Objective To summarize the progress of Masquelet technique to repair bone defect. Methods The recent literature concerning the application of Masquelet technique to repair bone defect was extensively reviewed and summarized. Results Masquelet technique involves a two-step procedure. First, bone cement is used to fill the bone defect after a thorough debridement, and an induced membrane structure surrounding the spacer formed; then the bone cement is removed after 6-8 weeks, and rich cancellous bone is implanted into the induced membrane. Massive cortical bone defect is repaired by new bone forming and consolidation. Experiments show that the induced membrane has vascular system and is also rich in vascular endothelial growth factor, transforming growth factor β1, bone morphogenetic protein 2, and bone progenitor cells, so it has osteoinductive property; satisfactory results have been achieved in clinical application of almost all parts of defects, various types of bone defect and massive defect up to 25 cm long. Compared with other repair methods, Masquelet technique has the advantages of reliable effect, easy to operate, few complications, low requirements for recipient site, and wide application. Conclusion Masquelet technique is an effective method to repair bone defect and is suitable for various types of bone defect, especially for bone defects caused by infection and tumor resection.
Objective To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Methods Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
Objective To investigate the amount of bone grafting, bone defect gap residual rates, and biomechanical stability of the injured vertebral body after reduction of thoracolumbar burst fractures, pedicle screw-rods fixation, and bone graft by bilateral pedicle or unilateral spinal canal. Methods Eighteen fresh lumbar spine (L1-5) specimens of calves (aged 4-6 months) were collected to establish the burst fracture model at L3 and divided into 3 groups randomly. After reduction and fixation with pedicle screws, no bone graft was given in group A (n=6), and bone graft was performed by bilateral pedicles in group B (n=6) and by unilateral spinal canal in group C (n=6). The amount of bone grafting in groups B and C was recorded. The general situation of bone defect gaps was observed by the DR films and CT scanning, and the defect gap residual rates of the injured vertebrae were calculated with counting of grids. The compression stiffness was measured by ElectreForce-3510 high precision biological material testing machines. Results The amount of bone grafting was (4.58 ± 0.66) g and (5.72 ± 0.78) g in groups B and C respectively, showing signficant difference (t=2.707, P=0.022). DR films and CT scanning observation showed large bone defect gap was seen in injured vertebrae specimens of group A; however, the grafting bone grains was seen in the “eggshell” gap of the injured vertebral body, which were mainly located in the posterior part of the vertebral body, but insufficient filling of bone graft in the anterior part of the vertebral body in group B; better filling of the grafting bone grains was seen in injured vertebral body of group C, with uniform distribution. The bone defect gap residual rates were 52.0% ± 5.5%, 39.7% ± 2.5%, and 19.5% ± 2.5% respectively in groups A, B, and C; group C was significantly lower than groups A and B (P lt; 0.05), and group B was significantly lower than group A (P lt; 0.05). Flexion compressive stiffness of group C was significantly higher than that of groups A and B (P lt; 0.05), but no significant difference was found between groups A and B (P gt; 0.05). Extension compressive stiffness in group C was significantly higher than that in group A (P lt; 0.05), but no significant difference was found between groups A and B, and between groups B and C (P gt; 0.05). The compression stiffness of left bending and right bending had no significant difference among 3 groups (P gt; 0.05). Conclusion Thoracolumbar burst fracture pedicle screws fixation with bone grafting by unilateral spinal canal can implant more bone grains, has smaller bone defect gap residual rate, and better recovery of flexion compression stiffness than by bilateral pedicles.
【Abstract】 Objective To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperativenonunion of fracture of lower limb. Methods Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nail ing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nail ing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. Results The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospital ization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Conclusion Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.
Objective To discuss the improved method and effectiveness of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae for treating thoracolumbar burst fracture. Methods Between March 2008 and September 2010, 21 patients with thoracolumbar burst fracture were treated by posterior pedicle-screw fixationcombined with restoring and grafting through the injured vertebrae. Of 21 cases, 15 were male and 6 were female with an age range of 20-61 years (mean, 38.4 years). Affected segments included T12 in 5 cases, L1 in 7 cases, L2 in 5 cases, and T12-L1 in 4 cases. According to Frankel classification for neurological function, 2 cases were rated as grade A, 4 cases as grade B, 6 cases as grade C, 5 cases as grade D, and 4 cases as grade E; based on Denis classification, all 21 cases were burst fractures, including 7 cases of type A, 11 cases of type B, and 3 cases of type C. The X-ray film was taken to measure the relative height of fractured vertebrae and Cobb’s angle, and the function of the spinal cord was evaluated at preoperation, postoperation, and last followup. Results All the incisions healed primarily. The 21 patients were followed up 12-30 months (mean, 26 months). No loosening or breakage of screws and rods occurred. X-ray films showed good bone heal ing with the heal ing time from 12 to 23 months (mean, 16 months). The Cobb’s angles at 1 week and 1 year postoperatively were (3.4 ± 2.4)° and (5.2 ± 3.2)° respectively, showing significant differences when compared with preoperative angle (22.1 ± 1.2)° (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). The anterior height of injured vertebrae recovered from (14.6 ± 2.1) mm (40.2% ± 1.5% of the normal) at preoperation to (36.0 ± 2.0) mm (95.3% ± 1.3% of the normal) at 1 week, and to (35.0 ± 2.4) mm (94.4% ± 2.5% of the normal) at 1 year; significant differences were found between preoperation and postoperation (P lt; 0.05), while no significant difference between 1 week and 1 year after operation (P gt; 0.05). At 1 year after operation, the Frankel neurological function grade was improved in varying degrees, showing significant difference when compared with preoperative grade (χ2=11.140, P=0.025). Conclusion Improved method of posterior pedicle-screw fixation combined with restoring and grafting through the injured vertebrae in treatment of thoracolumbar burst fracture can reconstructthe anterior and middle column stabil ity and prevent loss of Cobb’s angle and height of vertebrae.
ObjectiveTo evaluate the effectiveness of comprehensive management for early stage avascular necrosis of the femoral head (ANFH) by arthroscopic minimally invasive surgery by comparing with closed core decompression. MethodsBetween January 2007 and March 2010, 28 patients (33 hips) with early stage ANFH were treated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bone morphogenetic protein (BMP) in 18 cases (21 hips, trial group) or with simple closed core decompression in 10 cases (12 hips, control group). No significant difference was found in gender, age, disease duration, etiology, and staging between 2 groups (P gt; 0.05). ResultsIncision healed primarily in all patients, and no infection occurred. All patients were followed up 2.5 years on average (range, 1-3 years). Pain relief and improvement of hip function were obtained in all patients at 6 months after operation. At last follow-up, the Harris scores were 85.67 ± 4.78 in trial group and 81.33 ± 7.03 in control group, showing significant difference between 2 groups (t= —2.10, P=0.04). Collapse of the femoral head was observed in 1 hip (Ficat stage II) of trial group, and in 2 hips (Ficat stage I ) and 2 hips (Ficat stage II) of control group; hip arthroplasty was performed. Significant difference in total effective rate was found between trial group and control group (95.24% vs. 66.67%; χ2=4.85, P=0.03). ConclusionArthroscopic core decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed core decompression for treatment of early stage ANFH in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, reduction of hip joint replacement by accurate location of the lesions, and thoroughly debridement of necrotic bone.
Objective To investigate the diagnosis and effectiveness of surgical treatment for lumbar pyogenic spondyl itis. Methods Between February 2005 and June 2010, 15 cases of lumbar pyogenic spondyl itis were treated. There were 10 males and 5 females with an average age of 48.6 years (range, 26-72 years). Affected segments included L2, 3 in 3 cases,L3, 4 in 3 cases, L4, 5 in 8 cases, and L5, S1 in 1 case. All cases had cl inical manifestations of moderate or severe fever, local pain of lesion, and l imitation of the spinal movement; 10 patients had nerve root symptoms, and 8 patients had symptoms of lower limb paraplegia. Leukocyte, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) significantly increased in all cases. The preoperative X-ray and CT examinations showed no clear bone destruction; MRI showed decreased signal intensity on T1WI and increased signal intensity on T2WI, 7 cases had local ized abscess formation. The patients underwent focal cleaning and bone grafting and fusion combined with internal fixation, including anterior operation in 13 cases, posterior operation in 1 case, and combined anterior and posterior operation in 1 case. The results of bacterial culture were positive in 10 cases. According to the results of intraoperative bacterial cultures, sensitive antibiotics were selected. Results Healing of incision by first intention was achieved in 14 cases, healing by second intention in 1 case. After 2 weeks, 1 case recurred and symptoms was rel iefed after symptomatic treatment. Back pain and (or) lower limb pain were obviously improved in the other patients; body temperature recovered to normal after 3-4 days; leukocyte, ESR, and CRP significantly decreased. All the patients were followed up 12 to 70 months with an average of 35.4 months.The patients had no rejection, no fistula formation, no lumbar kyphosis, and no fixator loosening or breakage. The bony fusion time was 4-8 months. Conclusion Combination of cl inical manifestations, laboratory tests, and MRI can diagnose lumbar pyogenic spondyl itis, of which CRP is an important indicator to determine progression of the disease, and MRI is important for diagnosis. Debridement combined with interbody fusion and internal fixation is a safe and effective treatment method.
Objective To compare the effectiveness of three different bone grafts [autogenous bone, allogeneic bone, and bone morphogenetic protein (BMP) composite bone] combined with screw system for spinal fusion of degenerative lumbardisease. Methods Between January 2005 and January 2010, 102 cases of degenerative lumbar disease were randomly treated with autogenous bone (group A, n=35), allogeneic bone (group B, n=33), and BMP composite bone (group C, n=34). There was no significant difference in sex, age, disease duration, affected segments, Meyerding grade, preoperative intervertebral space height, and the Japanese Orthopaedic Association (JOA) score among 3 groups (P gt; 0.05). The intervertebral space height, bone fusion rate, and JOA score were compared among 3 groups at different time points. Results All patients of 3 groups were followed up 2 to 5 years, with an average of 3.2 years. At 6 to 24 months after operation, the intervertebral space height significantly increased when compared with preoperative value in 3 groups (P lt; 0.05); the intervertebral space height of groups A and C was significantly greater than that of group B at 6, 12, 18, and 24 months after operation (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Bone graft fusion was observed at 6 months in groups A and C and at 12 months in group B; at 24 months, the rate of bone graft fusion was 100% in groups A and C, and 87.88% in group B, showing significant difference (P lt; 0.05). There was significant difference in JOA score between preoperation and postoperative 12th and 24th months (P lt; 0.05); at 12 and 24 months after operation, JOA socre and improving rate of groups A and C were significantly higher than those of group B (P lt; 0.05), but no significant difference was found between groups A and C (P gt; 0.05). Conclusion The effect of BMP composite bone is equivalent to that of autogenous bone graft in treating spinal fusion of degenerative lumbar disease, and they are better than allogeneic bone graft. BMP composite bone can obtain adequate bone grafts without invasive sampling, and has fast fusion and high successful rate.
Objective To investigate the effectiveness and feasibil ity of modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis. Methods Between January 2005 and December 2009, 22 cases of thoracic tuberculosis were treated with modified single-stage transpedicular decompression, debridement, and posterior instrumentation. There were 12 males and 10 females with an average age of 39.4 years (range, 22-52 years). The mean disease duration was 1.2 years (range, 3 months to 10 years). The involved vertebral bodies were T5-12, including 2 segments in 17 cases and 3 segments in 5 cases. The kyphosis Cobb angle was (31.2 ± 14.5)° before operation. According to Frankel score system for neurological deficits, 2 cases were classified as grade A, 1 case as grade B, 8 cases as grade C, 5 cases as grade D, 1 case as grade E, and 5 cases had no neurological deficits before operation. Results All incisions healed by first intention. All patients were followed up 22.2 months on average (range, 12-65 months). Pain in low back was rel ieved in varying degrees 2 weeks after operation. Fusion was achieved in the bone implant area at 3 months after operation. According to Frankel score system, 1 case was rated as grade B, 2 cases as grade C, 4 cases as grade D, 7 cases as grade E, and 8 cases had no neurological deficits at last follow-up. The kyphosis Cobb angle was (16.2 ± 3.6)°, showing significant difference when compared with the value before operation (t=5.952, P=0.001). No loosening, emersion, breakage of internal fixation or pneumothorax occurred 1 year after operation. Conclusion Single-stage transpedicular decompression and posterior instrumentation is an effective and safe method in treatment of thoracic tuberculosis.
Objective To investigate the effectiveness of radical debridement, reconstruction with bone allograft, and pedicle screw-rod internal fixation via combined anterior and posterior approach in the treatment of lumbosacral tuberculosis. Methods Between January 2005 and May 2010, 16 patients with lumbosacral tuberculosis were treated. Radical debridement wasperformed via extraperitoneal approach, then tricortical il iac bone allograft was placed and pedicle screw-rod internal fixation was used to reconstruct the spinal column. There were 12 males and 4 females aged 38-65 years (mean, 48 years). The disease duration ranged from 6 to 24 months (mean, 10 months). The main cl inical symptom was persistent pain in lumbosacral area. The involved segments included L4, 5 (3 cases), L5, S1 (8 cases), and L4-S1 (5 cases). The lumbosacral angle was 18-32° (mean, 22°). The erythrocyte sedimentation rate (ESR) was 15-55 mm/1 hour (mean, 25 mm/1 hour). All the patients were given antituberculosis chemotherapy for 12 months after operation. Results The operation time was 120-240 minutes (mean, 180 minutes). The amount of bleeding was 300-600 mL (mean, 420 mL). All wounds healed by first intention, and no relative compl ication occurred. All 16 cases were followed up 12-24 months (mean, 16 months). No recurrence occurred and ESR recovered to normal. Persistent pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray films demonstrated that bony fusion was obtained in all patients at 8-12 months postoperatively. The lumbosacral angle was 16-31° (mean, 21°) at last follow-up. Conclusion The extraperitoneal approach can provide direct and safe access to the lesion. The structural il iac bone allograft and posterior instrumentation could reconstruct effectively the stabil ity of the lumbosacral junction.