Research and application of the reamer-irrigator-aspirator / 中国组织工程研究

BACKGROUND:Large volume of bone can be harvested by the reamer-irrigation-aspirator (RIA), which can be used for autologous bone graft, because there are many stromal stem cells and a variety of osteogenesis factors in the harvested bone. OBJECTIVE:To introduce the application progress of the RIA. METHODS:PubMed database was retrieved by the first author for RIA-related articles published from January 2000 to May 2017 using the keyword of "reamer-irrigator-aspirator". A total of 87 articles were searched initially and finally 38 articles met the inclusion criteria. RESULTS AND CONCLUSION:Compared with harvesting bone tissues from the iliac bone, the RIA can harvest more autologous bone tissues with more bone marrow stromal stem cells. Moreover, the osteogenic effect of the harvested autologous bone is better and there are fewer complications. Therefore, the RIA has been widely used as a method of harvesting non-structural autologous bone tissues. Removal of intramedullary lesions by the RIA is used in the treatment of long bone infection, osteomyelitis and bone tumors, as well as in the removal of intramedullary cement. RIA was originally used as a special reaming during intramedullary nailing for femoral shaft fractures, which could reduce high pressure and high temperature so as to decrease the risks of fat embolism and osteonecrosis. To conclude, the RIA can achieve satisfactory outcomes and result in few complications, but the clinical use is still limited by high cost, frequent fluoroscopy, bleeding and limited indications, as well as risks for iatrogenic fractures and perforation.

Analysis of risk factors of the infection after operation of open tibiofibula fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the related factors of the infection after operation of open tibiofibula fractures.</p><p><b>METHODS</b>The clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December 2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years; all the fractures were unilateral. According to Gustilo typing of fracure, 5 cases were type I, 44 cases were type II, 27 cases were type III a, 56 cases were type III b and 9 cases were type III c. These clinical data included patients' age, gender, body mass index (BMI), underlying diseases, time of operation, fracture site, fracture type, fixation method, postoperative drainage, debridement condition and so on. The postoperative infection conditions were recorded, and the correlation between above factors and infections were analyzed. Finally, the significant related variables were introduced into a Logistic regression model to evaluated their risk.</p><p><b>RESULTS</b>Among the 141 patients, 22 cases developed with infection (15.6%). The significant relative factors with infection contained fixation method, debridement condition, underlying diseases and postoperative drainage (P < 0.05). The correlativities were stepped up in order, their odds ratios value was 2.451, 3.164, 3.414, 5.117, respectively.</p><p><b>CONCLUSION</b>Active treatment for underlying diseases before operation, thorough debridement for open wound, suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.</p>

Application of serial tightening of reserved suture threads in delayed incision closure / 中国骨伤

<p><b>OBJECTIVE</b>To study clinical outcomes of serial tightening of reserved suture threads in delayed incision closure.</p><p><b>METHODS</b>From January 2005 to June 2013, 67 patients with delayed incision closure were treated with serial tightening of reserved suture threads. There were 37 males and 30 females, with an average age of 40 years old (ranged from 12 to 75 years old). Among them, 36 patients suffering from leg or forearm double fractures had the incision difficult to those primarily due to high tension or mergency; 13 patients had open wound which lasted for more than routine time for debridement and closure; 9 patients had wound infection; 9 patients had decompression incisions owing to compartment syndrome. The No. 4 suture thread was used to sew up the incision, and the 4 to 6 cm long thread was reserved at two ends of each thread. The reserved thread was tightened gradually from 2 to 4 days after operation according to conditions of swelling relieving. Finally, the reserved thread was not tied until the incision was completely closed.</p><p><b>RESULTS</b>After operation, the reserved threads were tightened and tied for 1 time in 6 patients, 2 times in 23 patients, 3 times in 27 patients, 4 times in 11 patients. Postoperative closure time ranged from 3 to 9 days, with an average of 6.2 days. All the incisions got delayed primary healing.</p><p><b>CONCLUSION</b>The method of serial tightening of reserved suture threads to close delayed incision closure avoids a second operation, which is simple and obtains a fine result.</p>

Clinical application of free upper limb lateral bone-skin flap in hand surgery field / 中华显微外科杂志

Objective To report the surgical method and treatment outecome of transfer of free upper limb lateral bone-skin flap for repair of bone defects and nonunion in hand and forearm.Methods 17 cases of hand composite trauma,5 cases of forearm composite trauma and 2 cases of nonunion in forearm were treated with free bone-skin flaps in distal humerus,whose pedicle was the posterior branch of radical collateral artery. Area of the flap was 2cm?3cm to 8cm?10cm,length of exseeted bone was 3～6 cm.Results All the bone-skin flaps completely survived,the donor area all achieved primary healing,On postoperative 1～4 years follow-up,the texture of the flap was excellent,and bone union was obtained in all transplants,the donor area of distal lateral humerus became thicker and thicker with new cortical bones formed.According to the upper arm function assessment criterion issued by hand surgery association of Chinese medical association.The hand function had excellent results in 17 cases and good results in 2 cases.Conclusion The bone-skin flap has following advantages:easy dissection,reliable blood supply,and no major vessel needed to be sacrificed,so it is an effective method for repair of skin and soft tissue with bone defects in hand and forearm,It.also can be used to repair refractory nonunion in ulna and radius.