterior lumbar interbody fusion (PLIF) using carbon cage for single-level interbody fusion. Recently, a number of authors have reported on local bone grafting using bone that is obtained from laminectomy, and have indicated that the achieved fusion rate is similar to that of autologous iliac bone grafting. However, there is no report comparing the fusion rates between autologous iliac bone and local bone graft with a detailed follow-up of fusion progression. The subjects were 101 patients whose course could be observed for at least 2 years. The diagnosis was lumbar spinal canal stenosis in 14 patients, herniated lumbar disc in 19 patients, and degenerative spondylolisthesis in 68 patients. Single interbody PLIF was performed using iliac bone graft in 54 patients and local bone graft in 47 patients. Existence of pseudarthrosis on X-P (anteroposterior and lateral view) was investigated during the same follow-up period. No significant differences were found in operation time and blood loss. Significant differences were also not observed in fusion grade at any follow-up period or in fusion progression between the 2 groups. Donor site pain continued for more than 3 months in 6 cases (11%). The final fusion rate was 94.5% versus 95.8%. Fusion results from the local bone group and the autologous iliac bone group were nearly identical. Furthermore, fusion progression was nearly identical. Complications at donor sites were seen in 17% of the cases. From the aforementioned results, it was concluded that local bone graft is as beneficial as autologous iliac bone graft for PLIF at a single level.