Effect of calcium sulfate on promoting natural healing of docking sites during bone transport / 中国骨伤

OBJECTIVE@#To observe clinical effect of calcium sulfate on promoting natural healing of docking sites during bone transport.@*METHODS@#A retrospective study was performed on the patients with posttraumatic chronic osteomyelitis treated by bone transport and calcium sulfate implantation from January 2013 to January 2018. There were 23 males and 4 females, aged from 20 to 61 years old with an average of (44.30±10.00) years, the courses of disease ranged from 3 to 86 months with an average of(13.26±16.47) months. Sixteen patients with posttraumatic chronic osteomyelitis were caused by internal fixation of closed fractures, and 11 patients were caused by open fractures. The length of bone defects after debridement ranged from 4 to 14 cm with an average of(9.11±2.57) cm. Postoperative complications, natural healing rate of the docking sites, external fixation index were observed, Checketts & Otterburn pin-tract infection classification was used to evaluate pin-tract infection, and Paley evaluation criteria was used to evaluate bone and function results.@*RESULTS@#Twenty-seven patients were followed up from 26 to 41 months with an average of (31.32±3.37) months. It did not happened skin embedded between bone stumps in all patients. All patients obtained bone union at (17.78±5.43) months after operation.Among them, 25 patients healed naturally in the docking sites, 2 patients with poor compliance healed after debridement and bone grafting in the docking sites. One patient occurred equines deformity, and no re-fracture or recurrence of infection occurred. According to Checketts & Otterburn pin tract infection classification, 22 patients (41 pin tracts)occurred pin-tract infection with varying degrees. The average external fixation index was (2.02±0.24) months/cm(ranged from 1.6 to 2.4 months/cm). According to Paley evaluation criteria, bony results showed 21 patients obtained excellent results, 5 good, and 1 moderate;functional results showed 19 patients got excellent results, 7 good, and 1 moderate.@*CONCLUSION@#During bone transport, the implantation of calcium sulfate on the bone defect areas could prevent skin embedding between the bone stumps, benefit for the natural healing of the docking sites, and could avoid the second-stage debridement and bone grafting for most patients. However, it should be noted that compliance needs to be increased.

Three-column reconstruction via posterior approach for the treatment of unstable thoracolumbar fracture accompanied by posterior column injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of three-column reconstruction via single posterior approach for the treatment of unstable thoracolumbar fractures accompanied by posterior column injury.</p><p><b>METHODS</b>From December 2008 to May 2010,three-column reconstruction via posterior approach was implemented to 21 patients with unstable thoracolumbar fractures accompanied by posterior column injuries. There were 13 males and 8 females, ranging in age from 23 to 54 years old(averaged,35.5 years old). Injured vertebrae: 1 patient had injury in T11, 4 patients had injuries in T12, 8 patients had injuries in L1, 5 patients had injuries in L2, 3 patients had injuries in L3. The Cobb angle was (25.34 +/- 3.42) degrees. The operation time,blood loss during operation, Cobb angle and the bony fusion were observed.</p><p><b>RESULTS</b>Twenty-one patients were followed up, and the duration ranged from 24 to 27 years old, with an average of 25.6 months. The operation time ranged from 135 to 275 min, with a mean of 185 min. The blood loss during operation ranged from 700 to 1 650 ml (averaged, 870 ml). All the patients had complete decompression. Postoperative Cobb angle was (4.01 +/- 2.03) degrees, and (4.34 +/- 2.38) degrees at the latest follow-up. All the patients got bony fusion.</p><p><b>CONCLUSION</b>To the patients with unstable thoracolumbar fractures accompanied by posterior column injuries, three-column reconstruction via single posterior approach has both anterior approach and posterior approach advantages, which can obtain excellent clinical outcomes.</p>