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Abstract Objective To evaluate the clinical and radiographic results and survival of the acetabular revision surgery of total hip arthroplasty with cemented implant without the use of reinforcement ring, associated with structural homologous bone grafting. Methods A total of 40 patients (44 hips) operated from 1995 to 2015 were retrospectively analyzed. Radiographs were evaluated according to the classification of the acetabular bone defect, graft shape, and the presence of osseointegration. Cases were considered as failures when the migration of the implant was > 5 mm in any direction, and/or the progression of radiolucency lines around the acetabular component were > 2 mm. We verified the association of radiographic findings with cases of failure using statistical tests and analyzed survival using the Kaplan-Meier curve. Results Of the 44 hips, 45.5% of the acetabular defects were Paprosky type 3A and 50% were 3B. In 65% of the hips, the graft configuration was classified as Prieto type 1 and in 31% as type 2. No radiographic evidence of osseointegration was observed in 13.6% of the cases. We observed 9 (20.5%) reconstruction failures. A correlation was observed between reconstruction failure and the absence of radiographic signs of graft osseointegration. Conclusion We observed good clinic and radiographic results, with survival of 79.54% in a mean follow-up of 9.65 years. Also, there was an association between absence of radiographic signs of osseointegration of the structural graft and failure in this series of patients with large bone defects. The failures did not correlate with the severity of the acetabular bone defect, thickness, or graft configuration.
Resumo Objetivo Avaliarosresultadosclínicos, radiográficos e a sobrevida da cirurgia de revisão acetabular de artroplastia total de quadril com implante cimentado sem uso de anel de reforço, associado à enxertia óssea homóloga estrutural. Métodos Um total de 40 pacientes (44 quadris) operados de 1995 a 2015 foram analisados retrospectivamente. As radiografias foram avaliadas de acordo com a classificação do defeito ósseo acetabular, o formato do enxerto e à presença de osteointegração. Foram considerados casos de insucesso a migração do implante > 5 mm em qualquer direção e/ou a progressão de linhas de radioluscência em torno do componente acetabular > 2mm. Verificamos a associação dos achados radiográficos com os casos de falha utilizando testes estatísticos e analisamos a sobrevida utilizando a curva de Kaplan-Meier. Resultados Dos 44 quadris, 45,5% dos defeitos acetabulares eram Paprosky tipo 3A e 50%, 3B. Em 65% dos quadris, a configuração do enxerto foi classificada como tipo 1 de Prieto e em 31% como tipo 2. Não foi observada evidência radiográfica de osteointe-gração em 13,6% dos casos. Observamos 9 (20,5%) falhas de reconstrução. Foi observada correlação entre falha da reconstrução com a ausência de sinais radiográficos de osteointegração do enxerto. Conclusão Observamos bons resultados clínicos e radiográficos, com sobrevida de 79,54% em seguimento médio de 9,65 anos. Também houve associação entre ausência de sinais radiográficos de osteointegração do enxerto estrutural e falha nesta série de pacientes com grandes defeitos ósseos. As falhas não se correlacionaram com a severidade do defeito ósseo acetabular, espessura ou configuraçãodoenxerto.
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Humanos , Reoperación , Trasplante Homólogo , Estudios Transversales , Oseointegración , Trasplante Óseo , Artroplastia de Reemplazo de CaderaRESUMEN
Objective:To explore the mid-term efficacy of liquid nitrogen-inactivated autologous tumor segment bone replantation for repairing bone defects after resection of malignant tumors in the long bone shaft.Methods:A retrospective analysis was performed on the clinical data of 16 patients treated with liquid nitrogen-inactivated autologous bone graft at Beijing Jishuitan Hospital from July 2015 to June 2017 to repair defects caused by malignant tumour resection of the diaphysis. There were 10 males and 6 females with a mean age of 23.4±11.6 years (range, 8-44 years), including 8 classic osteosarcoma, 2 high-grade surface osteosarcoma, 4 Ewing's sarcoma, 1 periosteal osteosarcoma, and 1 undifferentiated pleomorphic sarcoma. Tumors were located in the humerus in 2 cases, in the femur in 8 cases and in the tibia in 6 cases. The mean length of tumor was 12.4±4.8 cm (range, 5.5-26 cm). Postoperative imaging examination was performed every 6 months, and the healing status of the transplanted bone-host bone was evaluated based on the imaging assessment method of the International Society of Limb Salvage (ISOLS) imaging assessment after allogeneic bone transplantation, and the complications were assessed using the Henderson classification. The five-year survival rate for patients and grafted bone was calculated using the Kaplan-Meier survival curve.Results:The median follow-up was 64 (60.3, 69.8) months. At the end of follow-up, 13 patients were tumour free and 3 patients died of multiple metastases at 19, 20 and 33 months after surgery. There were 32 osteotomy ends in 16 patients, of which 30 healed, including 11 metaphyseal osteotomy ends, and the healing time was 9 (6, 12) months after replantation of the tumour segment with liquid nitrogen-inactivated autologous bone; 19 osteotomy ends in the diaphysis took 13 (9, 21) months to heal, with a statistically significant difference in healing time between different sites ( Z=-2.25, P=0.025). Sixteen patients had six complications, including two cases of non-union at the diaphyseal site, one case of failure of internal fixation due to non-union, three cases of recurrence, and no soft tissue complications or infections. One patient with failed internal fixation was treated with a vascularized tip iliac bone graft that healed 6 months after surgery. Another patient died of multiple metastases with 1 unhealed diaphysis left. Three cases of recurrence were all located in the extracranial soft tissue of the autologous tumor segment inactivated by liquid nitrogen. Among them, one case underwent reoperation and local radiotherapy, and there was still no tumor survival after 65 months of surgery, and two cases died due to multiple metastases. The five-year survival rate of patients was 81% as calculated using the Kaplan-Meier survival curve, and the graft survival rate was 100%. There was no amputation and the limb salvage rate was 100%. Conclusion:The use of liquid nitrogen-inactivated autologous tumor segment bone replantation for reconstruction of bone defects after resection of malignant tumors in the shaft has advantages of higher healing rate, shorter healing time at the metaphyseal end compared to the osteotomy end, fewer complications, and higher survival rate of the replanted bone.
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Severe upper extremity tendon injuries can have a major impact on the life of their victims. For patients with multiple tendon defects, allogeneic tendon transplantation is one of the fine methods to reconstruct their limb function because of its advantages of limited trauma and significant clinical effects. Before allogeneic tendon transplantation, clinical orthopaedists should fully understand its advantages, disadvantages and indications so that they can choose the most suitable protocols for diagnosis and treatment of the patients. Chinese and foreign scholars have done a lot of work in research of and report on allogeneic tendon transplantation since its first application to repair and reconstruct tendons. This article reviews the preservation, treatment, immune rejection and clinical effects of allogeneic tendon transplantation in upper limb injury.
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BACKGROUND: In our country, transplantation centers differ in the age limit for allogeneic hematopoietic transplantation (ALOHT). In our program, transplants with age- adjusted conditioning are performed in patients until 70 years old. Currently more than 60% of ALOHT reported to the Center for International Bone Marrow Transplantation Research (CIBMTR) are performed in patients older than 40 years. AIM: To report our experience with ALOHT in acute myelogenous leukemia (AML), analyzing patient age at transplantation in different periods and transplant results in different age groups. MATERIAL AND METHODS: A retrospective analysis of the database of adult hematopoietic transplants in AML patients was performed. Demographic data, disease characteristics, transplant data, survival and relapse times, and mortality were collected. RESULTS: In our program, 1030 transplants were performed in adults and 119 ALOHT were performed in AML patients, between 1990 and 2020. The median age of patients in all periods was 41 years, (range 16-69). The median age was 33 and 45 years, in the periods 1990-2000 and 2000-2020 respectively (p < 0.01). Seventy-eight patients received myeloablative conditioning (median age 44 years) and 41 reduced intensity conditioning (median age 53 years). Five-year overall survival was 44.6% (confidence intervals (CI) 41-48). Non relapse mortality of all periods was 19% (CI 17 - 40%) and relapse rate was 17 % (CI 16-22). No difference in five years overall survival among patients younger than 40, 41 to 50 and over 51 years was observed. Conclusions: Overall Survival, non-relapse mortality and relapse rate were similar in younger and older patients in our program and similar to those previously reported in other centers.
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Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Leucemia Mieloide Aguda/terapia , Trasplante de Células Madre Hematopoyéticas , Enfermedad Injerto contra Huésped , Trasplante Homólogo , Estudios Retrospectivos , Resultado del Tratamiento , Acondicionamiento PretrasplanteRESUMEN
Objective@#To establish a method for repairing extremities with extensively deep burn using large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin and observe its effect.@*Methods@#Medical records of two male patients with extremely extensive deep burn admitted to our hospital from May to November in 2018 were retrospectively analyzed. Two patients aged 44 and 25 years respectively, with total burn area of 90% and 97% total body surface area (TBSA) and full-thickness burn area of 85% and 70% TBSA, respectively. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and Meek miniature skin. The large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin was prepared according to the methods described as follows. Thin medium-thickness fresh scalps with 3% TBSA and 0.30-0.35 mm in depth were harvested from each donor and spliced into a large piece with epidermis upward by spraying Meek glue. Then the spliced scalp was punched after covered with a single-layer gauze. Autologous microskin was transported onto the dermis of fresh large piece of allogeneic scalp by traditional floating method. Bilateral extremities with full-thickness burn of two patients were selected for self-control. The left upper extremity was denoted as treatment group while the right upper extremity was denoted as control group in Patient 1. The right lower extremity was denoted as treatment group while the left lower extremity was denoted as control group in Patient 2. Wounds in the treatment group were treated with fresh large piece of allogeneic scalp spliced by Meek glue and autologous microskin with expansion ratio of 1∶15 after escharectomy, while wounds in control group received grafting of Meek miniature skin with expansion ratio of 1∶6 and or 1∶9 after escharectomy. The donors of allogeneic scalp were 32 males who were the relatives or friends of the patients, aged 21-50 years, with scalp area of (548±48) cm2. The healing conditions of donor sites of scalp were observed on post operation day 10, and were followed up within 3 months after operation to observe whether forming alopecia and hypertrophic scar or not. Wound healing condition was evaluated during follow-up in post operation week (POW) 2-5 and 4 months after operation. Wound coverage rates were calculated in both treatment and control groups in POW 2, 3, 4, and 5.@*Results@#The donor sites of all allogeneic scalp of donors healed completely on post operation day 10. There was no alopecia or hypertrophic scar within 3 months after operation for follow-up. In POW 2, allogeneic scalp grafts basically survived in treatment group without obvious exudation, and most of the Meek miniature skin survived in control group with obvious exudation. Part of allogeneic scalp grafts dissolved and detached in treatment group in POW 3, and the surviving grafts scabbed. The eschar detached and new epithelium was observed in treatment group in POW 4 and 5. In POW 3-5, surviving Meek miniature skin in control group creeped and was incorporated, and the wounds shrank. Hypertrophic scar was observed in both treatment and control groups 4 months after operation, without obvious difference in scar as a whole. The wound coverage rates were respectively 84%-98% and 76%-92% in treatment group of two patients in POW 2-5, close to or higher than those of control group (35%-97% and 28%-81%, respectively).@*Conclusions@#The study establishes a novel method for splicing fresh allogeneic scalps into a large piece as the covering of microskin, which has good effect for repairing extensively deep burn wounds. Considering that allogeneic skin is scarce, this method may be a new option in clinical treatment for extensively deep burn patients.
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Objective@#To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability.@*Methods@#A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017. A total of 28 cases were treated with autologous semitendinosus tendon (autologous group), including 19 males and 9 females, with an average age of 28.5±8.03 years (range, 16-46 years). A total of 27 cases were treated with allogenic tendon (allogenic group), including 17 males and 10 females, with an average age of 27.48±7.89 years (range, 16-46 years). ATFL/CFL was reconstructed by the same method in both groups. The reconstruction methods were the same between the groups. The talus and calcaneus were fixed with absorbable compression nails.@*Results@#The operation duration in the autologous group was 94.07±7.83 min, which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51, P<0.001). Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55, P<0.001). Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01, P<0.001). In the autologous group, 28 cases were followed up for 34.54±16.04 months, and 27 cases in the allograft group were followed up for 42.74±17.79 months. The mean AOFAS score improved from 63.64±11.20 before operation to 90.21±4.48 after operation in the autologous group, and that improved from 63.93±10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506, P=0.615). The mean VAS score decreased from 5.79±1.79 before operation to 1.54±1.35 after operation in the autologous group, and from 5.89±1.78 before operation to 2.04±1.32 after operation in the allogeneic group. There was no significant difference between the two groups after operation (t=-1.396, P=0.168). Tegner score increased from 4.07±1.39 to 6.43±1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333, P=0.740). Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group, 16.99°±3.78° to 7.14°±3.34° in the allogeneic group, and there was no significant difference between the two groups after operation (t=-1.382, P=0.171). Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group, from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group, and there was no significant difference between the two groups after operation (t=-0.326, P=0.746). No donor tendon dysfunction was found in the autologous group. At the end of follow-up, there was no difference in ankle dorsiflexion, plantar flexion and hind foot mobility between autologous group and allogeneic group.@*Conclusion@#Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results. The autologous tendon group was superior to the allogeneic group in terms of fever, wound healing time. However, there was no significant difference in clinical effects between the two groups.
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Objective To evaluate the clinical outcomes of locking plate combined with allogenic fibular intramedullary support in the elderly patients with varus proximal humeral fracture.Methods From May 2015 to July 2017,21 elderly patients with varus proximal humeral fracture were treated with locking plate combined with allogenic fibular intramedullary support at Department of Orthopaedics,The Second Clinical Medical College,Guangzhou University of Traditional Chinese Medicine.They were 6 men and 15 women,from 65 to 90 years of age (average,74.8 years).According to the Neer classification,2-part fracture was identified in 2 patients,3-part fracture in 14 and 4-part fracture in 5.Their operation time,amount of intraoperative bleeding,postoperative complications and functional scores at the last follow-up were recorded.The humeral neck angles and humeral head heights were compared between preoperation,postoperation and the last follow-up.Results Their operation time averaged 89.5 minutes (from 70 to 110 minutes) and intraoperative bleeding 179.5 mL (from 160 to 400 mL).They obtained follow-up from 12 to 26 months (average,18.1months).All the wounds were healed by the first intention.No such complications occurred as neurovascular lesion,shoulder dislocation or humeral head necrosis.However,screw cut-out was observed in one case.According to the Neer's scoring system,shoulder function was evaluated at the last follow-up as excellent in 3cases,as good in 15 and as fair in 3,giving a good to excellent rate of 85.7％.The humeral neck angle after operation was 136.4° ± 5.8°,significantly larger than the preoperative one (106.0° ± 7.3°) (P ＜0.05) but insignificantly different from the value at the last follow-up (135.4° ±6.5°) (P ＞ 0.05).The postoperative distance between the plate top and the humeral head top was 1.6± 0.2 mm,insignificantly different from that at the last follow-up (1.5 ± 0.2 mm) (P ＞ 0.05).Conclusion Locking plate combined with allogenic fibular intramedullary support can effectively reconstruct the medial proximal column of the humerus,restore the humeral neck angle,facilitate intraoperative fracture reposition and reduce operation time,leading to good functional recovery of the shoulder and prevention of related complications.
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Objective To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability.Methods A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017.A total of 28 cases were treated with autologous semitendinosus tendon (autologous group),including 19 males and 9 females,with an average age of 28.5±8.03 years (range,16-46 years).A total of 27 cases were treated with allogenic tendon (allogenic group),including 17 males and 10 females,with an average age of 27.48±7.89 years (range,16-46 years).ATFL/CFL was reconstructed by the same method in both groups.The reconstruction methods were the same between the groups.The talus and calcaneus were fixed with absorbable compression nails.Results The operation duration in the autologous group was 94.07±7.83 min,which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51,P＜0.001).Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55,P＜0.001).Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01,P＜0.001).In the autologous group,28 cases were followed up for 34.54± 16.04 months,and 27 cases in the allograft group were followed up for 42.74± 17.79 months.The mean AOFAS score improved from 63.64± 11.20 before operation to 90.21 ±4.48 after operation in the autologous group,and that improved from 63.93± 10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506,P=0.615).The mean VAS score decreased from 5.79± 1.79 before operation to 1.54± 1.35 after operation in the autologous group,and from 5.89± 1.78 before operation to 2.04± 1.32 after operation in the allogeneic group.There was no significant difference between the two groups after operation (t=-1.396,P=0.168).Tegner score increased from 4.07± 1.39 to 6.43± 1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333,P=0.740).Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group,16.99°±3.78° to 7.14°±3.34° in the allogeneic group,and there was no significant difference between the two groups after operation (t=-1.382,P=0.171).Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group,from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group,and there was no significant difference between the two groups after operation (t=-0.326,P=0.746).No donor tendon dysfunction was found in the autologous group.At the end of follow-up,there was no difference in ankle dorsiflexion,plantar flexion and hind foot mobility between autologous group and allogeneic group.Conclusion Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results.The autologous tendon group was superior to the allogeneic group in terms of fever,wound healing time.However,there was no significant difference in clinical effects between the two groups.
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The length of tracheal defect or stenosis exceeded 5 cm could not be treated by simple resection and end-to-end anastomosis of the remaining trachea. Various ways of tracheal replacement had appeared sequentially, such as radial forearm free flap with cartilage grafts, tracheal tissue-engineering and tracheal allotransplantation. Among these methods, tracheal allotransplantation displayed a better long-term result. In this review, we are focused on recent advances in tracheal allotransplantation, particularly on revascularization and reepithelialization of graft, as well as on the application of immunosuppressive agents.
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Objective To evaluate the effect of living skin equivalents (LSE) constructed of mixed autologous and allogeneic skin cells and human amnion which served as a matrix on repairing scar contracture of the hand in a patient with recessive dystrophic epidermolysis bullosa (RDEB).Methods Skin tissues were obtained from a patient with RDEB and her mother,and epidermal keratinocytes and dermal fibroblasts were isolated from these tissues and cultured in vitro separately.Human amnion was obtained from the placenta of an unrelated healthy parturient undergoing cesarean delivery,and served as a matrix of the LSE.The autologous and allogeneic fibroblasts were mixed and seeded on the stromal side of the amnion,and then the autologous and allogeneic keratinocytes were mixed and seeded on the epithelial side of the amnion,so as to construct the human amnion-LSE (AM-LSE).Histological examination was performed to observe the structure of the skin tissues obtained from the patient and her mother,and immunofluorescence staining was conducted to detect the expression of type Ⅶ collagen in the skin tissues of the patient and her mother and in the AM-LSE.The AM-LSE was grafted on the skin defects of the patient after release of scar contracture of the hand.After grafting,the survival status of the AM-LSE graft and repairing effect on the wounds were evaluated.Results The constructed AM-LSE consisted of dermis,multilayered and fully differentiated epidermis and well-developed basement membrane.Immunofluorescence examination revealed that type Ⅶ collagen was linearly distributed along the basement membrane.Half a year after grafting,the AM-LSE survived well,and no obvious rejection reaction was observed.No blisters or ulcers occurred at the recipient sites,and the scar contracture was mild.The grafted area showed normal skin color with soft texture.The patient could grab and hold things,which had met self-care requirements of daily living.Conclusions The AM-LSE constructed of mixed autologous and allogeneic skin cells have good histological structures,and can be grafted on the wounds after resection of the scars in a RDEB patient.After grafting,no obvious rejection reaction was observed,and the skin was not liable to develop blisters,ulcers or scar contracture due to friction.
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Abstract Purpose: To investigate the efficacy of allogeneic mesenchymal stem-cells and autologous mononuclear cells to promote sensorimotor recovery and tissue rescue. Methods: Female rabbits were submitted to the epidural balloon inflation method and the intravenous cells administrations were made after 8 hours or seven days after injury induction. Sensorimotor evaluation of the hindlimbs was performed, and the euthanasia was made thirty days after the treatment. Spinal cords were stained with hematoxylin and eosin. Results: Both therapies given 8 hours after the injury promoted the sensorimotor recovery after a week. Only the group treated after a week with mononuclear cells showed no significant recovery at post-injury day 14. In the days 21 and 28, all treatments promoted significant recovery. Histopathological analysis showed no difference among the experimental groups. Our results showed that both bone marrow-derived cell types promoted significant sensorimotor recovery after injury, and the treatment made at least a week after injury is efficient. Conclusion: The possibilities of therapy with bone marrow-derived cells are large, increasing the therapeutic arsenal for the treatment of spinal cord injury.
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Animales , Femenino , Ratas , Traumatismos de la Médula Espinal/cirugía , Leucocitos Mononucleares/trasplante , Trasplante de Médula Ósea/métodos , Recuperación de la Función , Trasplante de Células Madre Mesenquimatosas/métodos , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/patología , Factores de Tiempo , Trasplante Autólogo , Trasplante Homólogo , Tomografía Computarizada por Rayos X , Modelos Animales de Enfermedad , Vías NerviosasRESUMEN
ABSTRACT Objectives: The purpose of this study was to compare union rates for isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all surgeries. Graft materials included b-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft, and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft use and an 83% (78/93) union rate with bone graft use. Odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the non-graft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis. Level of Evidence IV, Case Series.
RESUMO Objetivos: O propósito deste estudo foi comparar as taxas de união de artrodese subtalar isolada com e sem uso de enxertos ósseos ou seus substitutos. Métodos: Revisamos retrospectivamente 135 fusões subtalares com seguimento médio de 18 ± 14 meses. A via de acesso padrão foi utilizada em todas as cirurgias. Os enxertos utilizados incluíram fosfato b-tricálcico, matriz óssea desmineralizada, autoenxerto e aloenxertos da crista ilíaca e aloenxerto de lascas de osso trabecular. A fusão subtalar bem-sucedida foi determinada clínica e radiograficamente. Resultados: Verificou-se uma taxa de união de 88% (37/42) sem uso de enxerto e de 83% (78/93) com enxerto ósseo. A análise da razão de chances (odds ratio) de união óssea para enxerto e não enxerto foi 0,703 (IC 95%, 0,237-2,08). O tempo médio de união no grupo com enxerto foi de 3 ± 0,73 meses e 3 ± 0,86 no grupo sem enxerto, sem detecção de diferença estatisticamente significante (p = 0,56). Conclusão: O uso de enxerto não melhorou as taxas de união na artrodese subtalar. Nível de Evidência IV, Série de Casos.
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Abstract Acquired Cystic Kidney Disease (ACKD) is regarded as a common late condition of end stage renal damage and expresses its most important features when associated with long term hemodialysis. ACKD is also widely known as a premalignant lesion. Its occurrence in chronically rejected renal allografts is rare and its frequency and behavior in this setting are not well known. Herein we report a case of ACKD in a long standing nonfunctional allograft (215 months) which is not associated with malignancy and briefly review the related literature.
Resumo A doença renal cística adquirida (ACKD) é considerada uma condição tardia relacionada à doença renal crônica terminal e manifesta-se de modo mais evidente no contexto de hemodiálise de longo prazo. ACKD é amplamente reconhecida como lesão pré-maligna. Sua ocorrência em enxertos renais cronicamente rejeitados é rara, de modo que a frequência e o comportamento da entidade nesse cenário não estão bem documentados. Relatamos a ocorrência de ACKD em um aloenxerto renal não funcionante sem malignidade após 215 meses de transplante e brevemente revisamos a literatura relacionada.
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Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Trasplante de Riñón , Enfermedades Renales Quísticas/cirugía , Enfermedades Renales Quísticas/diagnóstico , Factores de Tiempo , AloinjertosRESUMEN
Bone replacement materials have been widely used to reconstruct atrophic jawbones. Based on previous reports demonstrating the presence of viable cells in bone blocks even after processing by musculoskeletal tissue banks for orthopedic use, the aim of this study was to evaluate the presence of cells in bone blocks from three Brazilian tissue banks for maxillary reconstructions. All samples were processed by the respective tissue banks, according to the guidelines of the Brazilian National Sanitary Surveillance Agency. Three samples were removed from each block for subsequent histological processing and stained using hematoxylin & eosin. Further evaluation included section staining by the Feulgen method and ultrastructural analysis using scanning electron microscopy (SEM). Light microscopy images from all bone samples showed presence of osteocyte-like cells in all groups and intense Feulgen staining, demonstrating presence of DNA in bone even after tissue processing. The ultrastructural analysis showed red blood cells in lacunae within the bone tissue. In conclusion, despite bone tissue processing by the musculoskeletal tissue banks, cells may be found within the bone used for allogeneic grafts.
Resumo Substitutos ósseos têm sido amplamente utilizados para reconstrução de ossos maxilares atróficos. Uma vez que relatos anteriores demonstram a existência de células viáveis em blocos ósseos após processamento pelos bancos de tecidos músculo-esqueléticos para uso ortopédico, o objetivo deste trabalho foi avaliar a presença de células provenientes de três bancos de tecidos músculo-esqueléticos do Brasil. Todas as amostras foram processadas pelos respectivos bancos seguindo as normas da Agência Nacional de Vigilância Sanitária brasileira. Foi realizada a retirada de 3 amostras de cada bloco, que foram destinadas para processamento histológico e subsequente coloração por hematoxilina e eosina e Feugen e análise ultra-estrutural através de microscopia eletrônica de varredura (MEV). As imagens de microscopia de luz de todos os fragmentos de enxertos ósseos mostraram presença de células do tipo osteócito em todos os grupos avaliados, bem como intensa coloração por Feulgen, demonstrando a presença de DNA nos ossos mesmo após o processamento realizado. As análises ultraestruturais evidenciaram a presença de hemácias nas lacunas do tecido ósseo. Conclui-se que mesmo após os processamentos realizados pelos bancos de tecidos músculo-esqueléticos é possível encontrar células nos ossos utilizados para enxertia alógena.
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Humanos , Trasplante Óseo , Bancos de Tejidos , Trasplante Homólogo , Brasil , Congelación , Microscopía Electrónica de RastreoRESUMEN
ABSTRACT OBJECTIVE: The present study aimed to report the results of the first series of cases of fresh ostechondral allografts in the knee joint in Brazil with a minimum follow-up of two years. METHODS: A protocol of procurement, harvesting, processing, and utilization of fresh osteochondral allografts in the knee joint was established, beginning with legislation modifications, graft harvesting techniques, immediate processing, storage of fresh grafts, and utilization of two surgical techniques of osteochondral transplantation. Eight patients were treated and followed-up for a minimum of two years. RESULTS: Patients were evaluated with subjective IKDC, KOOS, and modified Merle D'Aubigne and Postel questionnaires. Mean subjective IKDC score was 31.99 ± 13.4 preoperative and 81.26 ± 14.7 at the latest follow-up; preoperative KOOS score was 46.8 ± 20.9 and postoperative was 85.24 ± 13.9, indicating a significant improvement over time (p < 0.01). Mean modified Merle D'Aubigne-Postel score was 8.75 ± 2.25, preoperatively, and 16.1 ± 2.59 postoperatively. Friedman test for non-parametric samples demonstrated a significant improvement in postoperative scores (p < 0.01). CONCLUSION: The use of fresh osteochondral allografts in Brazil is a safe procedure, with good clinical results in the short- and medium-term for the treatment of osteochondral lesions greater than 4 cm2 in the knee joint.
RESUMO OBJETIVO: Relatar os resultados dos primeiros casos de transplante osteocondral a fresco na articulação do joelho no Brasil com um mínimo de seguimento de dois anos. MÉTODOS: Foi feito um protocolo de captação, processamento e uso de transplantes osteocondrais a fresco na articulação do joelho. Iniciou-se com modificações na legislação vigente, técnicas de captação de enxertos, processamento imediato, armazenamento a fresco dos enxertos e uso de duas técnicas cirúrgicas de transplante osteocondral. Oito pacientes foram transplantados e acompanhados com mínimo de dois anos de seguimento. RESULTADOS: Os pacientes foram avaliados por meio dos questionários do International Knee Documentation Committee (IKDC) subjetivo, Knee Injury and Osteoarthritis Outcome Score (KOOS) e índice de Merle D'Aubigne e Postel modificado. A média da pontuação da escala IKDC subjetiva pré-operatória foi de 31,99 ± 13,4 e de 81,26 ± 14,7 no pós-operatório e da escala KOOS pré-operatória foi de 46,8 ± 20,9 e de 85,24 ± 13,9 no pós-operatório, com melhoria significativa ao longo do tempo (p < 0,01). A média da pontuação pelo índice de Merle D'Aubigne e Postel modificado foi de 8,75 ± 2,25 no pré-operatório e de 16,1 ± 2,59 no pós-operatório. O resultado do teste de Friedman para amostras não paramétricas demonstrou melhoria significativa ao longo do tempo (p < 0,01). CONCLUSÕES: O transplante osteocondral a fresco no Brasil é um procedimento seguro, com bons resultados clínicos em curto e médio prazo para o tratamento de lesões osteocondrais maiores do que 4 cm2 na articulação do joelho.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Cartílago Articular , Traumatismos de la Rodilla , Ortopedia , Trasplante HomólogoRESUMEN
Objective To report treatment of acromiodavicular dislocation by reconstruction of coracoclavicular ligaments with allogeneic tendon graft and anchor internal fixation.Methods From January 2013 through January 2016,24 patients with acromiodavicular dislocation were treated at our department.They were 19 men and 5 women,21 to 46 years of age (average,31.4 years).Fourteen left and 10 right sides were involved.By Rockwood classification,6 cases were type Ⅲ,8 type Ⅳ and 10 type Ⅴ.All of them were treated with reconstruction of coracoclavicular ligaments with a11ogeneic tendon graft and anchor internal fixation.Maintenance of the reduced acromioclavicular joint was followed up postoperatively.Disabilities of the Arm,Shoulder and Hand (DASH) scores and Constant-Murley shoulder scores were used to evaluate the shoulder functions before and after operation.Results All the patients were followed up for 6 to 15 months (average,11.4 months).The shoulder joints were well reduced after removal of anchor internal fixation.21 cases were rated as excellent and 3 as good,giving a good to excellent rate of 100％.The fractures healed after 10 to 12 months (average,10.4 months).Compared with the preoperative value (10.7 ± 3.0),the DASH score at final follow-up was significantly improved (6.4 ± 2.6) (P ＜ 0.05);compared with the preoperative value (67.2 ± 2.6),the Constant-Murley score at final follow-up was also significantly improved (92.2 ±4.7) (P ＜ 0.05).The patients' satisfaction was 83.3 ％ (20 / 24).No adverse reaction occurred.Conclusion Reconstruction of coracoclavicular ligaments with allogeneic tendon graft combined with anchor fixation is a reliable technique for acromiodavicular dislocation.
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Objective To evaluate the clinical outcomes and report the second-look arthroscopic findings of reconstructed anterior cruciate ligament (ACL) using deep-frozen allograft.Methods Sixty-six patients undergoing ACL reconstruction using deep-frozen allograft in our institute with at least twelve months follow-up from January 2012 to March 2016 were included and received second-look arthroscopy.The patients consisted of 51 males and 15 females with an average age of 30.6 years (range,18 to 55 years) at the time of ACL reconstruction.Knee functions were evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score.Knee stability was evaluated by drawer test,Lachman test and KT-1000 arthrometer.Second-look arthroscopic evaluation was performed in all patients,focused on continuity of the reconstructed ACL,the synovial coverage and subjective tension of the graft,and the prevalence of cyclops-like lesion and other changes after reconstruction procedures.Resuits All patients were followed up for average 18.3 months (range,12 to 36 months).Thirty-one patients underwent second-look arthroscopy from 12 to 18 months,and the other 35 patients underwent second-look arthroscopy from 18 to 36 months after ACL reconstruction.No infection,rejection reaction and other serious complication were reported after operation.The knee range of motion was normal in all cases,except that 10° extension limitation in one case.The Lysholm score significantly improved from preoperative 54.95±9.01 to 12 months postoperatively 86.14±5.86,and the IKDC improved from 54.79±9.12 to 85.11±5.77.Lachman test was positive in 8 cases,but negative in 58 cases postoperatively.KT-1000 arthrometer measurement showed that the side-toside difference significantly improved from preoperative 6.70± 1.24 mm to postoperative 1.52± 1.02 mm.Complete discontinuity occurred in 2 cases of the reconstructed grafts,graft tear in 4 cases.Cyclops-like mass was identified in 2 cases.The overall synovial coverage was slightly better in the patients who were followed up more than 18 months than those less than 18 months.However,there was no significant difference among the groups in the field of graft tension.The patients with taut grafts showed statistically better KT-1000 values (1.14±0.35 mm) than those with lax grafts (2.95±1.38 mm).Conclusion Frozen allograft could be a reasonable choice for ACL reconstruction.However,the graft integration and remodeling could tend to be slow.
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Objective To investigate the method and efficacy in treating acetabular bone defects by the use of titanium wire mesh and impact bone allograft in revision total hip arthroplasty.Methods Twenty-two patients (22 hips) with acetabular bone defects in revision total hip arthroplasty were treated with wire mesh and impact bone allograft from January 2008 to December 2013.There were 7 males and 15 females in the present study.The average age of the patients at the surgery was 64.8 (37-78) years.According to Paprosky classification,there were 9 cases of type ⅡA,4 cases of ⅡB,7 cases of ⅡC and 2 cases of ⅢB.Twenty cases with aseptic loosen and 2 with periprosthetic infection were underwent revision surgery.Deep frozen cancellous bone allograft was sterilized and morselized to particles with the size of 7 to 10 mm.After removal of loosed acetabular component,the bone grafts were impacted into the acetabular defects area to restore the bone quantity.Titanium wire mesh with appropriate diameter was chosen to fix on impacted bone graft and fixed acetabulum with screws.Polyethylene cup was cemented in the mesh wire with proper position.Harris hip score system was used to evaluate the hip joint function.The AP pelvis X-ray was taken at 1 week,3 months,12 months and annually thereafter postoperatively to evaluate the rotation center,fusion of the bone graft and loosening of cup.Results All patients were followed up with the average period 5.1 years (3-7 years).The average Harris hip score before revision was 43.75±13.45,while the score was 85.33±7.84 at last follow-up (t=7.930,P=0.000).The average height of hip rotation center of surgical side was 3.49±0.77 cm before surgery,while its height at last follow-up was 2.22±0.22 cm (t=4.390,P=0.005).The distance between hip rotation center and the base of acetabulum was 3.54±0.45 cm before surgery,while its value was 3.52± 0.76 cm at last follow-up.All the bone grafts came to infusion with the average time 12 months (9-15 months).There was no case with cup migration more than 4 mm or rotation greater than 5° at last follow-up.One patient had the symptom of sciatic nerve injury.No case was with infection or dislocation.Conclusion In the treatment of acetabular bone defects,wire mesh and impact bone allograft with cemented cup in revision total hip arthroplasty can reconstruct hip rotation center and the acetabular bone quantity effectively.Satisfied early-midterm curative effects could be acquired by using this method.
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Objective To evaluate regenerative nerve and functional recovery of target muscle in rats with sciatic nerve defect bridged by acellular nerve allograft made through chemical extraction.Methods Sciatic nerve of SD rats was processed in a volume fraction of 3％ Triton X-lO0 solution and 40 g/L sodium deoxycholate solution.Morphology of myelin sheath,axons and basal lamina tubes of sciatic nerve segments was observed under the light microscopy before and after the chemical processing.Twenty-five Wistar rats were divided into acellular nerve allograft group (n =10),autograft group (n =10) and normal control group(n =5) according to the random number table.A 1 cm sciatic nerve defect was created in acellular nerve allograft group and autograft group,and was respectively bridged by acellular nerve allograft and autograft.Sciatic nerve function index (SFI) was measured every two weeks.Twelve weeks after surgery,nerve conduction velocity (NCV),recovery rate of compound muscle action potential (CMAP) and recovery rate of muscle force were measured in each group.Results Cellular components including myelin sheath and axons were removed thoroughly,but the basal lamina tubes were preserved completely.At postoperative 2,4,6,8,10 and 12 weeks,SFI in normal control group (-1.7±5.9,-0.3 ±2.5,0.8 ±4.1,-1.4±3.6,-2.5 ±5.7 and-2.1±3.2) was superior over autograft group (-94.3±3.7,-90.1±4.1,-63.7±7.8,-51.9±8.2,-48.8±8.6 and -44.3 ± 10.5) and acellular nerve allograft group (-97.1 ± 5.3,-91.2 ± 6.1,-70.6 ± 5.5,-60.4±6.2,-58.2 ±10.2 and-56.4 ±8.0) (P ＜0.01).At postoperative 6,8,10 and 12 weeks,SFI in autograft group were better than those in acellular nerve allograft group (P ＜0.05).NCV [(61.6 ± 8.1) m/s],recovery rate of CMAP[(98.7 ± 5.9) ％] and recovery rate of muscle force [(101.8 ± 6.6) ％] in normal control group were higher than those in acellular nerve allograft group [(22.3 ± 4.7) m/s,(40.3 ± 9.2) ％ and (43.8 ± 9.3) ％] and those in autograft group [(29.0 ±5.5) m/s,(52.5 ± 10.6) ％ and (54.3 ± 10.5) ％] (P ＜ 0.01).NCV,recovery rate of CMAP and recovery rate of muscle force in autograft group were better than those in acellular nerve allograft group (P ＜ 0.05).Conclusions Acellular nerve segments are harvested satisfactorily by chemical extraction.Sciatic nerve defect in rats can be cured with the acellular nerve allograft,but the repair effect of autograft is relatively better.
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Sinus lifting has become a routine procedure in modern implant dentistry. Despite its predictability, this type of surgery may eventually lead to serious complications and sequelae. Most of the time, such complications are due to technical failures, such as perforation of the sinus membrane during surgery, which may eventually lead to graft loss due to infection within the sinus, which finds its drainage path into the mouth and leads to an oroantral communication (OAC). Epithelization of such a draining duct characterizes an oroantral fistula (OAF). This report presents the use of a palatal pedicle flap to successfully close an OAF in a patient who had previously undergone a sinus lifting procedure. Several surgical techniques may be used in the closure of an OAF, and the choice of a particular technique is subject to the characteristics and location of the communication as well as to the preference of the surgeon. The palatal pedicle flap was successfully chosen in the present case report. The palatal pedicle flap was considered an adequate option for closure of an OAF in a single-stage surgical procedure, with no loss of either keratinized mucosa or buccal sulcus depth in the area of the fistula.
A cirurgia de elevação da mucosa do seio maxilar para enxerto ósseo e posterior colocação de implantes osseointegráveis vem se tornando um procedimento de rotina na implantodontia moderna. Embora previsível, em alguns casos, tal procedimento, pode levar a complicações e sequelas consideráveis. Na maioria das vezes, essas complicações são ocasionadas por falhas técnicas, como a perfuração da membrana sinusal no momento transcirúrgico, o que pode acarretar perda do enxerto devido a um processo infeccioso no interior do seio maxilar, cuja via de drenagem acaba provocando a comunicação com a cavidade oral. A fístula bucossinusal é caracterizada pela persistência e epitelização desse pertuito. Neste relato é apresentado um caso de fechamento de fístula bucossinusal com o uso de um retalho palatino pediculado, em um paciente que havia desenvolvido um processo infeccioso, após ter sido submetido à realização de uma cirurgia para a elevação do seio maxilar. A cirurgia para o fechamento das comunicações bucossinusais apresenta técnicas variadas, que podem ser eleitas de acordo com as preferências do operador, além da localização e características da comunicação. Para o presente relato de caso, a técnica do retalho palatino pediculado foi eleita para o tratamento cirúrgico, proporcionando a cura do paciente. A técnica do retalho palatino pediculado mostrou-se uma opção adequada para o fechamento da fístula bucossinusal em um único ato cirúrgico, sem perda de mucosa ceratinizada ou diminuição do sulco vestibular na região da fístula.