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Objective:To investigate the therapeutic efficacy of Ilizarov bone shortening-lengthening technique for tibial defects of bone and soft tissue without vascular injury.Methods:A retrospective analysis was made of the 28 patients who had been treated by Ilizarov bone shortening-lengthening technique at Department of Orthopaedics, Wuxi No.9 People's Hospital from January 2007 to October 2017 for tibial de-fects of bone and soft tissue without vascular injury.They were 20 males and 8 females, aged from 18 to 69 years (average, 36.4 years).By the Gustillo classification, 5 cases belonged to type Ⅱ, 6 to type ⅢA and 17 to type ⅢB.Infection was complicated in 17 cases.After debridement or epluchage, the area of skin defects ranged from 4 cm × 3 cm to 16 cm × 5 cm and the length of bone defects from 4.5 to 11.0 cm (average, 6.9 cm).The wound healing, bone healing, functionary recovery of lower extremity and complications were observed postoperatively.Bone healing and functional recovery of lower extremity were evaluated according to the grading of Association for the Study and Application of the Method of Ilizarov (ASAMI).The complications associated with Ilizarov technique were assessed according to the Paley criteria.Results:The follow-up for all the patients lasted from 12 to 45 months (average, 20.5 months).The healing time for wounds ranged from 13 to 35 days (average, 21.9 days), the healing time for lengthened bone from 6 to 12 months (average, 8.9 months), and the healing time for bone defects at the dock sites from 6 to 11 months (8.3 months).According to the ASAMI grading, the bone healing was excellent in 21 cases and good in 7, giving an excellent to good rate of 100%(28/28) while the functionary recovery of lower extremity was excellent in 10 cases, good in 15, fair in 2 and poor in one, giving an excellent to good rate of 89.3%(25/28).The incidence was 14.3%(4/28) for major complications after Ilizarov surgery, 57.1%(16/28) for minor complications, 60.7%(17/28) for overall complications, and 1.7 times for each case.Conclusion:In the treatment of tibial defects of bone and soft tissue without vascular injury, Ilizarov bone shortening-lengthening technique can deal with the difficulties in repair of soft tissue defects, characterized by simplified wound closure, fast and improved bone healing at the dock sites, reduced complications and satisfactory functionary recovery of lower extremity.
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Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P ＞ 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8％),minor complications (57.6％) and overall complications (83.1％) than the induced membrane technique group (11.2 ± 2.8 months,16.7％,26.7％ and 30.0％,respectively) (P ＜ O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P ＜ 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.
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Objective To investigate the clinical effects of treating traumatic lesions of the popliteal artery by staged stretching.Methods From July 2011 to March 2016,29 patients with traumatic lesion of the popliteal artery underwent staged stretching after direct end to end anastomosis at Department of Orthopaedics,The 9th People's Hospital of Wuxi.They were 19 males and 10 females,with a mean age of 38.3 years (range,from 16 to 61 years).The average length of popliteal artery lesions was 3.7 cm (range,from 2 to 5 cm).After the keen joint was immobilized at flexion by external fixation,direct end to end anastomosis was performed with a proper segmental vascular freedom.From 4 weeks after operation,the popliteal artery was stretched stage by stage to its original length by gradual adjustment of the external fixation till the knee joint was fully extended.The color,skin temperature,pulp tension and capillary reaction of the toes were closely observed after surgery.CT angiography (CTA) was performed 6 months after surgery.The active range of motion was assessed at 12 months after surgery for the knee and ankle joints on the injured limb.Results All the patients were available for an average follow-up of 2 years (range,from 1 to 3 years).Blood supply was good for all the affected limbs.The staged stretching of the popliteal artery resulted in no rupture of any anastomotic stoma or no thrombus.CTA at 6 months after surgery showed fine patency of the popliteal artery and no formation of false aneurysm or arteriovenous fistula.At 12 months after surgery,the knee function was excellent in 15 cases,good in 10 and fair in 4;the ankle function was excellent in 18 cases,good in 8 and fair in 3.Conclusion Staged stretching is a safe,convenient and effective treatment of traumatic lesions of the popliteal artery.
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Objective To investigate the augmentation plating for femoral fractures and postoperative femoral nonunion. Methods A retrospective analysis was conducted of 60 patients with femoral fracture or postoperative femoral nonunion who had been treated with augmentation plating from January 2008 to July 2015. They were 36 males and 24 females, aged from 15 to 79 years ( average, 43. 4 years ) . Of them, 20 cases suffered nonunion following intramedullary nailing of femoral shaft fracture, 18 nonunion following lateral plating for femoral distal or lower fracture, and 22 femoral distal or lower fracture complicated with comminuted fracture of medial column. An incision ranging from 6 to 10 cm was made around the fracture ends for augmentative plating for all the patients. Autogenous iliac bone graft was performed in patients with atrophic nonunion or ob-vious gap after reduction of the comminuted fracture. Operation time, intraoperative bleeding, healing time, complications, and functionary recovery of the affected knee were recorded. Results The operation time averaged 121. 5 min and the intraoperative bleeding 356. 3 mL. All the patients were followed up for 12 to 36 months ( average, 16. 9 months ) . All the fractures and nonunions healed after an average time of 4. 2 months ( from 3 to 4 months ) . The time for initial partial weight-bearing averaged 4. 5 weeks ( from 2 to 6 weeks ) and the time for initial full weight bearing 3. 3 months ( from 2 to 4 months ) . Evaluation according to the Karlstrom and Olerud criteria at the last follow-up revealed 29 excellent, 24 good and 7 fair cases, yielding an excellent and good rate of 88. 3％. No infection, loosening, bending or breaking of internal implants, or refracture was noted during follow-ups. Conclusion Augmentation plating through a small incision can lead to fine outcomes for femoral fractures and postoperative femoral nonunion, because it makes up the deficient stability of original in-ternal fixation, reduces the dislocated bone blocks and provides bone grafting to improve defective local bone structure and defective osteogenesis.
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BACKGROUND: Lateral locking plate is a classical fixation method to treat lower and distal femoral fractures. However,the incidences of delayed healing, nonunion, plate extubation, and internal fixation rupture exceed 20% after internal fixation.OBJECTIVE: To compare the effectiveness of augmentation plating and single plating for distal and lower femoral fractures with medial comminution.METHODS: Totally 60 patients of lower and distal femoral fractures with medial comminution treated with open reduction and plate fixation were divided into augmentation plating (treatment group, 28 cases) and single lateral plating (control group, 32 cases). We observed the operation time and blood loss, recorded the out-off-bed rehabilitation time, full weight bearing time and complication. The functionary recovery of knee joint was evaluated according to Schatzker-Lambert method for distal femoral fractures in final follow-up.RESULTS AND CONCLUSION: (1) All patients were followed for at least 12 months. All incisions were healed by first intention. (2) The operation time and blood loss in the treatment group were greater than those in the control group (P <0.05). (3) The healing time (3.11±0.31 months), out-off-bed rehabilitation time (4.36±0.91 weeks), full weight bearing time (3.67±0.62 months), complication (0) and excellent and good rate of knee functionary recovery (100%) in the treatment group were better than those in the control group [(5.65±2.33), (7.25±1.02), (6.03±2.61) months, 8, 65.6%] (P < 0.05). (4)Although augmentation plating for treatment of lower and distal femoral fractures with medial comminution prolongs operation time and increases surgical blood loss, the results including the healing rate, complication and satisfaction rate are superior to those treated with single lateral plating.
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Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone.Methods From January 2008 to December 2015,50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous cancellous bone.They were 31 males and 19 females,aged from 13 to 69 years (average,34.6 years).The cancellous bone was wrapped by titanium mesh in 8 cases,by wire mesh in 10,by line binding in 13,and by induced membrane in 19.The bone defect was located at tibia in 22 cases,at radius in 10,at humerus in 8,at ulna in 7 and at femur in 3.The length of bone defect ranged from 3 to 9 cm,averaging 5.9 em.Bone healing,complications and functionary recovery of adjacent joint were recorded.The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria.Results The incisions healed by the first intention in 48 cases and by the second in 2.All were followed up for 12 to 48 months (average,19.1 months).All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends.The total clinical healing time ranged from 3 to 16 months (average,6.1 months).The last follow-ups showed that all the affected limbs resumed weight-bearing activities.The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping.Totally,the functionary recovery of adjacent joint was excellent in 18,good in 22,fair in 7 and poor in 3 cases (an excellent and good rate of 80.0％).Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after traditional bone grafting.Although it is effective for treatment of large segmental bone defect,its methods should vary according to the specific conditions of the patient.
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Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone.Methods From January 2008 to December 2015,50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous cancellous bone.They were 31 males and 19 females,aged from 13 to 69 years (average,34.6 years).The cancellous bone was wrapped by titanium mesh in 8 cases,by wire mesh in 10,by line binding in 13,and by induced membrane in 19.The bone defect was located at tibia in 22 cases,at radius in 10,at humerus in 8,at ulna in 7 and at femur in 3.The length of bone defect ranged from 3 to 9 cm,averaging 5.9 em.Bone healing,complications and functionary recovery of adjacent joint were recorded.The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria.Results The incisions healed by the first intention in 48 cases and by the second in 2.All were followed up for 12 to 48 months (average,19.1 months).All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends.The total clinical healing time ranged from 3 to 16 months (average,6.1 months).The last follow-ups showed that all the affected limbs resumed weight-bearing activities.The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping.Totally,the functionary recovery of adjacent joint was excellent in 18,good in 22,fair in 7 and poor in 3 cases (an excellent and good rate of 80.0％).Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after traditional bone grafting.Although it is effective for treatment of large segmental bone defect,its methods should vary according to the specific conditions of the patient.
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Objective To discuss the surgical techniques and results of internal fixation supplemented with soft tissue repair of triad injury of the elbow via the combined anterior-lateral approach.Methods A retrospective analysis was done on 15 patients with triad injury of the elbow treated from January 2011 to August 2014.There were 10 males and 5 females,aged 38.4 years (range,20-61 years).Injury resulted from traffic accidents in nine patients,high-level falls in three and groundlevel falls in three.Radial head fractures were Mason type Ⅰ in five patients,type Ⅱ in eight,and type Ⅲ in two.Fractures of the coronoid process of the ulna were Regan-Morrey type Ⅰ in four patients,type Ⅱ in ten and type Ⅲ in one.Time interval between injury and operation was 8.5 d.All patients were firstly operated on through the anterior approach to have Herbert screw fixation or anterior capsule suture lasso fixation of the coronoid fracture as well as Herbert screw fixation of the radial head fracture.And then,elbow lateral incision was made to repair lateral collateral ligament complex and common extensor tendon by 2-0 Ethibon suture.Elbow flexion-extension,forearm pronation-supination and Mayo elbow performance score (MEPS) were used to evaluate the clinical elbow functions.Complications were recorded after operation.Results All patients were followed up for mean 19.6 months (range,12-30 months).All coronoid fractures healed.Radial head fractures in 14 patients healed.Comparison of preoperative to final follow-up variables presented significant differences in elbow flexion-extension [(45.1 ± 5.6) °:(129.5 ± 9.3) °],forearm pronation-supination [(55.4 ±.8.7) °:(140.5 ± 10.3) °] and MEPS [(25.1 ± 9.6) points:(91.2 ± 5.2) points] (P ＜ 0.01).Complications included heterotopic ossification in one patient and nonunion of radial head fracture in one patient.No neurovascular injury of the elbow,elbow residual instability,dislocation,elbow stiffness and active pain occurred.Conclusion Combined anterior-lateral approach with internal fixation and soft tissue repair is a simple and safe method that effectively restore the elbow joint function.
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Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement (ROM) of adjacent joints by authors's method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months (average 19.7 months);all the bone defects healed,the clinical healing time was 3.0 to 7.0 months (average 4.7 months).The healing time in the 3 cases with induced membrane damage and defect (average 6.0 months) was longer than that in patients without induced membrane damage and defect(average 4.6 months).1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded:excellent in 8 cases,good in 10 cases,and fair in 2 cases (the excellent and good rate was 90％),the ROM of the adjacent joints graded:excellent and good in 8 cases,respectively,fair and poor in 2 cases,respectively (the excellent and good rate was 80％).Conclusion Induced membrane technique has advantages of simple surgery,faster healing of bone defect,no correlation between the healing time and the length of bone defect,fewer complications,etc,but in clinical application,the operators must understand the therapy principle and pay attention to the influencing factors and technical points so as to avoid operation errors,reduce complications and improve therapeutic effect.
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Objective To explore the application and effects of bone lengthening growth diary in self management of patients after lower limb lengthening. Methods A total of 54 cases applying lower limb lengthening were divided into the experimental group (n=28) and the control group (n=26) with random digit table. The basic treatment was consistent, the control group was given routine guidance, the experi-mental group implemented self- management with bone lengthening growth diary. Self- recognition of disease was assessed and compared between the two groups 12 weeks after operation. Self- efficacy and self- manage ment were assessed and compared between the two groups 2 and 12 weeks after operation. Results The self- recognition of disease in the observation group was better than that of the control group, for patients with higher self- recognition degree (21 cases vs. 10 cases), χ2=8.64, P<0.05, the difference was significantly different. The total scores of self- efficacy and self- management in the observation group were higher than those of the control group,(48. 42±3.43) vs.(34.14±4.13),t=11.750, P<0.01;(55.35±2.69) vs.(42.15±3.67), t=15.130, P<0.01, the difference was significantly different. Conclusions Bone lengthening growth diary plays a beneficial role on self-management of patients with lower limb lengthening.
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BACKGROUND:With the extensive application of anterior titanium plate, postoperative complications such as dysphagia, titanium loose, screw exit and disc degeneration of neighboring segments induced more and more attention of researchers. However, the application of anterior cervical cage is expected to avoid these complications. ＜br> OBJECTIVE:To observe primary curative effect of anterior cervical cage ROI-C in anterior cervical spine surgery. ＜br> METHODS:A total of 32 patients with cervical spondylosis were treated with anterior cervical cage ROI-C in the Wuxi Ninth Hospital Affiliated to Soochow University from April to December 2013. The cage was implanted to promote interbody fusion. Of 32 cases, 23 cases affected cervical spondylotic myelopathy, 2 cases affected nerve root type cervical spondylosis, 3 cases affected cervical hyperextension injury, 1 case affected cervical disc herniation, 2 cases affected cervical instability and 1 case affected segmental cervical ossification of the posterior longitudinal ligament. Japanese Orthopaedic Association and NDI scores were determined to assess neurological symptoms and functional improvement before internal fixation and during final fol ow-up. Simultaneously, adverse reactions were recorded. ＜br> RESULTS AND CONCLUSION:A total of 32 patients finished the regular fol ow-up for 4 to 8 months. Clinical symptoms and spinal cord function of al patients were obviously improved. No ROI-C loosing or displacement or secondary surgery was found. The average fusion time was 4.2 months (3 to 5 months). Mean score of Japanese Orthopaedic Association was increased from 9.2 points pre-surgery to 13.8 points post-surgery. Japanese Orthopaedic Association and NDI scores were higher during final fol ow-up than before fixation (P＜0.05). These data indicated that ROI-C effectively restored intervertebral height in anterior cervical spine surgery, stably reconstructed cervical vertebra, obtained interbody fusion, effectively avoided related surgical complications induced by plate implantation, improved neurological symptoms and function, and showed good short-term effects.
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BACKGROUND:Previous studies have mainly focused on costal cartilage, articular cartilage, nasal septal cartilage, and auricular cartilage, but in vitro culture of human vertebral endplate cartilage is stil rarely reported. OBJECTIVE: To discuss the feasibility of culture of vertebral endplate chondrocytes from type I neurofibromatosis associated with scoliosis patientsin vitro and to study the biological characters of the chondrocytes. METHODS: Through two-step enzymatic digestion and tissue culture, the chondrocytes from the vertebral endplate of seven type I neurofibromatosis patients isolated and cultured in monolayer and passaged to observe the changes of cel morphology under inverted phase contrast microscope. Colagen type II expression was detected by immunocytochemistry to identify whether the cels had chondrocyte characters. The growth kinetics was detected by using MTT colorimetric assay to draw the growth curve of passage 2 chondrocytes. RESULTS AND CONCLUSION:A few chondrocytes crawled from the cartilage after 2 weeks culture and cels were passaged at 3 weeks. Along with passage going on, the phenotype of chondrocytes was changed from polygonal, round, triangle, and irregular shapes to fusiform. The colagen type II expression in passage 2 cels was positive by immunohistochemical staining. MTT test showed the growth curve of the passage 2 chondrocytes presented a transverse “S”. Cels were found logarithmic growth at days 4-7, reached platform stage at days 8-13, and decreased at day 14. It is an effective and simple procedure by two-step enzymatic digestion and tissue explant method to culture vertebral endplate chondrocytes with high purity and good viability from type I neurofibromatosis patients associated with scoliosisin vitro. Passage 2 chondrocytes from the vertebral endplate exhibit the best viability at days 4-7, which can be used as targets for research of pathogenesis of type I neurofibromatosis with atrophic scoliosis.
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To compare the clinical efficacy of treating Denis type B thoracolumbar burst fracture with allogenic bone and calcium sulfate implanting in injured vertebra.A total of 46 patients were randomly assigned into 2 groups.Group A( n=22) received allogenic bone implanting in injured vertebra while group B( n=21) had calcium sulfate grafting in injured vertebra.Group A was better than group B in maintaining tanterior vertebral body height and lessening the degree of bone defect ( P 0.05).
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Objective To investigate the clinical effects,feasibility,points for attention and complications of treating distal radial fractures through minimally invasive palmar locking plate.Methods A total of 22 patients with distal radial fractures managed by minimally invasive palmar locking plate from August 2009 to August 2010 were enrolled in the study.According to AO classification,there were five patients with type A2 fractures,three with type A3,four with type B1,seven with type B3,two with type C1 and one with type C2.Two vertical or parallel palmar incisions of 2 cm long were performed.The distal transverse incision was along the proximal wrist crease,while the distal and proximal vertical incisions were close to the radial side of flexor carpi radialis.Then,palmar locking plate was inserted through deep pronator quadratus.Results Follow-up period was 10-18 months(mean,12 months).According to Dienst function evaluation criteria,the results were excellent in 13 patients,good in six,fair in three and poor in zero,with excellence rate of 86％.Complications were as follows:one patient had delayed healing of proximal wrist crease incision;one patient had numbness of thenar eminence and the symptom was disappeared three months postoperatively;two patients remained pain on ulnar side of the wrist joint;two patients had limited function of the wrist joint.Conclusions Minimally invasive palmar locking plate is safe,mini-invasive and reliable when treating distal radial fractures,which is conducive to early functional exercise.Furthermore,the method achieves satisfactory appearance of the incision which meets the minimal invasion and thus deserves clinical practice.