Objective To evaluate the method of the allogenous boneplate reconstructing the spinal channel and grafting in treatment of thoracolumbar burst fracture with paraplegia. Methods Thirty-six patients with thoracolumbar burst fracture with paraplegia were included in this study. Their ages ranged from 18 to 56 (average, 38). The vertebral injury involvedT11 in 3 patients，T12 in 10 patients，L1 in 14 patients，L2 in 7 patients，and L3 in 2 patients. Neurological deficits were classified by the Frankel grading. There were 9 patients in grade A, 11 patients in grade B, 13 patients in grade C, and 3 patients in grade D. All the patients were treatedwith the anterior approach, decompression of the spinal channel, interbody graft, and internal fixation. The grafting materials consisted of the allogenous femoral bone plate that was degreased in advance and implanted in the intervertebral posterior region, with cut ribs and bone mills during the decompression. Results Postoperative CT scanning showed clearance of the spinal cord compression and expansion of the spine channel. During the follow-up period averaged 2 years, almost all the patients showed an improvement in the neurological function. Spinal fusion occurred in 32 patients. There was no screw loosened or broken. Only 1 patient failed to achieve the fusion. Conclusion The anterior approach, allograft bone plate reconstructing the spine channel is a safe and effective method in treatment of the thoracolumbar burst fracture with paraplegia, which may be a replacement of the autogenous illiac bone graft.
Objective To introduce a clinical treatment for the reconstructionof calcaneal thalamus by bone autograft and subtalar arthrodesis for antiquatedintraarticular calcaneal fractures. Methods From July 2000 to October 2003, 11 cases with antiquated intraarticular calcaneal fractures were treated. Of the 11 cases, 9 were males and 2 females,whose ages ranged from21 to 48 years. All unilateral calcanei were involved in the 11 cases. The modified extended Lshaped approach lateral to calcaneus was adopted. The primary treatment was manipulation and immobilization with the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis. The average volume of the ilium for the autograft was 3.0 cm×2.5 cm×1.8 cm. Protruded osteophyte from the lateral wall of calcaneus were ablated in all 11 cases. Results All the 11 cases were followed up for 3 to 18 months, 11.5 monthson average. The reconstructed calcaneal thalamus was healed 10 to 12 weeks after the operation. Some of the patients could walk with load 8 weeks after the operation, and the average time for all the patients to walk with load was 13.2 weeks. There were 4 cases of excellent result, 5 cases of good result, and 2 cases of fair result, according to ZHANG Tieliang’s foot score system. Plain radiograph showed that Bohler angle, width of calcaneus and height of calcaneal thalamus were nearlyrestored to normal. Conclusion With the improvement of calcaneal abnormality and restoration of the shape and function of hind foot, reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is effective in treating antiquated intra-articular calcaneal fractures.
Objective To evaluate the medium-term results of uncemented acetabular revision with impacted deep frozen morsell ized allografts. Methods From April 1995 to December 2001, 58 cases (62 hips) were performed acetabularrevision by use of deep frozen morsel ized allograft firmly impacted into local ized defects as well as the entire acetabular cavity, followed by insertion of a uncemented cup with supplementary screw fixation. There were 32 males (34 hips) and 26 females (28 hips), with age of (49.6 ± 15.4) years old. Among 62 hips, 32 hips involved in left side and 30 hips involved in right side. The cause of revision was aseptic loosening of the cup in 56 hips, septic loosening of the cup in 3 hips, and polyethylene l iner dislodging with severe acetabular osteolysis in 3 hips. The average interval between the primary total hip arthroplasty and the revision was (10.1 ± 3.9) years. According to the American Academy of Orthopaedic Surgeons classification, 42 hips belonged to type II and 20 hi ps to type III acetabular defects. The cl inical and radiographic results were analyzed postoperatively. Results All wounds healed by first intention. No deep venous thrombosis and infection occurred postoperatively. All patients were followed up 6-13 years (average 8.1 years). The Harris score was improved from 61.1 ± 10.2 preoperatively to 92.0 ± 7.3 postoperatively, showing significant difference between preoperation and postoperation (P lt; 0.05). The results were excellent in 46 hips, good in 10 hips, fair in 4 hips, and poor in 2 hips, the excellent and good rate was 90.3%. The time for allograft incorporation was (12.5 ± 4.4) months after operation. The annual polyethylene l iner wear rate was (0.13 ± 0.09) mm. Linear and cavitary osteolysis was observed in 2 and 12 hips, respectively. Heterotopic ossification developed in 7 hi ps (11.3%); 3 hi ps were rated as grade I, 3 as grade II, and 1 as grade III according to Brooker classification. One cup underwent revision for asepticloosening and 2 were defined as radiographic failures. Kaplan-Meier survival rate of the cup was 94.2% ± 3.3% at 8 years after operation. Conclusion The combination of uncemented cup component with deep frozen morsel ized allografts seems to be a rel iable solution for restoring bone stock, relocating the hip center, and stabil izing the cup in acetabular revision, and provides favorable medium-term cl inical and radiographic results.
Objective
To investigate the effectiveness and long-term stability of small fenestration vertebral bone grafting and transpedicular bone grafting in the treatment of Denis types A and B thoracolumbar burst fractures.
Methods
Between January 2012 and February 2014, 50 patients with Denis type A or B thoracolumbar burst fractures were treated with vertebroplasty and pedicle screw rod fixation system, and the clinical data were retrospectively analyzed. Small fenestration vertebral bone grafting by trans-interlaminar approach was used in 30 cases (group A), and bone grafting by unilateral transpedicular approach was used in 20 cases (group B). X-ray and CT examinations of the thoracolumbar vertebrae were performed routinely before and after operation. There was no significant difference in sex, age, cause of injury, time from injury to operation, fracture type, injury segment, and preoperative Frankel classification, the percentage of the anterior body height of the injured vertebra, and visual analogue scale (VAS) score between two groups (P>0.05). There was significant difference in preoperative Cobb angle of kyphosis between two groups (P<0.05). The Cobb angle of kyphosis, the percentage of the anterior body height of the injured vertebra, and the recovery of neurological function were recorded and compared between two groups.
Results
The patients were followed up for 16-31 months (mean, 19.1 months) in group A and for 17-25 months (mean, 20.2 months) in group B. Primary healing of incisions was obtained in the two groups; no nerve injury and other operative complications occurred. The neurological function was improved in varying degrees in the other patients with neurological impairment before operation except patients at grade A of Frankel classification. The lumbar back pain was relieved in two groups. There was significant difference in VAS score between before operation and at 3 months after operation or last follow-up in two groups (P<0.05), but no significant difference was found between at 3 months and last follow-up in two groups and between two groups at each time point after operation (P>0.05). X-ray examination showed that there was no breakage of nail and bar, or dislocation and loosening of internal fixation during follow-up period. The bone grafts filled well and fused in the fractured vertebra. The vertebral height recovered well after operation. The percentage of the anterior body height of the in-jured vertebra and Cobb angle of kyphosis at 1 week, 3 months, and last follow-up were significantly better than preope-rative ones in two groups (P<0.05), but there was no significant difference between different time points after operation (P>0.05), and between two groups at each time point after operation (P>0.05).
Conclusion
For Denis types A and B thoracolumbar burst fractures, vertebral bone grafting and pedicle screw internal fixation through interlaminal small fene-stration or transpedicular approach can restore the vertebral height, correct kyphosis, and maintain the vertebral stability, which reduce the risk of complications of loosening and breakage of internal fixators. The appropriate bone grafting approach can be chosen based on the degree of spinal canal space occupying, collapse of vertebral and spinal cord injury.
OBJECTIVE To explore a simple and effective method for the treatment of ischemic necrosis of femoral head. METHODS The anterior region of hip joint was exposed by anterior hip route, a 1.5 cm x 1.0 cm hole was made at the upper region of the femoral neck just below the head. The necrotic bone and sclerotic bone were completely cleaned by drill and curettage until the fresh cancellous bone was exposed. After irrigation, the bone cavity was filled tightly by iliac bone graft until the collapsed femoral head recovered its normal shape. Traction and continuous passive motion(CPM) were performed at the early stage after operation. RESULTS Twenty cases with 29 femoral head ischemic necrosis (Marcus III to IV stage) were treated by above methods. After 1 to 3 years follow-up, the results were all satisfactory. The pain disappeared, and the functions of the hip joint were all excellent with almost normal walking and squatting. CONCLUSION The necrotic bone and the sclerotic bone can be removed by this method, thus optimal conditions for the reconstruction of blood supply is obtained. Abundant cancellous bone graft in the residual bone cavity can support the round shape of the femoral head. CPM is very important in the repair of hyaline cartilage and prevention of joint stiffness. It is a simple and effective method in treating femoral head ischemic necrosis.
ObjectiveTo explore the effectiveness of vacuum sealing drainage (VSD) combined with open bone graft for tibial traumatic osteomyelitis.
MethodsBetween June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years (range, 22-48 years). The time from injury to admission was 7-18 months (mean, 8.6 months). There was local bone scarring in 15 cases, the size ranged from 8 cm×4 cm to 15 cm×8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm (mean, 2.6 cm); 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer.
ResultsNail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months (mean, 13.5 months). In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days (mean, 8.8 days); the bone healing time was 32-40 weeks (mean, 34.4 weeks); and the frequency of VSD was 3-6 times (mean, 4.5 times). In 12 cases of partial bone sclerosis, the infection control time was 7-12 days (mean, 8.3 days); the bone healing time was 24-31 weeks (mean, 27.3 weeks); and the frequency of VSD was 3-5 times (mean, 3.6 times). Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients.
ConclusionThe VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.
Objective
To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis.
Methods
Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
