Pelvic discontinuity: Where are we today?

Pelvic discontinuities in revision total hip arthroplasty remain a challenging problem with an evolving set of treatment options. Discontinuities occur when bone loss of the acetabulum and subsequent unstable movement of the acetabular component result in a fracture between the anterior and posterior columns. These resemble chronic nonunions by the time of revision arthroplasty and are managed differently from the acute fracture type occurring during primary or revision acetabular reconstruction in a previously stable pelvis. We review the treatment options and describe our preferred method of treatment using surgical distraction.     

OP-1 injection increases VEGF expression but not angiogenesis in a rabbit model of distraction osteogenesis

We have previously shown that a single injection of rhBMP-7 (OP-1) applied to the regenerate early during distraction accelerates bone consolidation in a rabbit model of distraction osteogenesis. In the present study, we hypothesised that the injection of OP-1 improves bone consolidation by increasing blood flow to the distracted site. Blood flow into the regenerate of a rabbit model was measured and vascular endothelial growth factor (VEGF) expression was tested using semi-quantitative PCR. Immunohistochemistry was used for assessing the temporal and spatial expression of platelet endothelial cell adhesion molecule (PECAM), VEGF and its receptors following OP-1 injection. We observed a higher expression of VEGF and its receptors in the regenerate with OP-1 treatment. However, there was no difference in the increase in bone blood flow nor PECAM expression between the treated and control groups of animals. Interestingly, the increased expression of VEGF and its receptors was associated with chondrocyte and fibroblast-like cells, but not with endothelial cells. These results suggest that accelerated ossification by OP-1 may depend on a non-vascular mechanism, possibly involving a non-angiogenic function of VEGF signalling.     

Local anesthesia in pediatric dermatologic surgery: Evaluation of a patient‐centered approach

Background/Objectives

A few studies have documented the effect of local anesthesia for minor dermatologic surgical procedures on children and their parents. Our objective was to evaluate the psychological effect and global satisfaction of a patient‐centered approach to dermatologic surgery under local anesthesia.

Methods

Two self‐administered questionnaires were used to evaluate the distress and global satisfaction of 388 children who underwent dermatologic surgery under local anesthesia, accompanied by oral and written therapeutic education measures (structured information and a cartoon brochure illustrating the procedure) addressed to children and parents. Distraction techniques were also used during the procedures.

Results

Although 54.5% of patients manifested some degree of fear, all other parameters analyzed (pain, surgery‐related distress, surgical team–patient and –family relationship, global satisfaction) indicated that the procedures resulted in limited distress and that the large majority of children and parents tolerated them well.

Conclusion

Specific measures for therapeutic pediatric patient education may be helpful in limiting discomfort, anxiety, and pain perception linked to procedures performed under local anesthesia. Further controlled studies are required to more precisely assess the benefits of specific therapeutic education measures.     

Two-stage reconstruction of the severely deficient alveolar ridge: bone graft followed by alveolar distraction osteogenesis

Distraction osteogenesis for the augmentation of severe alveolar bone deficiency has gained popularity during the past two decades. In cases where the vertical bone height is not sufficient to create a stable transport segment, performing alveolar distraction osteogenesis (ADO) is not possible. In these severe cases, a two-stage treatment protocol is suggested: onlay bone grafting followed by ADO. An iliac crest onlay bone graft followed by ADO was performed in 13 patients: seven in the mandible and six in the maxilla. Following ADO, endosseous implants and prosthetic restorations were placed. In all cases, the onlay bone graft resulted in inadequate height for implant placement, but allowed ADO to be performed. ADO was performed to a mean total vertical augmentation of 13.7 mm. Fifty-two endosseous implants were placed. During a mean follow-up of 4.85 years, two implants failed, both during the first 6 months; the survival rate was 96.15%. In severe cases lacking the required bone for ADO, using an onlay bone graft as a first stage treatment increases the bone height thus allowing ADO to be performed. This article describes a safe and stable two-stage treatment modality for severely atrophic cases, resulting in sufficient bone for implant placement and correction of the inter-maxillary vertical relationship.     

纤维蛋白凝胶对上颌扩弓成骨矿化的影响

目的 研究原位注射纤维蛋白凝胶对SD大鼠上颌扩弓成骨矿化的影响。方法 体外实验中,将大鼠骨髓间充质细胞（rBMSCs）在不同凝血酶浓度制备的纤维蛋白凝胶环境下进行共培养,通过CCK-8、 ALP染色和活性定量以及茜素红染色,检测梯度浓度凝血酶制备的纤维蛋白凝胶降解产物对rBMSCs细胞增殖和成骨分化的影响。将rBMSCs分别采用共培养、二维表面培养和三维培养方法与纤维蛋白凝胶进行结合,观察细胞形态和黏附情况。体内实验中,构建SD大鼠上颌扩弓模型（n=12）,以100 g作为扩弓力,扩弓7 d,随机分为2组,每组6只,将仅配戴14 d保持器作为对照组（R组）,将原位注射纤维蛋白凝胶联合配戴14 d保持器作为实验组（R+FG组）,通过显微CT（Micro-CT）三维重建和分析,比较新生骨量和骨矿化密度的差异。通过H-E染色、Masson三色染色、TRAP染色和顺序荧光染色,观察腭中缝的组织学差异。采用GraphPad Prism 8.0.1软件包对数据进行统计学分析。结果 体外实验结果显示,纤维蛋白凝胶降解产物对rBMSCs细胞增殖和成骨分化无显著影响（P>0.05）,且以上述3种方式培养的rBMSCs均具有良好的细胞延展性。体内实验结果显示,实验组新生骨量（P<0.001）和骨小梁矿化密度（P<0.01）较对照组显著提升,腭中缝内可见大量矿化程度更高的新生骨小梁组织;破骨细胞数量减少,矿化沉积速率显著加快（P<0.001）。结论 纤维蛋白凝胶降解产物对rBMSCs增殖、分化无影响。SD大鼠上颌扩弓后,腭中缝组织可通过原位注射纤维蛋白凝胶,促进新骨生成和矿化速率,抑制破骨细胞分化。     

Combination therapy with intra‐articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit

The present study investigated intra‐articular injection of bone‐marrow‐derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight‐bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra‐articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra‐articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1466–1473, 2015.     

牵张成骨联合正颌正畸治疗成人严重小下颌畸形

目的：探讨牵引成骨技术联合正颌正畸治疗重度小下颌伴偏颌畸形患者下颌骨严重发育不足及咬合关系紊乱的疗效。方法：对2例继发于儿童时期颞下颌关节损伤的小下颌伴偏颌畸形患者采用牵张成骨技术进行治疗。手术行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体。第二期在拆除牵引器后进行正畸治疗,继而采用正颌外科方法进一步矫正颌面畸形及咬合关系,术后正畸治疗矫正咬合关系,排齐牙列。结果：2例患者均顺利完成治疗。下颌骨最小牵引距离25 mm,最大牵引距离30 mm,牵引区成骨良好,SNB角由术前平均67°增加到术后80°,小下颌及偏颌畸形得以矫治。联合正颌外科及正畸治疗后,面形及咬合功能均获得满意效果。术后经过2年6个月随访,未见复发。结论：联合应用牵张成骨和正颌外科技术并配合正畸治疗是矫治成人重度小下颌不对称性牙颌面畸形的有效治疗方案。