ABSTRACT
Objective@#To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach.@*Methods@#From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision.@*Results@#All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month′s follow-up, who didn′t accept any treatment because the patient didn′t feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all patients had achieved bone union. According to the modified Merle D′Aubigné and Postel scoring system, 5 cases were excellent, 2 cases were good, 1 case was fair.@*Conclusions@#Surgical management of complex acetabular fracture via lateral-rectus approach combine with 3D printing personalized acetabular wing-plate can effectively improve reduction quality and fixation effect. It will be truly accurate, personalized and minimally invasive.
ABSTRACT
BACKGROUND: Xenograft cortical bone is an easy and inexpensive bone graft material, which has good biocompatibility and bio-mechanical properties. As a bone graft, it can function as biological framework for new bone growth and bio-supporting. Moreover, it can also be processed into internal fixation devices.OBJECTIVE: To review the biological properties, preparation methods and clinical applications of heterogeneous cortical bone for fracture fixation.METHODS: A computer-based online search of Pubmed database (1990-01/2009-05) and CNKI (1990-01/2009-05) was performed for related articles with key words of "Xenograft cortical bone, Bone graft, Fixation" in English and Chinese.RESULTS AND CONCLUSION: A total of 128 articles were collected. Xenograft cortical bone has a good biological performance, in particular, a certain degree of bio-mechanical properties. It is not only able to complete bone filling, bone induction, but also function as internal fixator following processing. However, the traditional preparation process reduces their bio-mechanical properties. Heterogeneous cortical bone can be widely used in intra-articular fractures and cancellous bone fracture fixation, and can be self-absorbed, avoiding the second operation. However, its instability limits its initial mechanical properties of fractures at other sites.
ABSTRACT
Tendon healing following injury includes two forms, endogenous healing and exogenous healing. The ideal way ofpreventing adhesion of tendon is to improve the nutritional state and the surrounding environment of tendon so as to promote endogenous healing and restrain/ease exogenous healing. The normally-used method for preventing the adhesion includes:systemic or partial administration, protection and repair of tendinous sheath, substitution of tendinous sheath with autologous tissue or synthetic material, tendon transplantation, tendinous sheath reconstruction and so on, all of which do have some curative effects. However, recent research focus has come down to the degradable and absorbable polymeric biomaterials that can be used as barriers for preventing the adhesion. Besides, traditional Chinese medicine, rehabilitation therapy and early protected motion all can prevent the adhesion to some degree. In future, the tissue engineering tendon transplantation may become an investigative aspect. By using atreumatic technique and non-strangulated suture in the earlier period after tendon injury, warding and repairing tendinous sheath as much as possible as well as packaging the tendon with polymeric biomaterials during operation, and adopting combined therapy of rehabilitation therapy together with early protected motion after operation, we can prevent tendon adhesion obviously and have the gliding function of tendon recovered to the greatest extent.