Objective To compare the effect of different defect diameters on healing in the middle 1/3 tibia monolayer cortical bone defect mouse model so as to establish an animal model for bone tissue engineering study, mechanism study on bone defect repair, and gene therapy research. Methods Ten 8-week-old C57BL/6J mice, weighing (20 ± 2) g, were randomly divided into 2 groups, 5 mice in each group. The middle 1/3 tibiae monolayer cortical bone defect model of 0.8 mm (group A) or 1.0 mm (group B) in diameter was established with burr drill. At 7, 21, and 28 days after modeling, the molybdenum target X-ray radiography was used to observe the defect repair; at 28 days, Micro CT and three-dimensional imaging were used to evaluate bone defect repair, and tibia specimens were harvested for HE staining. Results At 7 days after modeling, tibia fracture occurred in 5 mice in group B, no fracture in group A. X-ray films, Micro CT scan, and HE staining showed bony union in group A at 28 days. The quantitative analysis of trabecular bone by Micro CT showed that trabecular number, connectivity density, and bone volume in group A were significantly greater than those in group B (P lt; 0.05), mean of segmented region—mean 2 was significantly less than that in group B (P lt; 0.05), but no significant difference was found in trabecular separation and trabecular thickness between 2 groups (P gt; 0.05). Conclusion The middle 1/3 tibia monolayer cortical bone defect mouse model of 0.8 mm in diameter is the ideal animal model for study repair mechanism of tibia defect or bone tissue engineering.
Objective To improve the harvesting techniques of anterolateral thigh perforator flap, and to reduce the operation time. Methods Between January 2008 and June 2015, 400 patients undergoing repair with anterolateral thigh perforator flap were included to analyze the technical factors, including 370 cases (92.5%) obtaining primary healing and 30 cases (7.5%) receiving re-exploration. Combined with the literature, a modified flap dissection was made: reverse tracing and sequential dissection of the descending branch of the lateral circumflex femoral artery. Between June 2015 and June 2016, the modified free anterolateral thigh perforator flap was used in 100 cases. Of 100 cases, 76 were male and 24 were female, aged from 11 to 71 years (mean, 35.6 years). The wound size ranged from 8 cm×5 cm to 23 cm×9 cm. The time between injury and surgery ranged from 5 to 31 days (mean, 14.3 days). Results The operation time of modified flap dissection was reduced to (30.1±19.3) minutes from (85.0±30.2) minutes (unmodified flap dissection). Postoperatively, 94 flaps survived uneventfully, and incision healed by first intention. Six flaps received re-exploration surgery because of vascular compromise; the flap survived after removal of thrombosis in 4 cases of vein thrombosis; the flap necrosed in 2 cases of vein and artery thrombosis, and skin grafting was performed. Ninety-four patients whose flaps survived were followed up 3-12 months (mean, 6.3 months); the flaps had good color and appearance, and second stage operation was performed to make the flap thinner in 21 cases. Conclusion Improved harvesting technique of free anterolageral thigh perforator flap could decrease surgery time and difficulty in dissection.
ObjectiveTo explore the surgical indications,decompression and fusion method,and fusion level selection of degenerative lumbar scoliosis (DLS) and multi-segment lumbar spinal stenosis. MethodsBetween April 2000 and November 2011,46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion (5 segments or above).Of 46 cases,25 were male and 21 were female,with a mean age of 70.2 years (range,65-81 years) and with a mean disease duration of 6.4 years (range,4 years and 6 months to 13 years).X-ray films showed that the lumbar Cobb angle was (26.7±10.0)°,and the lumbar lordotic angle was (20.3±8.8)°.The lumbar CT and MRI images showed three-segment stenosis in 24 cases,four-segment stenosis in 17 cases,and five-segment stenosis in 5 cases.A total of 165 stenosed segments included 12 L1,2,34 L2,3,43 L3,4,45 L4,5,and 31 L5 and S1.Visual analogue scale (VAS) score,Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score (29 points) were employed to evaluate effectiveness. ResultsThirteen patients had leakage of cerebrospinal fluid during operation,and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively,who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change,adequate drainage,debridement and suture.No death,paralysis,central nervous system infection,or other complication was observed in these patients.Forty-six cases were followed up 12-72 months (mean,36.2 months).Lumbago and backache and intermittent claudication of lower extremity were obviously improved.During follow-up,no screw incising,loosening and broken screws,or pseudarthrosis was noted under X-ray film and CT scanning.At last follow-up,the lumbar Cobb angle was reduced to (9.8±3.6)°,while the lumbar lordotic angle was increased to (34.1±9.4)°,which were significantly improved when compared with preoperative ones (t=16.935,P=0.000;t=15.233,P=0.000).At last follow-up,VAS,ODI,and JOA scores were 3.2±1.2,35.5%±14.0%,and 26.6±5.7 respectively,showing significant differences when compared with preoperative scores (8.0±2.2,60.8%±13.3%,and 12.9±3.4) (t=19.857,P=0.000;t=16.642,P=0.000;t=15.922,P=0.000). ConclusionMulti-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms,rebuild spinal balance,and improve the life quality of the patients.It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.