Comparison of bone transport technique combined with bone grafting plus internal fixation versus simple bone transport technique for large segmental bone defects at lower limbs after trauma / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between bone transport technique combined with bone grafting plus internal fixation and simple bone transport technique in the treatment of large segmental bone defects at lower limbs after trauma.Methods:A retrospective study was conducted to analyze the clinical data of 42 patients with large segmental bone defects at lower limbs after trauma who had been treated at Department of Trauma Orthopaedics, Honghui Hospital Affiliated to Medicine College, Xi'an Jiaotong University from September 2015 to September 2019. The patients were divided into 2 groups according to the different methods of repairing bone defects. In group A of 18 patients subjected to bone transport combined with bone grafting plus internal fixation, there were 11 males and 7 females with an age of (35.2±10.3) years, and 12 tibial defects and 6 femoral defects; in group B of 24 patients subjected to simple bone transport, there were 15 males and 9 females with an age of (37.3±9.4) years, and 17 tibial defects and 7 femoral defects. The external fixation time (EFT), external fixation index (EFI), total cure time and complications were recorded and compared between the 2 groups. At the last follow-up, the Ennecking score for limb functional recovery (score/total score 30) and Self-rating Anxiety Scale (SAS) were used to evaluate respectively the functional recovery of the limbs and postoperative anxiety.Results:The 2 groups were comparable because there was no significant difference between them in preoperative general data or follow-up time ( P>0.05). There was no statistically significant difference in the number of surgeries between the 2 groups ( P>0.05). The EFT [(5.9±1.5) months], EFI [(0.45±0.09) months/cm], total treatment time [(16.2±2.4) months], Ennecking score for limb functional recovery (87.0%±8.6%), SAS score [(43.2±9.0) points], and complications per capita [(0.4±0.2) times/case] in group A were significantly better than those in group B [(15.3±4.2) months, (1.19±0.28) months/cm, (19.7±3.5) months, (77.3%±9.2%), (58.2±9.3) points, and (1.2±0.5) times/case] (all P<0.05). Conclusion:In the treatment of large segmental bone defects at lower limbs, compared with simple bone transport technique, bone transport technique combined with bone grafting plus internal fixation has advantages of shorter external fixation time and overall cure time, a lower rate of complications, and better functional recovery of the limbs.

Hemilateral bone longitudinal transport technique for the treatment of hemilateral defects of long bones of lower limbs / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of Ilizarov hemilateral bone longitudinal transport technique in treating hemilateral bone defects associated with chronic osteomyelitis of lower extremity long bones.@*METHODS@#Clinical data of 13 patients with hemilateral bone defects caused by chronic osteomyelitis of lower extremity long bones and treated by Ilizarov hemilateral bone longitudinal transport technique were retrospective analyzed, including 10 males and 3 female, aged from 14 to 55 years old;4 patients occurred femoral and 9 patients occurred tibial;10 patients were diagnosed as traumatic osteomyelitis and 3 patients as hematogenous osteomyelitis. The anatomical classification of Cierny-Mader in 13 patients was type Ⅲ. Bone and wound healing, postopertaive complication, and bony and functional results were observed by Paley evaluation standard.@*RESULTS@#After removing external fixator, all patients were followed up from 6 to 70 months. Transporting time ranged from 54 to 158 d. And the time in external fixation ranged from 6.8 to 19.5 months. External fixation index (EFI) ranged from 1.23 to 1.6 months/cm. According to Paley's evaluation criteria, bony results were excellent in 13 patients;functional results showed excellent in 12 patients and good in 1 patient. Two patients occurred poor union on the docking sites and healed with autogenous iliac bone graft. The callus at the extended area was poorly mineralized and improved significantly when treated with low-intensity pulsed ultrasound in one patient. All patients had good wound healing without recurrence of osteomyelitis and refracture. There was no vascular and nerve injury and axial deviation in all patients and they were satisfied with the appearance and function of lower limbs. The range of motion of knee and ankle joint before operation was 120 ° to 150 ° and 35 °to 80 ° respectively, and at the latest follow-up was 110 ° to 140 ° and 30 ° to 75 ° .@*CONCLUSION@#Ilizarov hemilateral bone longitudinal transport technique is effective in treating infective hemilateral bone defects of lower extremity long bones, which could not only simplify architecture of external fixation, but also reduce the number of fixation pins, shorten the time in external fixator and decrease the incidence of pin tract infection. However, this technique is highly demanding, and the growth of callus in extended region and healing of bone apposition should be noticed.

Emergency ectopic embedment of a large extruded bone mass for open lower limb bone defects / 中华创伤骨科杂志

Objective:To explore the efficacy of emergency ectopic embedment of a large extruded bone mass in the treatment of open lower limb bone defects.Methods:From June 2015 to June 2019, 11 patients were treated for open lower limb bone defects at Department of Traumatic Orthopedics & Microsurgery, Renmin Hospital of Wuhan University by primary ectopic embedment of a large extruded bone mass. They were 8 males and 3 females, aged from 18 to 57 years (mean, 35.3 years). The time from injury to operation ranged from 4 to 12 hours (mean, 6.3 hours). The size of free bone mass ranged from 3 to 16 cm (mean, 8.7 cm). At the emergency primary stage, following vascular and nerve anastomosis, large extruded bone masses were embedded ectopically to the sites with rich blood supply after cleaning and disinfection. The embedment was lateral to the thigh in 9 cases and in the groin in 2 cases. Wound repair was performed at the second stage, and bone replantation at the third stage, followed by internal plate fixation in 6 cases and external fixation in 5 cases. Fracture union was evaluated by regular X-ray follow-ups. At the last follow-up, Paley score was used to evaluate the curative outcomes, SF-36 score to evaluate functional recovery, and complications were recorded.Results:All patients were followed up for 6 to 50 months (mean, 15.5 months). Follow-ups observed no osteomyelitis. Fracture union was delayed in the 2 cases with external fixation but eventually achieved after bone graft and internal fixation. All fractures united after 5 to 12 months (mean, 8.5 months). The total treatment time ranged from 8 to 16 months (mean, 12.5 months). According to the Paley scores at the last follow-up, 7 cases were excellent, 3 good and one was poor, giving an excellent to good rate of 90.9% (10/11). The SF-36 scores for the postoperative quality of life averaged 86.7.Conclusion:Emergency ectopic embedment of a large extruded bone mass is a feasible treatment for open lower limb bone defects, with advantages of simplicity in operation and a low incidence of osteomyelitis.

Comparison of in vivo versus in vitro fabrication of bone cement spacers in Masquelet technique for bone defects / 中华创伤骨科杂志

Objective:To compare in vivo versus in vitro fabrication of bone cement spacers in the treatment of bone defects by Masquelet technique. Methods:The data of 128 patients were analyzed retrospectively who had been treated for bone defects by Masquelet technique at Department of Orthopedics, Wuxi No. 9 People’s Hospital from January to August 2019. They were 74 males and 54 females, aged from 13 to 77 years. Their bone defects were traumatic in 54 cases and infectious in 74 cases. In 76 of them ( in vivo group), after a bone cement spacer was implanted into a bone defect during its dough phase, it was fabricated in vivo to form a cylindrical structure which was as large as or slightly larger than the defect size. In the other 52 cases ( in vitro group), before a bone cement spacer was implanted into a bone defect, it was fabricated in vivo during its dough phase into a cylindrical or block or bead chain or spherical form which was naturally solidificated at room temperature. The 2 groups were compared in terms of spacer filling time, bone healing time, delayed healing rate, infection control rate, spacer removal time, incidence of induced membrane or broken end bone lesion, as well as upper limb function evaluated by the Disability of the Arm, Shoulder and Hand Questionnaire (DASH) and the Paley lower limb grading at the last follow-up. Results:The 2 groups were comparable because there was no significant difference between them in gender, age, ratio of infected to non-infected cases, combined injuries, comorbidities or number of operations ( P>0.05). All the patients were followed up for 12 to 50 months (mean, 18.6 months). There were no significant differences between the 2 groups in spacer filling time, bone healing time, delayed healing rate, infection control rate or functional recovery for upper or lower limbs or for large or small bone defects (all P>0.05). In the in vivo group, for upper and lower limbs and for large and small bone defects respectively, the spacer removal time [(3.6±1.0) min, (4.1±1.1) min, (4.0±1.1) min and (3.9±1.0) min] and the incidence of induced membrane or broken end bone lesion [48.1%(13/27), 73.5%(36/49), 82.6%(39/46) and 66.7%(20/30)] were significantly longer or higher than those in the in vitro group [all (0.4±0.2) min; 3.2%(1/31), 9.5%(2/21), 0 (0/21) and 0 (0/31)] (all P<0.05). Conclusions:In the treatment of bone defects by Masquelet technique, in vivo and in vitro fabrication of bone cement spacers may lead to similar therapeutic effects. In vivo fabrication may be more suitable for lower limb, large or unstable bone defects but the spacer is not easy to remove and the induced membrane or bone ends are likely to get injured while in vitro fabrication may be more suitable for partial, small or upper limb defects because it may produce a variously shaped spacer.

Location of lower extremity deep venous thrombosis and incidence of pulmonary embolism in patients with lower extremity fracture during hospitalization / 中华创伤骨科杂志

Objective:To explore the association between location of lower extremity deep venous thrombosis and incidence of pulmonary embolism in patients with lower extremity fracture during hospitalization.Methods:A retrospective study was conducted of the 1,620 patients who had been treated for lower extremity fracture and deep vein thrombosis from October 2014 to November 2019 at Department of Orthopaedic Trauma, Honghui Hospital. They were 726 males and 894 females, aged from 18 to 98 years (average, 64.0 years). By the anatomical location of thrombosis, they were divided into a proximal thrombosis group and a distal thrombosis group; by the laterality of thrombosis, they were divided into a bilateral thrombosis group and a unilateral thrombosis group which was further divided into a left thrombosis subgroup and a right thrombosis subgroup. The incidences of pulmonary embolism were compared between 2 corresponding groups and subgroups.Results:Pulmonary embolism occurred in 13 of the 1,400 patients with distal thrombosis and in 12 of the 220 patients with proximal thrombosis; the incidence of pulmonary embolism in the proximal thrombosis group (5.45%, 12/220) was significantly higher than that in the distal thrombosis group (0.93%, 13/1,400) ( P<0.001). Pulmonary embolism occurred in 10 of the 337 patients with bilateral thrombosis and in 15 of the 1,283 patients with unilateral thrombosis; the incidence of pulmonary embolism in the bilateral thrombosis subgroup (2.97%, 10/337) was significantly higher than that in the unilateral thrombosis group (1.17%, 15/1,283) ( P=0.017). Pulmonary embolism occurred in 5 of the 677 patients with left thrombosis and in 10 of the 606 patients with right thrombosis; the incidence of pulmonary embolism in the right thrombosis subgroup (1.65%, 10/606) was insignificantly higher than that in the left thrombosis subgroup (0.74%, 5/677) ( P=0.129). Conclusions:In patients with lower extremity fracture, those with proximal or bilateral thrombosis are more prone to pulmonary embolism than those with distal or unilateral thrombosis, but the possibility of pulmonary embolism cannot be ignored clinically in those with distal or unilateral thrombosis.

Application of peripheral nerve block combined with intravenous rapid channel anesthesia in the lower extremity orthopedic surgery of the elderly patients / 中国基层医药

Objective@#To investigate the effect of peripheral nerve block combined with venous fast track anesthesia on elderly patients undergoing lower extremity orthopedic surgery.@*Methods@#From September 2015 to December 2017, 64 senile patients with lower extremity orthopedic surgery in the Fifth Hospital of Ningbo were selected in the research.According to the different methods of anesthesia, the patients were divided into observation group (30 cases, application of combined intravenous peripheral nerve block and fast track anaesthesia), and the control group (34 cases, application of simple intravenous general anesthesia). The heart rate, average arterial pressure, spontaneous breathing recovery time, extubation time, complication rate and cognitive function scores of the two groups were compared.@*Results@#The heart rate and average arterial pressure of T1 and T3 in the observation group were significantly lower than those in the control group (P<0.05). The spontaneous breathing recovery time[(8.32±3.26)min] and extubation time[(9.69±4.29)min] in the observation group were significantly shorter than those in the control group[(18.24±5.23)min and (27.24±4.58)min](t=8.961, 15.756, all P<0.05). The incidence rate of postoperative complications in the observation group (3.33%) was significantly lower than that in the control group (20.59%)(χ2=4.338, P<0.05). The cognitive function score of the observation group was significantly higher at 4 h and 8 h after surgery than that of the control group (t=6.745, 8.494, all P<0.05).@*Conclusion@#Peripheral nerve block combined with intravenous fast-track anesthesia is very feasible for elderly patients undergoing lower limb orthopedic surgery.The time for patients to recover from spontaneous breathing and extubation is shorter, and the risk of complications such as delirium, restlessness, nausea and vomiting is lower.

Stature Estimation of Sichuan Han Females Based on X-ray Photography of Total Lower Limbs / 法医学杂志

OBJECTIVES@#To establish a mathematical model of stature estimation for Sichuan Han females on the basis of the relationship between lower limbs and individual height, thus to provide evidence for forensic identification.@*METHODS@#Samples were collected from 171 Sichuan Han females. Large flat panel multi-function digital photography system was used to take the full-body X-ray films of the lower limbs. Indexes of long bones and stature of the subjects were measured, respectively. A linear regression analysis was carried out on the correlation between them, and a mathematical model of the stature calculation was established. Then the mathematical model was used to calculate the stature of another 29 Sichuan Han females to test its accuracy.@*RESULTS@#The maximum length of femur （x1） had the highest correlation with stature. A total of 13 linear regression equations were established （P<0.05）, with the correlation coefficient （R） 0.821-0.897 and the standard error of the estimation （SEE） 2.994-3.812 cm. The backtesting showed that the equation y=41.604+1.205 x1+1.318 x6+2.444 x12+1.852 x13-2.388 x14 had the smallest mean absolute deviation （2.485 years old） and the highest accuracy of ±2SEE （92.9%）, and that the equation y=48.783+2.568 x1 had the highest accuracy of ±1SEE （60.7%）.@*CONCLUSIONS@#The stature estimation is high by using the long bones of the lower limbs has high accuracy.

Preoperative deep venous thrombosis in female patients with lower extremity fracture in menstrual phase / 中华创伤骨科杂志

Objective To investigate the factors associated with preoperative deep venous thrombosis (DVT) in female patients with lower extremity fracture in menstrual phase.Methods A retrospective analysis was conducted of the 119 women with lower extremity fracture in childbearing age who had been treated at Traumatic Orthopaedics Center,Red Cross Hospital,Xi'an Jiaotong University Health Science College from October 2016 to October 2017.Of them,41 were in menstral phase,aged from 20 to 50 years (average,37.1 ± 8.9 years),and 78 were not,aged from 19 to 50 years (average,36.9 ± 8.0 years).The 2 groups were compared in terms of DVT incidence,D-dimer level,prothrombin time,partial prothrombin time,thrombin time,fibrinogen level,and preoperative bed time.Results The patients with menstruation had significantly higher incidence of lower extremity DVT (82.9％) and significantly longer preoperative bed time (9.1 ± 3.4 d) than those without menstruation did (14.1％ and 3.8 ± 2.2 d,respectively) (P ＜0.05).There were no significant differences between the 2 groups in the preoperative coagulation indexes:D-dimer,prothrombin time,partial prothrombin time,thrombin time or fibrinogen (P ＞ 0.05).Conclusions The incidence of preoperative DVT may be high the female patients with lower extremity fracture in menstrual phase,chiefly because of long preoperative bed time.Detection of D-dimer level is of limited significance in the screening for thrombosis in menstrual phase.Menstruation may not be a surgical contraindication.

Comparison of incidence of perioperative deep venous thrombosis and D-dimer level between different ages in patients with lower limb fracture in Northwest China / 中华创伤骨科杂志

Objective To compare the perioperative incidence of deep venous thrombosis (DVT) and level of plasma D-dimer between different ages in patients with lower limb fracture in Northwest China.Methods The data were retrospectively analyzed of the 1,185 patients with lower limb fracture in 5 provinces in Northwest China from July 2014 to March 2017.They were 583 males and 602 femals,with an average of 60.3 years(from 18 to 102 years).Of them,723 were from Shaanxi Province,148 from Gansu Province,137 from Qinghai Province,128 from Ningxia Hui Nationality Autonomous Regions and 49 from Xinjiang Uygur Autonomous Region.They were divided into a young group (≤44 years old) (n =288),a middle-aged group (from 45 to 59 years old) (n =256),a junior elderly group (from 60 to 74 years old) (n =263),and a senior elderly group (≥75 years old) (n =378).The incidences of perioperative deep venous thrombosis (DVT) and levels of plasma D-dimer were compared between the 4 age groups.Results The DVT incidences before and after operation in the young group were significantly lower than in the other 3 groups (P ＜ 0.05);the DVT incidence after operation in the middle-aged group was significantly lower than that in the junior elderly group (P ＜ 0.05).The pre-and post-operative levels of plasma D-dimer increased with the age of the patients;the pre-and post-operative levels of plasma D-dimer in the senior elderly group were significantly higher than in the other 3 groups (P ＜ 0.05).Conclusions The perioperative incidence of DVT was high in the elderly patients with lower limb fracture in Northwest China,peaking in the age range from 60 to 74 years old.The pre-and post-operative levels of plasma D-dimer increased with the age of the patients.

Causes and strategies for postoperative bone nonunion after bone transport of lower limb bone of chronic osteomyelitis with bone defect / 中国骨伤

<p><b>OBJECTIVE</b>To explore causes and strategies for postoperative bone nonunion after bone transport of lower limb bone of chronic osteomyelitis with bone defect.</p><p><b>METHODS</b>From June 2012 to December 2015, clinical data of 38 patients with lower limb bone of chronic osteomyelitis with bone defect were retrospectively analyzed, including 23 males and 15 females aged from 20 to 56 years old with an average of 36.5 years old; 5 cases occurred on 5 femoral osteomyelitis and 33 cases were tibial;the time from injury to bone transport ranged from 2 to 19 months with an average of 7.4 months; the distance of bone defect ranged from 4 to 12 cm with an average of 7.3 cm. Bone transport were performed at 1 week later after operations, and transport directions were from near-end to far-end for 30 cases, from far-end to near-end for 3 cases and bidirectional transport for another 5 cases. The alignment and transport speed were adjusted and weight-bearing was encouraged. Regular follow-up was performed and X-ray films were taken to observe complications such as poor mineralization in transport gaps, nonunion of docking sites, and recurrent fracture. Paley scoring was used to evaluate clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 12 to 36 months with an average of 23.1 months. No recurrence of osteomyelitis, but multiple complications associated with poor bony healing occurred. In the process of bone transport, 3 cases occurred poor mineralization in transport gaps, 17 cases occurred ununion of docking sites, 5 cases suffered fracture gap, 1 case occurred fracture without remove of external fixation, and 4 cases occurred facture after remove of external fixation. The time of taken fixation ranged from 9 to 27 months with an average of 16.3 months; index of external fixation ranged from 1.7 to 2.7 months/cm with an average of 2.24 months/cm. According to Paley's scoring, bony results showed 12 cases excellent, 16 good, 3 moderate and 7 poor;and functional results showed 14 cases excellent, 18 good, 3 moderate and 3 poor.</p><p><b>CONCLUSIONS</b>Bone transport technique could effectively solve clinical problems of long bone osteomyelitis with bone defect. However, long treatment period influence prognosis. Therefore, indications should be chosen strict, and operations should be precise and accurate, also monitored across whole process and followed up in time. Doctors should be actively guide corresponding prevention strategies.</p>

Clinical observation of biological artificial material-induced artificial bone in repair of lower extremity bone defects / 中华创伤杂志

ObjectiveTo observe the clinical effects of biological artificial material (BAM)induced artificial bone in the repair of lower extremity bone defects. MethodsThe study involved 32 patients with lower extremity bone defects treated by BAM artificial bone grafting from January 2008 to December 2010.Their age was at a range of 21-77 years (mean,32.5 years).The volume of bone defects was 1.0 cm × 2.0 cm × 2.5 cm-3.0 cm × 3.5 cm × 5.0 cm ( mean,15.4 cm3 ).The main causes of bone defects were comminuted fracture,bone cyst,fibrous dysplasia,and chronic osteomyelitis.A followup was performed immediately after the surgery and at 1,2,3,5,7,9,12,18 months after surgery to observe the systemic and local reactions,changes of blood calcium/phosphorus,repair of bone defect and restoration of function of the affected extremity.ResultsAll patients were followed up for 9-18 months (mean,10.5 months).There were no local or systemic grafts rejection from the postoperative period to the last follow-up.Follow-up X-ray films showed fuzzy boundary of BAM artificial bone implantation area and bone tissues around bone defects three months postoperatively and new bone formation. Apparent bone ingrowth into the BAM artificial bone implantation area,integrated artificial bone materials and bone tissues,and basically repaired bone defects were founded six months postoperaively.The time for full weight-bearing of the affected extremity was on postoperative 2.5-4 months ( mean,3.2 months).ConclusionBAM artificial bone is characterized by good biocompatibility,osteogenesis effect and a certain stiffness and strength of inner structure and can he used to repair the lower extremity bone defects.