Objective To evaluate the biomechanical characteristicsof titanium mesh with anterior plate fixation or ilium autograft in anterior cervical decompression.Methods Six fresh cervical spine specimens(C3-7) of young cadaver were used in the biomechanical test. After C5, C5,6 and C4-6 were given vertebrectomy,ilium autograft and titanium mesh with anterior plate fixation were performed. Their stabilities of flexion,bilateral axial rotation,the lateral bending and the extension were tested. Intact cervical spine specimens served as control group. Results Ilium autograft improved the stability of the unstable cervical vertebrae and decreased the flexion, the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Whereas, axial rotational motion was decreased insignificantly(Pgt;0.05). Titanium meshwith anterior plate fixation improved the stability of the unstable spine and decreased the flexion,the bilateral axial rotation,the lateral bending or the extension, showing a significant difference when compared with control group(Plt;0.05). Conclusion The vertebrectomy and anterior cervical fusion by ilium autograft was the least stable construct of all modes tested,and the titanium mesh implantation is stabler than the intact cervical sample.
Objective To investigate the effect and safety of the anterior uncovertebral joint resection in treatment of cervical spondylotic myelopathy accompanied by radiculopathy. Methods From March 2002 toJuly 2004, 9 patients (5 males, 4 females; aged 38-66) with cervical spondylotic myelopathy accompanied by radiculopathy underwent the anterior uncovertebral joint resection and discectomy using the titanium cage implantation. There were 6 unilateral and 3 bilateral compressed nerve roots. Results During the follow-up for 3-16 months, CT scanning or X-ray films revealed thatall the patients improved with an enlargement of the intervertebral foramen, and MRI demonstrated that compression of the spinal cord and nerve roots vanished.Seven patients had a relief in the radicular pain although the other 2 still had a residual pain. All the patients improved to some extent in symptoms of myelopathy. No patient suffered vertebral artery injury during the operation. Conclusion The uncovertebral joint resection can directly decompressthe nerve roots. The key to avoidance of an injury to the vertebral artery is agood understanding of the regional anatomy and a good performance of the operation.
Objective To observe the effect of biological fixation of femoral stem prosthesis with multilayer macropores coating by combined use of autologousbone grafting. Methods The reconstructing femoral stem prostheses were designed personally, proximal 2/3 surfaces of which were reformed by thick multilayer stereo pore structure. Twentyfour adult mongrel canines underwent right femoralhead replacement and were divided randomly into two groups. The autogenous bonemud of femoral head and neck were not used in the control group. The histologicexamination, roentgenograms and biomechanical test were carried out in the 1st,3rd and 6th month after operation to observe the bone formation and fixation inthe exterior and interior sides of the prostheses. Results Onthe whole view,bone reconstruction occurred in experimental group in the 3rd and 6th month. Roentgenograms also proved to be superior to the control group. Histological examinationshowed that both the maximum bone inserting depth（μm） and average engorging ratio(%) of newly formed bone in experimental group surpassed those in the control group. The maximum shear strength of prosthesisbone interface in experimental group was significantly higher than that in the control group（Plt;0.01）. Conclusion Intensity of biological fixation can be strengthened remarkably by using femoral stem prothesis with multilayer macropores coating by combined use of autologous bone grafting.
Objective To investigate the clinical effect of free forearm flap and titanium mesh in repairing maxillary defects. Methods From January 2002 to November 2002,partial maxillectomy or maxillectomy wereperformed in 3 patients with maxillary gingival carcinoma, in 1 patient with palatine mucoepicermoid carcinoma and in 1 patient with maxillary sinus carcinoma. Maxillary defects were reconstructed withfree forearm flaps ranging from 4 cm×5 cm to 6 cm×7 cm and titanium mesh.The effect was estimated by clinical examination, CT and nasopharyngoscope. Results Five cases were followed up 515 months. All the flaps were alive. Facial, alveolar process and palatal contours were restored well. Epithelium was found on the nostril surface of the titanium mesh. The functions of speech and chew were restored well. Conclusion A combination of the free forearm flap and titanium mesh is an ideal method in reconstruction of maxillary defects.
ObjectiveTo investigate the technique and the effectiveness of digital three-dimensional (3-D) titanium mesh in repairing skull defect under the temporalis and reconstructing temporal muscle attachment points. MethodsBetween January 2009 and December 2012, 58 patients with skull defect after decompressive craniectomy at the frontal temporal region were treated. Of 58 patients, 33 were male and 25 were female, aged 17-62 years (mean, 36.2 years). The disease duration was 15 weeks to 25 months (mean, 5.8 months). The size of skull defect ranged from 8 cm×6 cm to 15 cm×12 cm. The patients underwent skull impairment patch surgery with digital 3-D titanium mesh and reconstruction of the temporal muscle attachment points at titanium mesh temporal corresponding position. ResultsThe operation time was 60-100 minutes (mean, 87 minutes). After operation, 2 cases had slight red swelling with little exudation at skin incision margin, which was cured after symptomatic treatment; 2 cases had symptom of headache, which disappeared after incision healing; primary healing of incision was obtained in the other patients. Fifty-eight patients were followed up 6-24 months (mean, 16 months). The patients were satisfied with shaping, and had no chewing pain. Head CT after operation showed good fixation of titanium mesh and titanium nail, and satisfactory skull shape symmetry; no postoperative complication of subcutaneous effusion, intracranial bleeding, titanium mesh loosening, or titanium mesh exposure occurred. ConclusionThe surgery technique of digital 3-D titanium mesh to repair skull defect in frontal temporal region and to reconstruct temporal muscle attachment points at the corresponding position of titanium mesh, basically can obtain anatomical reduction of the skull, frontal temporal, and each layer of scalp. It has the advantages of less complication, less titanium nail, and satisfactory shape.
ObjectiveTo study the efficacy of anterior cervical Vectra-t dynamic plate and titanium mesh for cervical spondylosis. MethodsA retrospectively analysis involving 20 cases (44 sections) from June 2010 to October 2012 was performed in the department of orthopaedic in the West China Hospital of Sichuan University. All patients received the operation of anterior cervical vertebral resection decompression, titanium mesh and bone graft, and Vectra-T plate. The data of the JOA scores, cervical curvature, the conditions of vertebral body fusion after bone graft and the situation of titanium mesh subsidence were all collected. Statistical analysis were performed using SPSS 19.0 software. Resultsa) All the 20 cases received a 12-to 30-month follow-up. The results of statistical analysis showed that:the JOA scores were as follows:7.68±1.66 for preoperative, 10.91±1.97 for after surgery and 12.74±1.27 for the endpoint of follow-up, and significant differences were found between these scores (P < 0.05). b) There was no loose of screw or plate. The local cervical angle and regional cervical angle were improved after surgery. In the 44 segments of fusion, 43 segments fused within 6 months, one of the segment delayed to fuse 12 months after surgery. c) The subsidence of titanium mesh were 2.7±2.7 mm on average in 3 months after surgery, 3.6±1.0 mm on average in 6 months after surgery, 3.9±1.2 mm on average in 12 months after surgery and 4.0±1.2 mm on average in last follow-up. Titanium mesh subsidence mainly concentrated in the postoperative period of 6 months. After six months of titanium mesh subsidence was no longer apparent. ConclusionThe application of Vectra-T dynamic plate can effectively improve the curvature of the cerical sagittal position, prevent protrusion deformity, reduce the related complications after bone graft, effectively avoid the stress shelter in the static plate, andspromote the fusion between the cervical vertebral bodies. However, the long-term curative effects are still needed to be assessed by large sample randomized controlled trials with long-term follow-up.
ObjectiveTo evaluate the effectiveness of three-dimensional (3D) printing artificial vertebral body and interbody fusion Cage in anterior cervical disectomy and fusion (ACCF) combined with anterior cervical corpectomy and fusion (ACDF).MethodsThe clinical data of 29 patients with multilevel cervical spondylotic myelopathy who underwent ACCF combined with ACDF between May 2018 and December 2019 were retrospectively analyzed. Among them, 13 patients were treated with 3D printing artificial vertebral body and 3D printing Cage as 3D printing group and 16 patients with ordinary titanium mesh Cage (TMC) and Cage as TMC group. There was no significant difference in gender, age, surgical segment, Nurick grade, disease duration, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, and Cobb angle of fusion segment between the two groups (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, complications, and implant fusion at last follow-up were recorded and compared between the two groups; JOA score was used to evaluate neurological function before operation, immediately after operation, at 6 months after operation, and at last follow-up; VAS score was used to evaluate upper limb and neck pain. Cobb angle of fusion segment was measured and the difference between the last follow-up and the immediate after operation was calculated. The height of the anterior border (HAB) and the height of the posterior border (HPB) were measured immediately after operation, at 6 months after operation, and at last follow-up, and the subsidence of implant was calculated.ResultsThe operation time of 3D printing group was significantly less than that of TMC group (t=3.336, P=0.002); there was no significant difference in hospitalization stay and intraoperative blood loss between the two groups (P>0.05). All patients were followed up 12-19 months (mean, 16 months). There was no obvious complication in both groups. There were significant differences in JOA score, VAS score, and Cobb angle at each time point between the two groups (P<0.05). There was an interaction between time and group in the JOA score (F=3.705, P=0.025). With time, the increase in JOA score was different between the 3D printing group and the TMC group, and the increase in the 3D printing group was greater. There was no interaction between time and group in the VAS score (F=3.038, P=0.065), and there was no significant difference in the score at each time point between the two groups (F=0.173, P=0.681). The time of the Cobb angle interacted with the group (F=15.581, P=0.000). With time, the Cobb angle of the 3D printing group and the TMC group changed differently. Among them, the 3D printing group increased more and the TMC group decreased more. At last follow-up, there was no significant difference in the improvement rate of JOA score between the two groups (t=0.681, P=0.502), but the Cobb angle difference of the 3D printing group was significantly smaller than that of the TMC group (t=5.754, P=0.000). At last follow-up, the implant fusion rate of the 3D printing group and TMC group were 92.3% (12/13) and 87.5% (14/16), respectively, and the difference was not significant (P=1.000). The incidence of implant settlement in the 3D printing group and TMC group at 6 months after operation was 15.4% (2/13) and 18.8% (3/16), respectively, and at last follow-up were 30.8% (4/13) and 56.3% (9/16), respectively, the differences were not significant (P=1.000; P=0.264). The difference of HAB and the difference of HPB in the 3D printing group at 6 months after operation and last follow-up were significantly lower than those in the TMC group (P<0.05).ConclusionFor patients with multilevel cervical spondylotic myelopathy undergoing ACCF combined with ACDF, compared with TMC and Cage, 3D printing artificial vertebrae body and 3D printing Cage have the advantages of shorter operation time, better reduction of height loss of fusion vertebral body, and maintenance of cervical physiological curvature, the early effectiveness is better.
Objective To explore the effectiveness of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction in the treatment of head titanium mesh exposure complicated with soft tissue infection. Methods Between January 2015 and December 2021, 13 patients with head titanium mesh exposure complicated with soft tissue infection were admitted. There were 9 males and 4 females with a mean age of 42.9 years (range, 23-64 years). The duration of titanium mesh exposure was 22-609 days (median, 102 days). The wound site located at the frontal part in 3 cases, the parietal part in 1 case, the occipital part in 2 cases, the frontal-parietal part in 1 case, the temporal-parietal part in 4 cases, and the frontotemporal part in 2 cases. The titanium mesh had been taken out in 5 patients before admission, leaving skull defect and shape collapse, with signs of infection. The bacterial culture was positive in 7 cases and negative in 6 cases. The imaging examination revealed that the size of the skull defect ranged from 6 cm×5 cm to 21 cm×17 cm and the scalp defect ranged from 1 cm×1 cm to 15 cm×10 cm. The soft tissue infection did not reach dura in 5 cases, reached dura in 6 cases, and reached frontal sinus in 2 cases. The two-stage surgical protocol was used in all patients. In the first-stage operation, the latissimus dorsi myocutaneous flap was designed to repair the skull and scalp defects after removing the titanium mesh and thorough debridement. The size of muscle flap ranged from 13.5 cm×4.0 cm to 21.0 cm×17.0 cm, and the skin flap ranged from 7.0 cm×4.0 cm to 15.0 cm×10.0 cm. After the flap survived and stabilized, the second-stage operation was performed. The titanium mesh was implanted to reconstruct the skull contour. The size of titanium mesh ranged from 7.0 cm×6.0 cm to 21.5 cm×17.5 cm. The interval between the first- and second-stage operations was 3.7-17.8 months, with an average of 11.4 months. The survival of the skin flap, the appearance of the head, and the presence of re-exposed titanium mesh and infection were observed after operation. Results At the first-stage operation, venous embolism occurred in 1 case, and no obvious abnormality was observed after treatment. All the flaps survived and the incisions healed by first intention. Besides, the incisions of the second-stage operation healed by first intention. All patients were followed up 1-96 months (median, 14 months). During follow-up, no exposure to titanium mesh, infection, or other complications occurred. The appearance satisfaction rate of the patients was 92.31% (11/13). There was no significant difference in the skull contour between the affected side and the healthy side in all patients. Conclusion For the head titanium mesh exposure with soft tissue infection, the application of two-stage operation on free latissimus dorsi myocutaneous flap transplantation and skull contour reconstruction can reduce the risks of implant exposure and infection again by increasing the thickness of the scalp and blood supply, filling the wound cavity, and obtain good effectiveness.