Emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part without replantation condition / 第二军医大学学报

Objective To investigate the feasibility of emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part, when the soft tissue is severely damaged and the amputated thumb is not replantable. Methods When the soft tissues of the amputated thumb was severely damaged and replantation was not applicable, thumb reconstruction as phase one emergency management was proceeded. The skin and nail bed of the amputated thumb was removed. The bone was in situ replanted, and the tendon was repaired. The nail flap from the ipsilateral toe was grafted and the bone and tendon was wrapped around to reconstruct the thumb. Results A total of 5 patients underwent surgical treatment. All reconstructed thumbs survived with an appearance similar to the contralateral sides. The patients were followed up for 10 months on average (range, 4 to 18 months). The result of two-point discrimination test was 10.1 mm on average (range, 9.2-12.0 mm). The preserved joints possessed partial function. The average range of motion of the metacarpophalangeal joint was 69.6° (range, 20° to 90°). The range of motion of interphalangeal joint was 15° and 20° in 2 patients, respectively. No infection or bone resorption occurred. The injury was healed successfully in 4 patients, and delayed union occurred in one patient. Conclusion Complete bone and tendon from the nonreplantable amputated part combined with wrap-around flap can be used for emergency thumb reconstruction and it can achieve good clinical results.

Management principle and clinical suggestions of osteotomy gap of opening wedge high tibial osteotomy / 中国修复重建外科杂志

Objective: To summarize the management principle and clinical suggestions of the osteotomy gap of opening wedge high tibial osteotomy (OWHTO). Methods: The related literature of the osteotomy gap of OWHTO in recent years was reviewed, summarized, and analyzed. Results: Delayed union and non-union of the osteotomy gap are main complications of OWHTO. Tomofix plate, as locking steel plate, has the characteristics of angular stability and can better maintain the stability of the osteotomy gap, promote bone healing, and avoid loss of correction. There are some treatment options for the osteotomy gap site, such as, without bone, autologous bone graft, allogeneic bone graft, bone substitute materials graft, and augment factor graft to enhance bone healing. When the osteotomy gap is less than 10 mm, it achieves a good outcome without bone graft. For the obesity, lateral hinge fracture, large osteotomy gap, or correction angle more than 10°, the bone graft should be considered. In cases whose osteotomy gap is nonunion or delayed union, the autologous bone graft is still the gold standard. When the osteotomy gap repaired with the allogeneic bone graft, it is better to choose fragmented cancellous or wedge-shaped cancellous bone, combining with the locking plate technology, also can achieve better bone union. The bone substitute material of calcium-phosphorus is used in the osteotomy gap, which has the characteristics of excellent bone conduction, good biocompatibility, and resorption, combining with the locking plate technology, which can also achieve better bone union in the osteotomy gap. The augment factors enhance the bone healing of the osteotomy gap of OWHTO is still questionable. The bone union of the osteotomy gap is also related to the size of the osteotomy gap and whether the lateral hinge is broken or not. Conclusion: No matter what type of materials for the osteotomy gap, OWHTO can improve the function and relieve pain for knee osteoarthritis. More randomized controlled trials are needed to provide evidence for clinical decision to determine which treatment option is better for the osteotomy gap of OWHTO.

Clinical effect of platelet-rich plasma combined with bone graft on bone defect in humeral condylar / 局解手术学杂志

Objective To investigate the effect of platelet-rich plasma(PRP) combined with bone graft in the treatment of humeral condylar bone defect.Methods A total of 135 patients with humeral condylar bone defect in Ankang central hospital from January 2012 to December 2015 were divided into the PRP combined group(n =69) and the conventional group(n =66) according to the order of admission time.The patients of PRP combined group were treated with platelet-rich plasma combined with autologous bone graft,and patients of conventional group received autologous bone graft,respectively.The surgery time,hospitalization time,wound healing,fracture union and the motion of elbow joint at postoperative 1 year between two groups were compared.The Kaplan-Meier survival curve was used to reflect the bone healing in both groups,and the log-rank test was used to compare the result.Results There was no statistically significant difference in the surgery time,hospitalization time,wound healing and motion of elbow joint at postoperative 1 year between the two groups(P ＞ 0.05).But the average time of wound healing (3.8 ± 0.72) weeks and the time of bone union (18.8 ± 3.50) weeks in PRP combined group were significantly shorter than (6.4 ±0.58) weeks and (22.7 ± 1.55) weeks in the conventional group(P =0.000),the differences were significant.The KaplanMeier survival curve of the bone union in the PRP combined group was also significantly better than that in the conventional group.Conclusion PRP can promote the healing of fracture in patients with humeral condylar bone defect after autologous bone graft,which contributes to the recovery of elbow function.

Reconstrução imediata de fenestração peri-implantar por meio de enxerto autógeno em bloco obtido do ramo mandibular / Immediate reconstruction of peri-implant fenestration with autogenous block grafts harvested from mandibular ramus

As fenestrações das paredes alveolares são relativamente comuns durante o procedimento cirúrgico para instalação de implantes. O objetivo do presente trabalho foi relatar um caso clínico de reconstrução de fenestração peri-implantar imediatamente após a instalação de implante osseointegrável, através de enxerto ósseo autógeno em bloco obtido do ramo mandibular. Paciente do sexo masculino procurou o Departamento de Cirurgia e Clínica Integrada para trocar sua prótese parcial removível classe IV de Kennedy por prótese parcial fixa implantossuportada. Foram instalados dois implantes nos espaços protéticos correspondente aos dentes 12 e 21. Houve uma fenestração peri-implantar da parede vestibular durante a instalação do implante correspondente ao dente 12, que foi reconstruídapor meio de enxerto autógeno em bloco obtido do ramo mandibular e fixado por meio de parafuso bicortical. Após seis meses de concomitante período de incorporação do enxerto ósseo autógeno e osseointegração, iniciou-se o processamento para confecção da prótese parcial fixa implantossuportada. Diante da reabilitação protética alcançada, concluiu-se que o enxerto ósseo autógeno obtido da área doadora ramo mandibular constitui uma alternativa segura e eficaz para reconstrução de defeitos peri-implantares em forma de fenestração óssea...

Alveolar wall fenestrations are common during implant placement. The aim of this paper is to report a case where a peri-implant bone fenestration was reconstructed immediately after implant placement by an autogenous mandibular bone block. A male patient was referred to the Department of Surgical and Integrated Clinics to substitute his Kennedy´s Class IV removable partial denture for an implantsupported fixed prosthesis. A peri-implant bone fenestration at the buccal wall was seen at the region of 12, being reconstructed by a mandibular bone block secured by a bicortical screw. Six months later the surgical procedures, an implant-supported complete fixed partial prosthesis was developed. The autogenous bone block harvested from the mandibular ramus was a safe alternative to reconstruct the peri-implant bone defect such as fenestration types...

Application of spiral computed tomography to evaluate the autogenous grafted bone in unilateral complete cleft lip and palate patients following early orthodontic tooth movement / 中华医学美学美容杂志

Objective The purpose of this study was to evaluate the outcome of autogenous bone grafts in unilateral cleft lip and palate patients following early orthodontic tooth movement,and to determine the volume of new bone formation in the bone grafted region with spiral computed tomography.Methods Computed tomography scans of 12 patients were taken immediately preoperatively and at 6 months postoperatively.The patients underwent bone grafting between 9 and 13 years of age were divided into two groups based on whether postoperative orthodontic tooth movement were initiated or not.Three-dimensional models were created in each period,and the defect of alveolar cleft and volume of the newly formed bone were calculated in each patient.The roots of the moved teeth and their positions to the alveolar bone were also observed.Results The preoperative cleft width and cleft volume were not significantly different between both groups.The volume of the newly formed bone in group A was (0.98±0.23) mm3,significantly higher than that in group B,which was (0.73± 0.15) mm3.The rate of newly formed bone in group A was (72.5 ± 11.9)％,significantly higher than that in group B,which was (53.2±9.7)％.The cleft adjacent teeth could move smoothly into the bone grated area,with no root resorption observed in the computed tomography scans.Conclusions Early orthodontic tooth movement can reduce bone resorption in autogenous bone grafted unilateral cleft lip and palate patients through the observation of spiral computed tomography.It plays an active role in the bone remolding process after bone grafting.

The Result of Bone Grafting for Fibrous Dysplasia / 대한골관절종양학회지

PURPOSE: Fibrous dysplasia is related to the mutation of gene encoding the alpha-subunit of a signal-transducing G-protein and has variable clinical course. Operation can be performed to prevent functional disorder or structural deformity. After curettage, autologous bone graft were used to fill the defects after curettage. The aim of this study is to compare the result of autogenous cancellous bone grafting and allogenic bone grafting for fibrous dysplasia. MATERIALS AND METHODS: Among the patients who visit our hospital during the period of April, 1997 to October, 2013, we selected 34 patients who diagnosed fibrous dysplasia and visited our clinic over 1 year. There were 13 males and 21 females. Average age was 26.4 (range 2 to 57) years old. Autogenous bone graft (group I) in 5 cases, Non-autogenous bone graft (group II) in 30 cases. Iliac bone is used in all cases of autogenous bone graft. There were no significant difference in age, follow-up period, preoperational laboratory finding between two groups. Radiographic image was done to evaluate the recurrence of fibrous dysplasia or secondary degeneration. RESULTS: There were four cases in recurrence (group I: 1 case, group II: 3 cases, p=0.554). In all recurrent cases, reoperations were done using curettage and autogenous iliac bone graft. There was no re-recurrence after reoperation. One case of secondary aneurysmal bone cyst was confirmed (group II) and 1 cases of pathologic fractures had developed (group I: 0 case, group II: 1 cases, p=0.559). No malignant change occurred. CONCLUSION: There were no significant difference between autogenous bone graft group and non-autogenous bone graft group. Our result suggested that autogenous bone graft seems to be good method to treat fibrous dysplasia, in the case of small volume of tumor lesion or non-weight bearing portion.

Treatment for Bone Defect of Open Tibial Fractures by Using Intramedullary Nail Fixation with Autogenous Iliac Bone Graft

PURPOSE: This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures. MATERIALS AND METHODS: Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali. RESULTS: This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively. CONCLUSION: Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.

Influência do laser em baixa intensidade no processo de reparo de enxerto ósseo autógeno implantado em bloco na mandíbula de ratos modificados sistemicamente com nicotina: estudo histomorfométrico / Influence of Low level laser therapy on healing process of autogenous bone block graft installed in mandible of systemically modified rats by nicotine: histomorphometric study

Introdução: A nicotina, uma das drogas mais nocivas a saúde, causa, entre outros fatores, morbidade do enxerto ósseo e compromete a cicatrização óssea. Por outro lado, o tratamento com laser em baixa intensidade pode proporcionar efeitos bioestimulantes, aumentando a microcirculação sanguínea da área irradiada e estimulando fibroblastos, promovendo melhores condições de cicatrização. O objetivo do presente estudo foi analisar a influência do laser em baixa intensidade sobre o processo de reparo de enxertos ósseos autógenos em bloco instalados em animais modificados sistemicamente pelos efeitos indesejáveis da nicotina. Materiais e Métodos: Foram utilizados 72 ratos (Wistar) divididos em Grupo A (n=36), subgrupos GI e GII, submetidos à aplicação de nicotina e Grupo B (n=36), subgrupos GIII e GIV, submetidos à aplicação de solução fisiológica. Transcorridos 30 dias das aplicações, todos animais receberam enxerto ósseo autógeno na mandíbula, tendo como área doadora o osso parietal da calvária, sendo que os animais pertencentes aos subgrupos GII e GIV, receberam o tratamento com laser em baixaintensidade na interface enxerto-leito receptor. Os animais de cada grupo foram submetidos à eutanásia aos 7, 14 e 28 dias pós cirurgia de enxerto. Após o processamento laboratorial de rotina foi realizada a análise histomorfométrica, visando analisar qualitativamente e quantitativamente as etapas presentes nesse processo de reparo ósseo. Resultados: A análise histológica revelou que o grupo nicotina apresentou um atraso da atividade osteogênica na interface enxerto-leito receptor, como também menor organização do tecido de granulação em substituição ao coágulo sanguineo. Contudo, a irradiação do tecido com laser embaixa intensidade proporcionou melhor reparo ósseo. Histometricamente, os subgrupos submetidos à irradiação laser (GII e GIV) demonstraram maior formação óssea comparados aos seus respectivos subgrupos (GI e GIII), com os resultados considerados estatisticamente...

Background: The nicotine is one of the mostly drugs more harmful to the health cause, among other factors, morbidity of bone graft and compromises bone healing. Furthermore, treatment with low level laser can provide biostimulation effects, increasing the blood microcirculation in the irradiated area and stimulating fibroblasts promoting better healing. The aim of this study was to evaluate the influence of low level laser therapy on the healing process of autogenous bone grafts installed in block in systemic modificated animals by undesirable effects of nicotine. Methods: Were used 72 rats (Wistar) divided into Group A (n = 36) subgroups GI and GII, submitted to the application of nicotine and Group B (n = 36) subgroups GIII and GIV, submitted to the application of saline solution. After 30 days of applications, all animals received autogenous bone block graft stabilized on mandible, with the parietal bone donor area of the skull, and the animals belonging to subgroups GII and GIV received treatment with low level laser in the bed-graft interface. The animals in each group were euthanized at 7, 14 and 28 days after bone graft surgery. After routine processing was performed histomorphometric analysis in order to analyze qualitatively and quantitatively the timing sequence of bone repair. Results: The histological analysis revealed that the nicotine group showed a delay of osteogenic activity in the bed-graft interface, as well as decreased organization of granulation tissue replacing the blood clot. However, the low level laser irradiation showed better bone healing. Histometrically, the laser subgroups (GII and GIV) demonstrated greater bone formation compared with the respective subgroups (GI and GIII), with significantly statistically results (P˂0) at 14 days (GI 14,27% ± 2,22% versus GII 24,37% ± 11,93% and GIII 24,94% ± 13,06% versus GIV 27,53% ± 19,07%) and 28 days (GI 36,89% ± 8,40% versus GII 45,81% ± 6,03% and GIII 50,31% ± 2,69% versus GIV 58,19%…

The effect of platelet rich plasma in bone formation on implant installation in the tibia of beagle dogs

INTRODUCTION: The purpose of this study is to evaluate the effect of platelet rich plasma in bone formation and osseointegration of implant installed in the bone marrow space. MATERIALS AND METHODS: Five beagle dogs were used as experimental animals. Two implants were installed on each tibia in the dogs. Implants of the control group were installed with no additional graft. Those of the experimental group 1 were installed with autogenous bone graft from the ilium autogenous bone. Platelet rich plasma (PRP) alone was used in experimental group 2 and the mixture of PRP and autogenous bone was used in experimental group 3. The animals were sacrificed at 8 weeks after implantation. The parts of tibia containing implant were harvested and radiographs were taken for radiographic examination. The specimens were prepared for histological examination and histomorphometric analysis of implant-bone contact ratios. RESULTS: 1. All implants showed sufficient osseointegration in the cortical bone radiographically and histologically, but osseointergration in the marrow space was not satisfactory. 2. Histomorphometrically, the implant-bone contact ratios in the bone marrow was sequentially high in the experimental group 3 (autogenous bone + PRP group), group 1 (autogenous bone group), group 2 (PRP group), and control group (non-additive). 3. It was verified that there was statistical significance between two experimental groups (group 1 and 3) and the other groups (group 2 and control group). (P<0.005) 4. However, there was no statistical significance between group 3 and group 1, also group 2 and control group respectively. CONCLUSION: These results suggest that platelet rich plasma is effective to osseointegration in the implant installation but there is no statistical significance.

Plasma rico em plaquetas associado ou não ao osso esponjoso autógeno no reparo de falhas ósseas experimentais / Platelet rich plasma associated or not to autogenous bone graft on the reparation of experimental bone defects in the rabbits cranium

O presente estudo avaliou a influência do plasma autógeno rico em plaquetas (PRP), associado ou não ao autoenxerto esponjoso (EOE), na reparação de falhas ósseas criadas no crânio de coelhos. A falha I foi preenchida com o PRP; a falha II com 3mg de EOE; a falha III com EOE associado ao PRP e a falha IV não foi preenchida, servindo como controle. Após as cirurgias, os animais foram separados em três grupos e eutanasiados aos 30, 60 e 90 dias. Na avaliação mesoscópica, independentemente do período de observação, o preenchimento ósseo, na falha controle e naquelas tratadas com PRP, iniciou-se a partir das bordas para o centro e do fundo para a superfície das falhas. Já nas falhas tratadas com EOE e com enxerto associado ao PRP, foi notado também crescimento ósseo na porção central das falhas. Na análise radiográfica, foi observada maior radiopacidade no interior das falhas tratadas com EOE e com enxerto associado ao PRP, em todos os tempos. Microscopicamente, aos 30 dias, na falha tratada com EOE associado ao PRP, os fragmentos ósseos do enxerto estavam indistintos do tecido ósseo neoformado, presente em toda a borda do defeito, associado à moderada quantidade de tecido conjuntivo fibroso muito vascularizado e celularizado. Esse tecido apresentou material amorfo, eosinofílico e extracelular, junto a um processo inflamatório, constituído por linfócitos e, em menor número, por macrófagos e células gigantes multinucleadas, que podem ter influenciado negativamente a formação óssea precoce. Aos 60 e 90 dias, apenas focos ocasionais de inflamação linfocitária foram observados. O comportamento dos dois tratamentos, PRP associado ou não ao EOE, em relação a preenchimento ósseo, foi semelhante ao final do período de observação; o enxerto, utilizado de forma isolada, determinou precocidade de reparação óssea e a tromboplastina, utilizada para formação do gel de plaquetas, incitou uma reação semelhante a do tipo corpo estranho, que atuou negativamente...

The present study evaluated autogenous platelet rich plasma's (PRP) influence on the reparation process of four bone defects made on rabbit's skull, associated or not to autogenous bone graft (EOE). Defect I received PRP only; defect II received 3mg of EOE only; defect III received EOE associated to PRP; defect IV was left to heal naturally, serving as control. After each surgery the animals were randomly divided into three groups that were euthanized at 30, 60 and 90 days. In the mesoscopic evaluation bone ingrowth started from the defect's borders to the center and from the bottom to the surface for all observation times on the control (VI) and PRP only (I) groups. In the groups treated with EOE only (II) and EOE associated to PRP (III) new bone was observed in the center of the defects. Radiographic analysis showed greater central radiopacity for groups treated with EOE only (II) and EOE associated to PRP (III) at all observation times. Microscopically in the group treated with EOE associated to PRP (III) at 30 days the graft was indistinguishable from new bone present on the border of the defect, associated to a moderate quantity of a very vascularized and cellular fibrous connective tissue. This tissue showed an extracelular eosinophilic amorphous foamy material, associated to an inflammatory process constituted by lymphocytes and in less number by macrophages and multinucleated giant cells that may have negatively influenced early bone formation. At 60 and 90 days occasional spots of lymphocytic inflammation were observed. Both treatments, PRP associated or not to EOE, were similar for the bone ingrowth at the final time of observation; the graft used alone determined early bone reparation and thromboplastine used for the platelet gel formation incited a foreign body-like reaction that acted negatively on the initial reparation.

The Effect of New Bone Formation of Onlay Bone Graft Using Various Graft Materials with a Titanium Cap on the Rabbit Calvarium

0.05).SUMMARY: This result suggests that autogenous bone is the best choice for new bone formation, but when autogenous bone graft is in limited availability, alloplastic and xenogenic bone graft also can be an alternative bone graft material to use with a suitably guided membrane.

Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion

PURPOSE: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. MATERIALS AND METHODS: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. RESULTS: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. CONCLUSION: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results

Clinical usages of ramal autogenous bone grafts in dental implant surgery

Structural augmentation with biomaterial loaded allograft threaded cage for the treatment of femoral head osteonecrosis surgical technique / 中国矫形外科杂志

[Objective]To introduce the surgical technique and its rationale and to evaluate the early and mid-term clinical outcome of routine core decompression and insertion of a biomaterial loaded allograft threaded cage(ATC)in the treatment of necrotic femoral head．[Methods]Seventy-six patients(78 hips)with femoral head necrosis were allocated to a program of either core decompression or core decompression and implantation of ATC．[Results]At review all patients had a minimum follow-up of 24-months(24 to 68 months)．In the control group，no significant improvement in Harris hip score(HHS)was found，and 13 of the 22 hips had deteriorated to stageⅢ．In the treatment group．the mean HHS was improved from 62．8 to 81．6．Collapse was seen in 1 hip，and this collapse Was progressive in 3 hips．[Conclusion]It，s thus evident that the technique is attractive as a salvage procedure．which shows encouraging Success rates and early clinical results.

Autogenous Bone Graft for Medial Tibial Bone Defect in Total Knee Arthroplasty

PURPOSE: To evaluate clinical and radiographic results associated with the use of autogenous bone graft with preservation of cortical bone in the patients with severe bone defect of the proximal medial tibia in total knee arthroplasty. MATERIALS AND METHODS: From January 2000 to June 2003, thirty three primary total knee arthroplasty were performed with autogenous bone graft for severe peripheral defect of the proximal medial tibia. After sclerotic bone of defect site was removed by the burr, reconstruction of medial wall was done by use of resected bone, which was fixed by wedge-shaped bone. Autogenous cancellous bone was grafted in the central type bone defect area. We reviewed the result using the HSS knee rating scores and observed the radiographic changes. RESULTS: The mean HSS knee rating score was 43.5 preoperatively and was 91.3 at last follow-up. Radiologically, union of the tibial bone grafts were impossible to determine, but there were no evidence of the displacement of grafted bone, osteolysis and loosening of the inserted implants. CONCLUSION: The method of autogenous bone graft applied with preservation of cortical bone and wedge bone graft could be supposed as useful in the reconstruction of the tibial bone defects as well as in the stability of the tibial component.

Comparison of the Result of Lumbar Posterolateral Bone Fusion using Autogenous Bone Graft with Allobone Graft

OBJECTIVE: The purpose of this study is to analyze clinical outcome of lumbar spinal fusion with autobone graft and with allobone graft as an additional autograft extender. METHODS: Fifty two patients who underwent lumbar posterolateral arthrodesis for degenerative lumbar diseases between February, 1998 and October, 2000 were evaluated. Arthrodesis was performed by transpedicular screw fixation. We used autogenous bone graft in 32 cases (Group A) and allobone graft in 20 cases (group B). Post operative radiographs were obtained to review the resorption of graft bone and the evidence of fusion. A modified Lenke scale was used to assess the status of the fusion. RESULTS: There were 17 men and 35 women. Mean follow up period was 12 months. According to the modified Lenke scale, spinal bone fusion rate was 93.75% in the group A and 85% in the groub B. CONCLUSION: Lumbar spinal fusion using allobone graft is favorably good compare to autobone graft.

Posterior Lumbar Interbody Fusion with Cancellous Allograft / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVES: This study compared the clinical results of the posterior lumbar interbody fusion (PLIF) using a cancellous allograft with the conventional autologous iliac bone graft. SUMMARY OF LITERATURE REVIEW: The allograft is known to produce a similar effect as that of a nonvascular autogenous bone implantation. However, the implantation process occurs more slowly with the various degrees of the inflammatory reaction caused by the immunological reactions. MATERIALS AND METHODS: From June 1999 to February 2002, 39 patients were operated on by a single surgeon. There were 14 cases with 1 level, 4 cases with 2 levels posterior fusion with a cancellous allograft (objective group), and 20 cases with 1 level and 1 case with 2 levels posterior fusion with a conventional bone graft (control group). The clinical results and standing lateral views of the lumbar spine were compared and analyzed in order to assess the fusion rate, the changes in the distance between the two vertebral bodies and changes in the lordotic angle formed between the fused bodies immediate after surgery and at the final follow-up. RESULTS: During the early post-operative period, the control group showed superior results. However, there were no significant differences between the two groups at the final follow-up. There were no statistically significant differences in the fusion rate, the changes in the intervertebral distance, and the lordotic angle. CONCLUSION: PLIF using a cancellous allograft and a locally harvested autograft showed acceptable radiological union rate and clinical results. It is believed that this is an excellent surgical technique with a shorter operation time, less bleeding, less pain and no morbidity of the donor site.

Implant in autogeneous bone graft in mandible

Augmented bony change following platelet rich plasma(PRP) application on maxillary defect

PURPOSE: Platelet Rich Plasma(PRP) application is increasing with sinus inlay bone graft, but there is few research with radiographic ananlysis on effect of PRP in maxillary sinus. The author investigated the amount of bony changes of maxillary sinus for dental implantation among the patients with maxillary inlay graft. MATERIALS AND METHODS: With 10 patients who were treated with sinus inlay autologous bone grafting combined with PRP technique, and with 5 patients who were treated with sinus inlay grafting only without PRP, the panoramic radiographys which were taken at preoperation, immediate postoperation, 3months postoperation, and 4 months postoperation(a month after dental implantation)periods were analysed. The films had been scanned, and then proceeded throughout image analysis system. The bone density of maxillary grafted sites was compared with adjacent tooth enamel density and remeasured according to density luminosity of each film. The density changes on PRP group and bone graft only group were an lysed with non-parameteric statistics method. RESULTS: In PRP combined patients group, bone density on postoperation periods was increased totally. The remarkable enhanced change of bone density was observed on 3 months postoperation period, thereafter the increasing rate was slightly reduced . In only bone graft patients group, bone density on postoperation periods was also increased compared with preoperation period, but the bone density of 4 months postoperation period was decreased compared with 3 months postoperation period. The amount of bone density on PRP group was significantly changed according to periods in contrast to bone graft only group. CONCLUSION: The bone density on PRP group was remarkably increased at 3 months postoperation compared to bone graft only group and it was seemed to be associated with more new bone formation, less grafted bone resorption at bone grafted sites with PRP.

Autogenous Bone Graft with Bone peg for the Medial Tibial Bone Defect in Total Knee Arthroplasty

PURPOSE: The aim of this study is to report the usability of autogenous bone graft with bone peg in total knee arthroplasty in the patients with tibial medial bone defect from osteoarthritis due to severe varus deformity. MATERIALS AND METHODS: From July 1998 to December 2000, fifteen total knee arthroplasties with autogenous bone graft were performed for the medial tibial bone defects. The proximal tibia was resected and then bone pegs which were prepared from resected portion of distal femur and proximal tibia were inserted into the defect site with the shape of peg in the anterior posterior view using press fitting method. Instead of applying screw or K-wire, we performed press-fitting method for early stability. For attaining the stability, we preserved the sclerotic rim and designed precisely the bony defect site. We reviewed the result using the HSS Knee Rating Scale and observed the radiologic change. RESULTS: In HSS Knee Rating Scale review, 52.4 of preoperative score was improved to 84.7 at postoperative 1 year. Tibio-femoral angle , the average 17.8 degrees of varus was improved to the average 5.8 degrees of valgus at 1 year postoperatively. The average union period was 5 months, and there was no evidence of the displacement of grafted bone and loosening of the inserted implants. CONCLUSION: The method of autogenous bone graft applied with bone peg could be supposed as the stable fixation method without using screws or K-wires.