Seven cases with bone tumor in upper limb were reported. Five cases were treated by using free vascularized fibular graft, 2 cases by using fusion between humorus and clavicle. A follow-up study of six patients showed that the graft bone was united within 3 months in 5 cases, in 6 months in one case. Partial function of upper limb in 6 patients have been restored.
Since 1979, vascularized iliac bone graft based on the deep circumflex iliac vessels (DCIV) or the deep superior branches of superior gluteal vassels (SGV) was used to the treatment of bone defect, non-union of fracture, and aseptic necrosis of the femoral head in Ⅱ4 cases. Of these Ⅱ4 graftings, 68 were pedicled, 46 were microvascular free transfer. Early callus formation developed 6 weeks after surgery. Solid bony union was obtained in 3 months. Among 32 patients with aseptic necrosis of femoral head followed more tha 1 years, dior relief of pain and omprovement of X-ray findings were obtained in 31. The advantages of using vascularized iliac bone graft, especially based on the DCIV and SGV, are discussed. The author has a good opinion of vascularized iliac bone graft based on the SGV.
Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
The treatmen t of the bone defect of the distal part of the radiu s included repair of the bone defect and resto rat ion of the funct ion of the w rist jo in t. Since 1979, th ree operat ive methods w ere u sed to t reat 13 cases, and they w ere graf t ing of the vascu larized f ibu la by anastom rsis f ibu lar vessels, graf t ing of upper part of f ibu lar w ith lateral inferio rgen icu lar artery and graf t ing vascu larized scapu la f lap. Follow up had been carried ou t from1 to 10 years. The resu lt w as sat isfacto ry. The discu ssion included the repair of the defect of the m iddle o r distal part of the radiu s, the operat ive methods, main at ten t ion s and indications. It was considered that it shou ld be based on the length of bone defect wh ile the operative method was considered.
ObjectiveTo summarize the effectiveness of nitinol memory alloy two foot fixator with autologous cancellous bone grafting in treating old scaphoid fracture and nonunion.MethodsBetween January 2013 and January 2017, 11 patients of old scaphoid fracture and nonunion were treated with nitinol memory alloy two foot fixator and autologous cancellous bone grafting. All patients were male with an average age of 26.1 years (range, 18-42 years). The fractures were caused by sport in 3 cases, falling in 7 cases, and a crashing object in 1 case. The interval between injury and operation was 6-18 months (mean, 8.9 months). Postoperative outcome measures included operation time, fracture healing time, grip strength, range of motion (ROM) of flexion, extension, ulnar deviation, and radial deviation, Mayo score, visual analogue scale (VAS) score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe operation time was 35-63 minutes (mean, 48 minutes). All incisions had primary healing with no infection and loosening or breakage of internal fixator. All patients were followed up 12-30 months (mean, 20.7 months). X-ray films showed that fracture healing was achieved in all patients with an average time of 15 weeks (range, 12-25 weeks). All internal fixators were removed after 10-12 months of operation (mean, 11.2 months). At last follow-up, the grip strength, ROMs of flexion, ulnar deviation, and radial deviation were superior to those before operation (P<0.05), no significant difference was found in ROM of extension between pre- and post-operation (t=0.229, P=0.824). There were significant differences in above indexes between affected and normal sides (P<0.05). At last follow-up, the Mayo, VAS, DASH scores were also significantly superior to those before operation (P<0.05).ConclusionFor the old scaphoid fracture and nonunion, Ni-Ti arched shape-memory alloy fixator and autologous cancellous bone grafting can obtain good effectiveness, which is an effective treatment.
In order to observe stereological correlation between new vessels and surrounding tissue, 6 rabbits were used for the following experiments. The mandible defect model was made by cutting 1 cm x 0.5 cm bone from both right and left side of mandible. Then, the left defect was repaired by the bone segment from the right side, and the right defect was repaired by frozen allogenic bone segment. One month later, the metabolism of the bone segments was observed by nuclein scintiphotography. The revascularization of the bone segments was observed by vascular corrosion cast method. It was shown that new vessels from host soft tissue could penetrate the periosteum of allogenic transplanted bone, along the absorbing path, ingrowth into the bone. The metabolism of the bone was active. It was suggested that the vessel growth from host to the graft is one of the main patterns of revascularization.
The paper introduced bone graft nourished by venous blood, compared with vascularized and conventional bone graft in the animal experiment. B、h(?)ological, radiological methods and tatracycline labeling, the results confirmed that the bone gra(?) nourished by venous blood is inferior to the vascularized bone graft, but is significantly superior to the conventional bone graft in the survival amount, vitality of osteocytes and bone union. The survival mechanism and practicality of bone graft nourished by venous blood were preliminarily discussed in the paper.
OBJECTIVE To compare the osteogenesis of recombination artificial bones, which are bovine deproteined bone (bDPB) and bovine bone morphogenetic protein (bBMP), combined with tumor necrosis factor alpha (TNF alpha), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) respectively. METHODS One hundred trephined skull bone defects in fifty rabbits were divided into four groups, which implanted with bDPB/bBMP/TNF alpha, bDPB/bBMP/bFGF, bDPB/bBMP/EGF, and bDPB/bBMP respectively. X-ray and histological changes were observed in the 1st, 2nd, 4th, 6th, 8th weeks after implantation. The content of 35S and 45Ca and ash weight were measured at 10 and 42 days after operation. RESULTS The osteogenesis of bDPB/bBMP/TNF alpha group was ber than that of bDPB/bBMP/bFGF group(P lt; 0.01), while bDPB/bBMP/bFGF group was ber than that of bDPB/bBMP/EGF(P lt; 0.01). No significant statistical difference were found between bDPB/bBMP/EGF and bDPB/bBMP(P gt; 0.05). CONCLUSION TNF alpha combined with bBMP and carrier can stimulate bone formation and increase the volume of new bone in vivo. It suggests that bDPB/bBMP/TNF alpha is a valuable biomaterial of bone graft.
Objective To investigate the way to reconstruct bone scaffold afterremoval of giant benign bone tumor in extremities of children. Methods From June 1995 to October 2000, 6 cases of benign bone tumor were treated, aged 614 years. Of 6 cases, there were 4 cases of fibrous hyperplasia of bone, 1 case of aneurysmal bone cyst and 1 case of bone cyst; these tumors were located in humerus (2 cases), in radius (1 case), in femur (2 cases) and in tibia(1 case), respectively. All patients were given excision of subperiosteal affected bone fragment, autograft of subperiosteal free fibula(4-14 cm in length) and continuous suture of in situ periosteum; only in 2 cases, humerus was fixed with single Kirschner wire and external fixation of plaster. Results After followed up 18-78 months, all patients achieved bony union without tumor relapse. Fibula defect was repaired , and the function of ankle joint returned normal. ConclusionAutograft of subperiosteal free fibula is an optimal method to reconstruct bone scaffold after excision of giant benign bone tumor in extremities of children.