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Nonunion is the interruption of fracture healing process for a variety of reasons.The cause of the disease is different,and the treatment method is also different.Non-infective nonunion is that there are no local infection factors when nonunion occurs after wound and fracture,and it is most common in all nouunion.However,it is still a difficult problem for clinical orthopaedics.With the development of medical technology orthopaedics attach great importance to this kind of nonunion and study it deeply,its incidence is getting lower and lower.Despite brilliant results,the treatment for this kind of nonunion remains tricky.The treatment of non-infective nonunion can be divided into conservative treatment and surgical treatment,and the latter is still the main treatment.This article gives a systematic review of the treatment of non-infective nonunion.
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Objective To investigate the clinical efficacy of bone grafts containing bone morphogenetic protein 2 (Bone Conduction) treating of nonunion of femoral fracture after intramedullary nailing.Methods The clinical data of 49 patients with nonunion of femoral fracture after intramedullary nailing from August 2008 to August 2016 were analyzed retrospectively.They were divided into experimental group and control group according to different bone grafting methods.The experimental group (n =23) was treated with Bone Conduction combined with allograft bone grafting.The control group (n =26) was treated with autogenous bone grafting.The autogenous bone was taken from the ipsilateral ilium.The two groups were compared operative time,intraoperative blood loss,postoperative wound complications,hospitalization time,postoperative visual analog scale,mean image healing time and the score for distal femoral fractures after the operation.All patients were followed up for 12 to 24 months.Follow-up methods were divided into telephone follow-up and outpatient follow-up.The patients were followed up for outpatients before fracture healing.The patients were followed up by telephone after fracture healing.The healing time of fracture,the flexion and extension activities of the knee joint at 9 months after operation were recorded.SPSS19.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ±s).The independent sample t test was adopted in measurement data and the counting data was tested by Chi-squared test.Result In the experimental group,operative time was (138.7 ± 34.6) minutes,intraoperative blood loss was (315.4 ± 52.8) ml,postoperative wound complications was 0 case,hospitalization time was (8 ± 3) days,postoperative visual analog scale was 5 scores,but in the control group,operative time was (170.5 ± 32.5) minutes,intraoperative blood loss was (367.2 ± 56.4) ml,postoperative wound complications was 3 cases,hospitalization time was (13 ± 2) days,postoperative visual analog scale was 8 scores.There were significant differences between the two groups,P ＜0.05.All patients who followed up for 12-24 months were recovered,with an average follow-up of 15 months.Mean image healing time in the experimental group and control group was separately(4.9± 2.5) months,(5.2 ± 2.8) months.The excellent and good rates ofthe score for distal femoral fractures 9 months after the operation was separately 95.7％,96.2％,there was no significant difference between the two groups,P ＞ 0.05.Conclusions Bone graft material containing bone morphogenetic protein 2 (Bone Conduction) has the advantages of simple operation,less trauma,less complications,high osteogenic activity and good bone graft effect are equalled with iliac bone graft,the bone graft material containing bone morphogene protein is an effective method to treat nonunion of femoral fracture after intramedullary nail.
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OBJECTIVE: To investigate the effect of balloon kyphoplasty combined with bone cement on the treatment osteoporotic vertebral fracture.METHODS: A total of 58 aged patients with single osteoporotic vertebral compression fracture (58 vertebral bodies) were treated with balloon kyphoplasty. The fracture always occurred at T_8-L_4 segment of vertebral body in particular at T_(10)-L_2 segment of thoracic waist. By local anesthesia, lateral or bilateral pedicle of vertebral arch was punctured to injection bone cement under C-arm fluoroscopy.RESULTS: Bone cement leakage occurred in 8 cases, including leakage along posterior longitudinal ligament into adjacent posterior margin of vertebral body (n=1), external edge of vertebral body (n=6), and subcutaneous tissue (n=1); however, all the patients did not have clinical symptoms. C-arm fluoroscopy showed that height of vertebral body was increased, and rachiokyphosis was improved after treatment. Pain was obviously improved, and the easement rate of pain was 100%. There was significant difference in visual simulation score, angle degree of rachiokyphosis, and living activity scale before and 6 months after treatment (P < 0.05), but there was no significant difference between 6 months after treatment and following up stopping (P>0.05).CONCLUSION: Balloon kyphoplasty can significantly ease pain caused by osteoporotic spinal fractures and tumor metastatic spinal fractures and can partially restore vertebral body height and kyphosis deformity, there is conducive to improving spinal function and improving the quality of life.
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Pedicle screw instrumentation has become the standard stabilization of the posterior lumbar spine.Loosening due to osteoporosis is the common reason for failure.Bone cement augmentation is regarded as an efficient way to enhance screw strength in osteoporotic bones.In this review,a brief introduction to the recent advances in researches on the biomechanics of the bone-screw interface,the pedicle screw augmentation technique and the materials of bone cement is presented.The paper emphasizes the significance of studies on the augmentation indications,vicariousness activity in osteoporosis sclerotin and the strength.