Clinical application of β-tricalcium phosphate artificial bone material for alveolar cleft repair / 口腔疾病防治

Objective@# To investigate the osteogenic effect of β-tricalcium phosphate (β-TCP) and bone morphogenetic protein-2 (BMP-2) in the repair of the alveolar cleft.@*Methods @# Fifty-nine patients with unilateral alveolar cleft who visited Capital Medical University School of Stomatology from January 2016 to May 2021 were included. They were divided into three groups according to the different bone repair materials: autologous bone, β-TCP and BMP-2 +β-TCP. The preoperative and postoperative CBCT data of the patients were imported into Mimics 21.0 software. The preoperative volume of the bone defect and the new volume of bone formation were calculated by the three-dimensional reconstruction method. The osteogenesis rate was calculated to evaluate the osteogenesis effect@*Results@#The wounds in the three groups healed well after the operation, without implant material discharge, infection, dehiscence, rejection or other symptoms. Twelve months after the operation, CBCT scanning and three⁃dimensional reconstruction images of the three groups of patients showed the formation of new bone bridges in the alveolar ridge fissure area. The image density of the new bone tissue was not significantly different from that of normal bone tissue, and the continuity of the maxilla was re⁃ stored to varying degrees. The bone rate of autogenous bone was 65.00% ± 16.66%, β⁃ TCP group and BMP⁃2+ β⁃ The bone composition rate of TCP was 69.82% ± 17.60%, 71.35% ± 17.51%, respectively, and there was no significant dif⁃ ference compared with the autogenous bone group (P = 0.382, P = 0.244). The β⁃TCP and BMP⁃2+ β⁃TCP groups had no significant differences in bone rate (P = 0.789). @*Conclusion@#β⁃TCP could be used to replace autologous bone for alveolar cleft repair. The addition of BMP⁃2 to β⁃TCP did not significantly improve the osteogenesis rate.

Conservación de injerto autólogo de cabeza femoral en colgajo óseo para tratamiento de los defectos acetabulares / Conservation of autologous graft of femoral head in bone flap for treatment of acetabular defects

Resumen: Objetivo: Describir una técnica de conservación ósea de uso común en neurocirugía en un procedimiento ortopédico. Material y métodos: Se describe el caso de una paciente que se somete a artroplastía primaria de cadera con un resultado no satisfactorio inicial, planteándose previo al cierre la necesidad de una revisión con reconstrucción acetabular. Conservando cabeza femoral de paciente en tejidos blandos para realizar reconstrucción en segundo tiempo. Resultados: Tras seguimiento por seis meses se encuentra completa osteointegración de injerto de cabeza femoral, con buena evolución clínica y radiológica de la paciente. Las técnicas de conservación ósea en colgajos óseos han demostrado buenos resultados en la osteointegración de los injertos en otras áreas como neurocirugía. Conclusiones: La conservación de colgajos óseos en tejido celular subcutáneo para posterior uso como injerto es una opción viable de tratamiento también en la cirugía ortopédica.

Abstract: Objective: To describe a bone preservation technique commonly used in neurosurgery in an orthopedic procedure. Material and methods: We describe the case of a patient who undergoes primary hip arthroplasty with an initial unsatisfactory result, the need for a revision with acetabular reconstruction is considered before the wound closure. Keeping the patient's femoral head in soft tissues for second-time reconstruction. Results: After six months of follow-up, complete osseointegration of the femoral head graft was found, with a good clinical and radiological evolution of the patient. Bone conservation techniques in bone flaps have shown good results in the grafts osseointegration in other areas such as neurosurgery. Conclusions: The conservation of bone flaps in subcutaneous tissue for later use as a graft is a viable treatment option also in orthopedic surgery.

Meta-analysis of bone morphogenetic protein versus autologous bone grafting for limb long bone nonunion / 中国组织工程研究

BACKGROUND: Bone morphogenetic proteins have strong bone induction properties and have been proved to promote bone healing in fracture, bone defect and other diseases. However, few studies are reported on the use of bone morphogenetic proteins in the treatment of bone nonunion, and the results of various studies remain controversial, which makes the role of bone morphogenetic proteins in the treatment of limb long bone nonunion unclear. OBJECTIVE: Meta-analysis was used to systematically evaluate the advantages and disadvantages of bone morphogenetic protein versus autogenous bone grafting in the treatment of limb long bone nonunion. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and WanFang databases were searched to retrieve the randomized controlled trials and non-randomized controlled trials of bone morphogenetic proteins for limb long bone nonunion published before April 2019. Quality evaluation and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5. 1 software provided by Cochrane system. RESULTS AND CONCLUSION: Eight articles were enrolled, including 4 randomized controlled trials and 4 non-randomized controlled trials, all of which were small sample-size studies involving 30-124 cases. A total of 613 cases of nonunion were included. In the study group, patients received bone morphogenetic proteins or bone morphogenetic proteins in combination with bone grafting. In the control group, patients received autologous bone grafting. Meta-analysis results showed that there were no significant differences in postoperative healing rate, infection rate, secondary operation rate, and postoperative improvement in limb function between study and control groups (P > 0. 05). The mean healing time in the study group was significantly shorter than that in the control group [WMD=-1. 24, 95%C/(-1. 70,-0. 79), P 0. 05). These results suggest that bone morphogenetic protein can provide a viable alternative to autologous bone grafting, and it is also a safe adjuvant for autologous bone grafting, which has the potential advantage of accelerating fracture healing, but the current evidence does not support bone morphogenetic protein in combination with autologous bone grafting.

Complicaciones en craneoplastias: hueso autólogo criopreservado vs. polimetilmetacrilato. Análisis retrospectivo de 63 pacientes / Complications in cranioplasties: autologous bone cryopreserved vs. Polymethylmethacrylate. Retrospective analysis of 63 patients

Introducción: se define como craneoplastia a la reparación quirúrgica de los defectos óseos craneanos. En nuestro medio el material utilizado mayormente es el hueso autólogo criopreservado (HACp) y, en caso de no contar con dicho tejido, el Polimetilmetacrilato (PMMA) es de elección. Objetivo: Se plantea un estudio retrospectivo observacional a fin de analizar y comparar complicaciones en pacientes sometidos a craneoplastias con HACp en comparación a un grupo de pacientes a los que se les realizó craneoplastia con PMMA. Materiales y métodos: Se incluyeron pacientes que fueron sometidos a craneopatías durante un periodo de 5 años (2008-2013). El seguimiento delos pacientes fue de al menos 12 meses. Se analizaron variables relacionadas a complicaciones tempranas y tardías. Resultados: 63 pacientes recibieron craneoplastia con HACp (31 pacientes, 52%) o polimetilmetacrilato (31 pacientes, 49%). La tasa de complicación global fue del 36,6%. Doce pacientes (19,04%) requirieron tratamiento quirúrgico. Las complicaciones más frecuentes fueron las colecciones subcutáneas no infectadas (19%), seguidas por las infecciones de heridas (17%). No existen diferencias estadísticamente significativas en cuanto a para complicaciones, tanto globales como en las distintas categorías (p>0,05), para ambas técnicas quirúrgicas. Conclusión: Las craneoplastias tanto con HACp como aquellas con PMMA presentan una alta tasa de complicaciones. En nuestra serie no se hallaron diferencias entre ambos grupos estudiados.

Introduction: cranioplasty is defined as the surgical procedure to cover a skull bone defect. In our institution, we mainly use cryopreserved autologous bone graft (HACp), and if it is not available, polymethylmethacrylate is chosen (PMMA). Objective: We performed an observational retrospective study to assess complications in both groups of patients. Materials and Methods: Patients who underwent cranioplasty between 2008 and 2013 were included. Minimum follow up was 12 months. Variables related with early and late complications were analyzed. Results: 63 patients received cranioplasty consisting of autologous bone graft (32 patients, 52%) or PMMA (31 patients, 48%). The global complications rate was 36.6%. 12 patients (19.04%) required surgical treatment for these complications. The most common complications were sterile persistent subcutaneous fluid collection (19%) and wound infection (17%). No differences in complications rates were found between both groups (p>0.05). Conclusions: Cranioplasty following craniectomy is associated with a high complication rate. In our series, both groups showed no differences in complications rates.

Tratamiento de quiste óseo traumáticomandibular de grandes dimensiones: revisión de la literatura y reporte de un caso / Treatment of a large mandibular traumatic bone cyst: literature review and case report

Antecedentes: El quiste óseo traumático o simple se presenta en el área maxilofacial demanera más frecuente en la región posterior mandibular; su dimensión es usualmente de1-3 cm de diámetro y se trata convencionalmente con curetaje óseo. Método: Se realizauna revisión de la literatura y se presenta el caso de un quiste óseo mandibular de grandesdimensiones para el que se propone una alternativa terapéutica a la que se utiliza actualmentepara los seudoquistes de grandes dimensiones. Resultados: El caso correspondea una paciente de diecinueve años de edad con un diagnóstico de quiste óseo simplemandibular de gran dimensión (10 cm de diámetro mayor), quien fue tratada en el HospitalRegional Vicente Corral Moscoso, del Ministerio de Salud de Ecuador. La terapia consistióen curetaje intracavitario e injerto autólogo de cresta iliaca, el cual mostró adecuadosresultados rápidos y adecuados en la reconstrucción de la mandíbula...

Background: The traumatic or simple bone cyst is frequently found in the maxillofacial areamostly in the posterior body of the mandible; its average diameter is 1-3 cm and the usualtreatment is bone curettage. Method: A review of literature and a case of a large mandibulartraumatic bone cyst are presented. An alternative therapy to treat large pseudocysts isproposed. Results: A 19-year-old female patient with diagnosis of a large simple bone cyst(diameter: 10 cm) was treated at the Regional “Vicente Corral Moscoso” Hospital that isaffiliated to the Ministry of Health of Ecuador. The treatment consisted of intracavitary curettageand autologous iliac crest bone graft, achieving a fast and adequate bone mandiblereconstruction...

Diagnosis and treatment of chondroblastoma / 中国综合临床

Objective To summarize the keypoints of clinical diagnosis of chondroblastoma and the experience on the treatment Methods The clinical materials of 16 cases(11 males,aged from 12 to 26 years)from June 1992 to February 2003 of pathologically diagnosed chondroblastoma were analyzed retrospectively. The tumor located at distal femur in 6 cases,great trochanter in 1 case,proximal tibia in 6 cases,proximal humerus in 2 cases, talus in 1 case. The main symptoms were swelling and painful joint. All the 16 cases were treated with curettage and autologous bone graft from iliac crest. Results Twelve cases were followed up for 6 months to 5 years .averaging 3. S years. All the bone graft healed well. One case., recurred 2 years after the initial curettage and was treated with curettage again. No recurrence occurred at the last follow-up 6 months after the second curettage. The function of the involved joints was nearly normal in all cases except for one case with slight limitation of knee flexion. Conclusions Mastering the image and clinical characteristics of chondroblastoma can avoid misdiagnosis and mistreatment Curettage can control the tumor satisfactorily. Postoperative rehabilitation can improve the function of the involved limb.

Avaliação dos enxertos homógenos como substitutos aos enxertos autógenos na fixação de implantes osteointegrados: uma revisão sistemática da literatura / Homogeneous grafts as alternative to autogeneous grafts in the treatment with osteointegrated implants: a systematic review of the literature

A falta de estrutura óssea influência diretamente no resultado protético, quando se utiliza implantes ósseointegrados. Os enxertos ósseos para reconstrução total de maxilas atróficas anterior aos implantes, tornam-se, muitas vezes, um procedimento indispensável. O osso ilíaco é uma área doadora muito utilizada para enxertos ósseos. Avaliou-se clinicamente 12 pacientes com atrofias totais de maxila, que foram submetidos a enxertos retirados da crista ilíaca. Encontrou-se uma melhora do perfil externo, bem como no posicionamento labial dos pacientes após o enxerto ósseo. Em todos os casos houve aumento do rebordo alveolar. Concluiu-se também, que é possível utilizar enxertos ósseos da crista do ilíaco para reconstruções de maxila atróficas, para instalação de implantes ósseointegrados.

The lack of bone structure direct influences prosthethic results, when there is a need for the use of osseointegrated implants. The bone graft for the reconstruction of atrophic total maxillae before the implants has become, in many cases. Was analyzed 12 patients with total maxillae atrophy who where undergone to bone graft surgery from the iliac crest. Was found an improvement of the external profile, as well as, in the patients in the patients lip positioning after bone graft. In all cases there was an increase of bone in alveolar crest. Also in conclusion, it is possible the use iliac bone graft to reconstructed atrophic total maxillae in order to perform osseointegrated implants.

Avaliação clinica de enxertos ósseos autógenos de crista ilíaca em maxilas atróficas para instalação de implantes osseointegráveis / Clinical evaluation of bone autogenous bone graft from iliac crest in a atrophic maxillae to perform ossointegrated implants

A falta de estrutura óssea influência diretamente no resultado protético, quando se utiliza implantes osseointegrados. Os enxertos ósseos para reconstrução total de maxilas atróficas anterior aos implantes, tornam-se, muitas vezes, um procedimento indispensável. O osso ilíaco é uma área doadora muito utilizada para enxertos ósseos. Avaliou-se clinicamente 12 pacientes com atrofias totais de maxila, que foram submetidos a enxertos retirados da crista ilíaca. Encontrou-se uma melhora do perfil externo, bem como no posicionamento labial dos pacientes após o enxerto ósseo. Em todos os casos houve aumento do rebordo alveolar. Concluiu-se também, que é possível utilizar enxertos ósseos da crista do ilíaco para reconstruções de maxila atróficas, para instalação de implantes osseointegrados.

The lack of bone structure direct influences prosthethic results, when there is a need for the use of osseointegrated implants. The bone graft for the reconstruction of atrophic total maxillae before the implants has become, in many cases. Was analyzed 12 patients with total maxillae atrophy who where undergone to bone graft surgery from the iliac crest. Was found an improvement of the external profile, as well as, in the patients in the patients lip positioning after bone graft. In all cases there was an increase of bone in alveolar crest. Also in conclusion, it is possible the use iliac bone graft to reconstructed atrophic total maxillae in order to perform osseointegrated implants.

Preliminary Application of One-level Posterior Lumbar Interbody Fusion with Prospace and Facet Fusion Using Local Autograft / 中国修复重建外科杂志

Objective To evaluate the safety and efficacy of one-level posterior lumbar interbody fusion(PLIF) combined with Prospace and facet fusion using local autograft. Methods Clinical and radiographic data of 76 patients treated by this technique was reviewed from May 2002 to December 2004. Of them, there were 52 males and 24 females, with an average age of 53.2 years (23-81 years), including 60 cases of degenerative disc disease, 9 cases of failed back surgery syndrome and 3 cases of spondylolysis. The disese courses were 1.2-8.7 years (mean 3.6 years). The levels of PLIF were: L2,3 in 2 cases, L3,4 in 7, L4,5 in 54, L5/S1 in 10, L4/S1 in 1 and L5,6 in 2. After decompression, Prospace was inserted into interbody space bilaterally,and located in disc space 4 mm beyond the rear edge of the vertebral body. Local laminectomy autograft was packed both laterally into and between 2 implants. Then the remanent local autograft was placed over facet bed. Pedicle screws were used after insertion of Prospace. Clinical results were evaluated by the JOA score. Disc height ratio and lumbar lordosis angles were measured on lateral radiographs. Fusion status was determined by evidence of bridge trabeculae across facet joint and interbody space on CT scan without mobility in lateral dynamic X-rays, and no radiolucent gap between Prospace and endplate. Paired t-test was used for statistical analysis. Results Mean blood loss and operative time was 384 ml and 178 minutes, respectively. The average JOA score at final follow-up (26.1 + 2.7) was significantly improved when compared with that of pre-operation (14.5 ± 4.0, P ＜ 0.05), with a mean recovery rate of JOA score 81.1% (37.5%-100.0%). The fusion rate was 97.4% (74/76). Mean disc height ratio and the involved segmental lordosis angle were increased from preoperative 0.27 ±0.07 and 5.8 + 2.2° to 0.33 + 0.06 and 11.3 + 2.0° respeetively at the final follow-up, and the differences were significant ( P ＜ 0.05). There were no device-related complications. Conclusion This surgical technique combined with Prospace interbody device is a safe and effective surgical option for patients with one-level lumbar disorders when PLIF is warranted.

Economical Analysis of Cervical Disc Disease by Anterior Inter-body Fusion Methods - Comparing of Bone Graft vs Plating -

OBJECTIVES: The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. MATERIALS AND METHODS: Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. RESULTS: Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was 49.0+/-8.1 years, mean duration of admission was 17.27+/-10.51 days, mean costs for treatment was 1,970,000+/-475,000 won. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was 28.7+/-10.4 days, mean costs for treatment was 2,194,473+/-561,639 won. The periods of stabilization was 6.6+/-3.36 weeks on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14-patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was 11.24+/-3.29 days, mean costs for treatment was 1,850,823+/-389,372 won. The periods of stabilization was 5.88+/-7.07 weeks on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. CONCLUSIONS: The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.