Autogenous iliac bone graft for osteochondral lesions of the talus with subchondral cyst / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst.@*METHODS@#Twenty-two osteochondral lesion of talus patients with subchondral cyst were collected from January 2011 to December 2014, including 18 males and 4 females aged from 34 to 58 years old with an average of (46.4± 6.9) years old. All patients manifested pain and swelling of ankle joint, 7 patients manifested partially limited activity of ankle joint, 2 patients manifested unstable of ankle joint, and 2 patients manifested poor force line of foot. All lesions located on the medial side of talus dome. The area of cartilage injury ranged from 64 to 132(101.6±27.1) mm2, and diameter of subchondral cyst ranged from 9 to 15(10.5±1.8) mm. VAS score and AOFAS score were used to evaluate pain releases and recovery of ankle joint function before operation, 12 and 24 months after operation. Healing condition of autograft was assessed under arthroscopy after removal of internal fixation at 1 year after operation.@*RESULTS@#All patients were followed up from 24 to 60 months with an average of(42.5±9.9) months. Postoperative MRI at 12 months showed autograft healed well but little cyst still seen. Bone grafting and talus healed well, and formation of fibrocartilage well under arthroscopy. Postoperative MRI at 24 months showed combination of bone grafting and surrounding bone well, and small cyst could seen but less than before. VAS score at 12 months after operation 2.8±0.8 was less than that of before operation 6.2±1.5, but had no differences compared with 24 months after operation 2.6 ±0.8 (>0.05). AOFAS score at 12 months after operation 83.0±5.6 was less than that of before operation 55.3±13.7, but had no differences compared with 24 months after operation 83.7±6.6(>0.05).@*CONCLUSIONS@#Autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst could have a good synosteosis and fibrous cartilage on surface, and relieve clinical symptoms.

The combination of a vascularized fibula with a massive allograft for reconstruction after intercalary resection of long bone tumor in extremities / 中华骨科杂志

Objective To investigate the effects of combined use of an allograft and vascularized fibular flap for the reconstruction of bone defects after intercalary resection of long bone malignancy.Methods From April 2006 to October 2009,19 patients that had intercalary resection of long bone malignancy (5 in humerus,7 in femur,7 in tibia)underwent reconstruction with an allograft and vascularized fibula construct,including 11 males and 8 females with an average age of 18.5 years.The average length of the defect was 13.2±4.3 cm.Free vascularized fibula flaps were used in 16 patients and ipsilateral pedicle vaseularized fibula grafts in 3.Time to union was recorded through evaluation of plain radiographs.Bone scan was used to evaluate the viability of the vascularized fibula.Patients were examined oncologically and radiographically and were assessed functionally with MSTS-93.Results The mean follow-up time was 27.5 months.The average length of the fibula flap was 17.9±5.2 cm.Viability of the fibular grafts was verified in all cases.The average time for bone union at allograft-host junction was 11.3±2.8 months in femur,14.1±3.3 in tibia,6.8±1.4 in humerus,respectively.The MSTS-93 average score at final follow-up was 95.2% in upper extremity and 91.8% in lower extremity.The oncology result in patients with follow-up more than 2 years was continuous disease free in 11 patients.no evidence of disease after recurrence following resection in 1,alive with tumor in 1,and died of lung metastasis in 1.Conclasion Vascularized fibular flap in combination with massive allograft provide an option for reconstruction of large bony defects after long bone malignancy extirpation.The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing,leading to earlier patient's recovery of function.

Panorama atual do uso de xenoenxertos na prática odontológica / Current overview of the use of xenograft in dentistry

O reparo de perdas ósseas severas é, ainda, um grande desafio na Medicina Regenerativa, onde o osso autógenocontinua sendo o padrão-ouro a despeito de apresentar desvantagens como necessidade de segundo sítio cirúrgico e morbidade. Alternativamente, o xenoenxerto acelular e desproteinizado de origem bovina, adequadamente processado e apresentando-se biocompatível eosteocondutor, ocupa um papel de destaque no auxílio ao reparo ósseo. Estudos in vivo e clínicos baseados em análise histomorfométrica demonstraram melhor performance emrelação aos materiais aloplásticos e alógenos, possivelmente em função das propriedades inerentes da apatita natural e, ainda, da arquitetura porosa naturalmente desenhada. Estudos recentes tem avaliado a associação de xenoenxertos a fatores de crescimento e células osteoprogenitoras com o intuito de aproximar a resposta tecidual ao xenoenxerto à do enxerto autógeno. Conclui-se que xenoenxertos adequadamente processados possuem características físicoquímicas e comportamento biológico favoráveis ao reparo ósseo, demonstrando segurança, aplicabilidade e satisfatória previsibilidade clínica.

Repair of severe bone loss is still a major challenge for Regenerative Medicine, where the bone graft is the gold standard in spite of some disadvantages such as need for second surgical site and morbidity. Alternatively, the properly processed acellular and deproteinized bovinexenograft, presenting biocompatibility and osteoconductive properties, plays an important role in bone repair. Basedon histomorphometric analysis, in vivo studies and clinical trials showed better performance compared to alloplasticmaterials and allograft, possibly because of the inherent properties of natural apatite and biologically designed porous architecture. Recent studies have evaluated the association of the xenograft, growth factors and stem cells aiming to attribute autograft properties to xenograft. We conclude that xenografts handled appropriately, will show physicochemical properties and adequate biological behavior helpingto repair bone defects, demonstrating safety, applicability and satisfactory clinical predictability.

Reconstrução frontal e supra-orbitária utilizando crista ilíaca / Frontal and supra-orbital reconstruction with iliac crest

O tratamento das fraturas do seio frontal de forma adequada apresenta grande significado clínico, pois as seqüelas geradas podem trazer transtornos funcionais e estéticos importantes. Em função de sua localização em íntimo contato com as estruturas da fossa anterior do crânio, estas afecções, muitas vezes, estão associadas a tratamentos reparadores tardios, já que se torna prioridade a estabilização do quadro neurológico do paciente antes de qualquer intervenção reconstrutiva. Isso pode resultar em desarmonia facial evidente e de difícil tratamento. Um caso de seqüela de fratura do seio frontal está relatado, no qual foi realizada reconstrução frontal e supra-orbitária com enxerto retirado da crista ilíaca, para restaurar o contorno estético. São discutidos pontos relacionados ao tratamento dessas fraturas, dentre eles o conhecimento da anatomia da região, acessos cirúrgicos, quando intervir cirurgicamente e as possíveis complicações do procedimento.

The appropriate treatment of frontal sinus fractures is of great clinical significance as the resulting sequelae may cause major functional and aesthetic disorders. In view of their location in close contact with the structures of the anterior cranial fossae, these injuries are frequently associated with late repair treatments, as the stabilization of the neurological picture takes priority over any reconstruction intervention. This may result in overt facial disharmony and difficulty in treatment. A case of a sequela resulting from a frontal sinus fracture is reported, in which a frontal and supra-orbital reconstruction was carried out with an iliac crest bone graft to repair the aesthetic contour. Aspects of the management of these fractures are discussed, including a knowledge of the regional anatomy, surgical approaches, when to make the surgical intervention and the possible complications of the procedure.