Mechanical circulatory assist using a miniaturized Archimedes screw

An axial flow blood pump (Archimedes screw) for intraarterial left ventricular assist was evaluated in comparison to standard roller pump left heart bypass (LHBP) in 13 bovine experiments (bodyweight 74 +/- 15 kg). Full systemic heparinization (ACT greater than 500 s) was used for LHBP in comparison to limited systemic heparinization (ACT greater than 180 s) for axial. A standard battery of blood samples was taken before and at regular intervals throughout perfusion: (table; see text) Transarterial access and relatively limited blood trauma appear to be the main advantages of the evaluated axial flow blood pump. However, the impossibility to assess the pump flow may be a major problem for the management of the failing left ventricle.     

Anterior iliac crest bone graft harvesting using the corticocancellous reamer system

OBJECTIVE: To evaluate the anterior iliac crest bone graft harvesting procedure using a corticocancellous acetabular reamer system. DESIGN: A total of 390 bone grafting procedures were reviewed using retrospective chart review. Two hundred twenty procedures were performed using the reamer system, and 170 were performed using traditional techniques (cortical strip, tricortical wedge, and cancellous trap door grafts). SETTING: The Hospital for Special Surgery, New York, New York. PARTICIPANTS: Operative cases involving an anterior iliac crest bone graft procedure between January 1, 1991 and February 28, 1998. MAIN OUTCOME MEASUREMENTS: Complications were organized by the categories major, intermediate, and minor. Statistical analysis included assessment of comorbidity to determine risk factors that may be associated with a propensity for complications. RESULTS: Of the 390 patients reviewed, 13.1 percent (51 of 390) developed a total of seventy-one complications. Of the seventy-one complications, forty were reamer-associated and thirty-one were traditional method-associated complications. As compared with the traditional group, major morbidity was lower in the reamer group (0.9 percent [2 of 220] as compared with 1.8 percent [3 of 170] [ p = 0.4]). Intermediate and minor morbidity were slightly higher in the reamer group than in the traditional group (5.9 percent [13 of 220] as compared with 5.3 percent [9 of 170] [ p = 0.7] and 9.5 percent [21 of 220] as compared with 7.1 percent [12 of 170] [ p = 0.4], respectively). Of the forty reamer-associated complications, 90 percent (36 of 40) resolved within ninety days (average 36.6 days). Of the thirty-one traditional method-associated complications, 74.2 percent (23 of 31) were resolved by 90 days (average 50.6 days). Using logistical regression analysis obesity (body mass index) ( p = 0.03) and smoking ( p = 0.03) were correlated with development of a complication. Furthermore, if a patient was obese and a smoker, the analysis predicted an 83 percent chance of developing a complication. CONCLUSIONS: The reamer technique was found to be safe and efficacious while producing a large amount of autogenous corticocancellous bone graft. Overall complication rates for the reamer and the traditional groups were comparable. The corticocancellous reamer system represents an effective option for bone graft harvesting.     

Treatment of scaphoid nonunion by radical curettage, trapezoidal iliac crest bone graft, and internal fixation with a Herbert screw

Ten adult male patients with scaphoid nonunions were treated by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw. The mean patient age was 24.7 years, and the mean duration of the nonunion before surgery was 37.3 months. Mean follow-up time was 30.4 months. Nine of the ten nonunions healed, although one patient required a second bone-grafting procedure. The mean postoperative grip strength was 45.0 kg, and the mean postoperative pinch strength was 11.5 kg. The mean postoperative range of motion was volar flexion, 76.1 degrees; dorsiflexion, 74.2 degrees; radial deviation, 22.1 degrees; and ulnar deviation, 40.1 degrees. The scapholunate angle decreased from a mean of 72.8 degrees preoperatively to 60.6 degrees postoperatively (p less than 0.025). The mean carpal index was 0.57 postoperatively. Mean scaphoid length increased postoperatively and was within 0.2 mm of the opposite (normal) scaphoid in every patient except the single patient with a persistent nonunion (p less than 0.025). All patients returned to work (eight as laborers), and nine of ten wrists were subjectively rated as good or excellent. The results of the series suggests that treatment of displaced scaphoid nonunion by radical curettage, trapezoidal iliac crest bone grafting, and internal fixation with a Herbert screw is an effective method of treatment that reconstitutes scaphoid anatomy and promotes excellent wrist function.     

Surgical technique: iliac crest corticocancellous bone graft harvest using a trap-door technique

Many alternatives exist for bone grafting in foot and ankle surgery. We describe a technique and case report of iliac crest autograft harvest using a trap-door technique. This technique provides an excellent alternative source of bone while minimizing complications associated with some other iliac crest bone graft harvest techniques.     

髂骨取骨术后并发症的研究进展

取自体髂骨植骨是迄今最常使用的骨移植方式,其优点是可以获得一定量较好的骨质,并可以从髂嵴的前侧或后侧取骨。虽然该技术简单,但许多文献报道其并发症较多、发生率高。因此,一些学者通过改良取骨技术、微创取骨、发明不同的取骨器械以及供区重建等方法来降低取髂骨术后并发症的发生率,且临床研究结果满意;然而,另外一些研究则显示取髂骨的并发症被放大了,传统手术与使用上述技术的远期并发症发生率并无明显差异。近年来,髓内取骨技术(Reamer-Irrigator-Aspirator,RIA)被广泛应用于临床,与取髂骨术相比具有更低的并发症发生率,并在非结构性自体骨植骨方面可取代髂骨。本文就取髂骨取骨术后并发症的研究进展做一综述。     

Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review

Bone grafting is a commonly performed surgical procedure to augment bone regeneration in a variety of cases in orthopaedic and maxillofacial surgery. Autologous bone graft remains to be the 'gold standard' and the iliac crest to be the most common harvesting site. The intramedullary canal of long bones represents another potential site for large volume of autologous bone graft harvesting and is recently being used as an alternative donor site. However, harvesting of autologous bone graft is associated with morbidity and a number of complications. The aim of this systematic review was to collect and summarise the existing data on reported complications after harvesting autologous bone from the iliac crest (anterior and posterior) and the long bone intramedullary canal using the RIA device. We searched the PubMed Medline and Ovid Medline databases, from January 1990 to October 2010, to retrieve all relevant articles. A total of 92 articles (6682 patients) were included in the analysis. Overall, the complication rate following RIA was 6% (14 complications in 233 patients) and 19.37% after iliac crest bone graft harvesting (1249 complications in 6449 patients). The rate of each of the reported complications was assessed and, when the donor site was properly documented, comparison within the anterior and posterior iliac crest donor sites was performed. Although the difference of the overall morbidity rates between the two harvesting sites was not statistically significant (p=0.71); the rates of certain complications were found to significantly differ when anterior or posterior iliac crest was used. The rates of infection (p=0.016), haematoma formation (p=0.002), fracture (p=0.017), and hyperthrophic scar (p=0.017) were significantly higher when the donor site was the anterior iliac crest compared to the posterior iliac crest; whereas the rates of chronic donor site pain (p=0.004) and sensory disturbances (p=0.003) were significantly lower. The incidence of bone graft harvesting related complications can be reduced further if certain principles are followed depending on the performed harvesting methods; but overall the use of RIA device as harvesting method seems a promising alternative with a low complication rate.     

Donor site morbidity in the iliac crest bone graft.

BACKGROUND: Open iliac crest bone grafting is a common surgical procedure with recognized short-term complications. The present paper documents the medium- to long-term complications and level of patient satisfaction following the procedure. METHODS: Seventy-three patients undergoing an open iliac crest bone graft over the past 6 years at Wellington Hospital were retrospectively reviewed. All patients completed a postal questionnaire which assessed their current pain, sensory changes in and below the scar, scar appearance and overall appearance with the bone graft donor site. RESULTS: Sixteen patients (21.9%) reported pain, 11 patients (15%) stated that their scar was sensitive to touch and 19 patients (22%) reported a degree of sensory change below the scar. Six patients (8.2%) felt that the scar appearance was totally unacceptable. Overall satisfaction, however, was high with 70 patients (95.8%) 'fairly satisfied' or 'totally satisfied' with their iliac crest donor site. CONCLUSIONS: Bone grafting from the iliac crest is a relatively benign procedure in terms of patient satisfaction, and the most significant morbidity is pain.     

髂骨移植并发症的相关研究

[目的]探讨髂骨移植的并发症的原因及预防措施.[方法]回顾研究1990年～2005年10月828例髂骨移植患者,对出现的并发症进行统计分析.[结果]浅感染45例;深部感染10例;局部血肿60例;深部血肿4例;神经损伤30例;血管损伤3例,均发生在髂骨后部取骨时,为臀上动脉断裂;髂骨骨折2例,腹壁疝1例.[结论]取骨位置及操作不当是引起并发症的主要原因,了解髂骨解剖特点,正确选择取骨位置、微创操作是预防并发症的主要措施.     

Revascularization of a partially necrotic talus with a vascularized bone graft from the iliac crest

Summary A 16-year-old patient had a compound dislocation of the right talus. Following primary treatment, which included a subtaler screw arthrodesis, the talus developed clinical, radiological, and isotope scan signs of necrosis [3]. In spite of a walking caliper to prevent weight bearing on the ankle, the talar articular cartilage of the ankle joint also showed signs of degeneration. The talus was revascularized with a vascularized corticocancellous iliac crest bone graft. Six months postoperatively, there were clinical, radiological, and bone scan signs of significant revascularization. The patient is free of pain and able to walk with full weight bearing on the foot.     

Correlation of bone tunnel diameter with quadrupled hamstring graft fixation strength using a biodegradable interference screw

Purpose: The purpose of this study was to determine whether the ultimate load at failure of a quadrupled hamstring tendon graft (QHT) fixed with a biodegradable interference screw is improved with a more precise match of the bone tunnel diameter to the diameter of the QHT. Type of Study: Biomechanical testing. Methods: In group A, 8 cadaver knees with a mean age of 69.4 years (range, 60 to 76) were used. QHT graft diameters were measured using sleeves in standard 1.0-mm increments, with matching bone tunnels drilled in 1.0-mm increments. In group B, 9 cadaver knees, with a mean age of 66.5 (53 to 81) were used. Grafts were measured using sleeves in 0.5-mm increments and matching bone tunnels in 0.5-mm increments were drilled. In both groups, the QHT grafts were fixed with a biodegradable interference screw (BioScrew, Linvatec, Largo, FL) in both the tibia and the femur. Tendon interference fixation was tested to failure using a material testing device that tensioned the grafts directly in line with the bone tunnels. Bone mineral density was measured using dual photon absorptimetry for the metaphyseal area of the tibias and femora in the area of interference screw fixation. Results: Femoral maximum load at failure significantly improved from 341 N in the 1.0-mm group to 530 N (P <.05) in the 0.5-mm group; the tibial maximum load at failure improved from 221 N to 308 N (P =.35). Conclusions: Fixation strength results of this study suggest that commercially available instrumentation could be improved with sleeves and reamers available in 0.5-mm increments.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 8 (October), 2002: pp 901–907     

Endoscopic fixation of a double-looped semitendinosus and gracilis anterior cruciate ligament graft using bone mulch screw

Surgeons are switching to the four-bundled hamstring graft, composed of double-looped semitendinosus and gracilis tendons (DLSTG), to replace the torn anterior cruciate ligament. Mechanically, the DLSTG is superior; it is twice as strong and stiffer than a patella tendon graft, and the four bundles share load and mimic the function of the anteromedial and posterolateral bands of the native anterior cruciate ligament. Morbidity from tendon removal is minimal and by 3 months soreness disappears and isometric knee flexion strength returns to normal. It is safe for the patient to undergo aggressive rehabilitation without a brace and to return to sports activities at 4 months when the knee is reconstructed with a DLSTG graft. This report describes the rationale and technique for implanting the DLSTG in a femoral tunnel using rigid fixation instead of a compliant suture bridge. Fixation is achieved by looping the tendons over a post (Bone Mulch Screw) inside the femoral tunnel. The strength, stiffness, and biologic bond of the graft is enhanced by compaction of bone into the femoral tunnel thorugh a bore in the Bone Mulch Screw.     

使用自制植骨漏斗经伤椎植骨联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效

【摘要】 目的：探讨使用自制微创经皮植骨漏斗进行伤椎植骨联合经皮椎弓根螺钉内固定术治疗胸腰椎骨折的临床疗效。方法：回顾性分析自2020年1月～2021年6月收治的26例无神经损伤的胸腰椎骨折患者临床资料。男13例,女13例,年龄51.23±9.56岁（33～65岁）;均为单节段损伤,T12 2例,L1 8例,L2 8例,L3 5例,L4 3例。采用跨伤椎经皮椎弓根螺钉复位内固定,再通过自制的微创经皮植骨漏斗进行伤椎内空腔内植骨（自体髂骨）。记录患者手术时间、术中出血量和并发症发生情况,观测患者术前、术后1周及末次随访时疼痛视觉模拟评分（visual analogue score,VAS）、Oswestry功能障碍指数评分（Oswestry disability index,ODI）、伤椎前缘高度压缩比、伤椎中部高度压缩率及矢状面Cobb角情况,并进行统计学分析。结果：所有患者手术顺利完成,随访时间为15.19±2.51个月（12~22个月）,手术时间84.62±12.88min,出血量55.58±12.44mL,无伤口感染、脊髓损伤等并发症,1例患者出现1枚椎弓根螺钉尾冒松动脱落。术后1周及末次随访时患者伤椎椎体前缘高度压缩率[（6.89±7.25）%、（10.28±7.50）%]、椎体中部高度压缩率[（7.11±5.75）%、（10.63±6.24）%]、Cobb角（4.38°±7.77°、2.14°±7.78°）、VAS评分（3.35±0.56、1.73±0.45）和ODI[（41.96±3.82%、13.77±2.42）%]较术前明显改善（P<0.05）,末次随访时伤椎椎体前缘高度压缩率[（10.28±7.50）%]、椎体中部高度压缩率[（10.63±6.24）%]较术后1周轻度增加,Cobb角（2.14°±7.78°）较术后1周略有下降（P<0.05）,末次随访时患者VAS评分（1.73±0.45）和ODI[（13.77±2.42）%]较术后1周好转（P<0.05）。结论：对于无神经损伤的胸腰椎骨折患者,使用自制微创经皮植骨漏斗进行伤椎植骨联合经皮椎弓根螺钉内固定手术治疗可有效恢复椎体高度,矫正后凸畸形。     

强化力学结构治疗股骨头坏死的临床研究

目的探讨髓芯减压术后利用空心骨螺钉结合自体骨移植强化股骨头力学结构,治疗早期股骨头坏死的疗效.方法自2000年2月至2005年2月,共收治股骨头坏死塌陷前期患者31例,其中FicatⅠ期18例,Ⅱ期13例.男18例,女13例;年龄27～49岁,平均37岁.2例为双侧,其余为单侧.发病至手术时间为6～26个月.多数患者术前曾行6个月以上的非手术治疗,但疗效不佳.自转子下经股骨颈钻隧道至股骨头坏死区域,行髓芯减压术后,取自体髂骨装入空心骨螺钉内并植入股骨头坏死区的隧道内,隧道远端用含脱钙骨基质（decalcified bone matrix,DBM）的生物材料填充.患者术后1～2周使用助步器下床活动,6周后根据恢复情况增加负重,10周时可扶拐行走.结果所有病例术后随访1～5年,平均2.8年.髋关节Harris评分,优21例,疼痛消失,不需服用镇痛药;良8例,明显减轻,偶尔服用镇痛药;可2例,有改善,可正常行走或稍有跛行,但需经常服用镇痛药.Harris髋关节评分由术前的76分提高到术后的91分.结论采用空心骨螺钉结合自体骨移植治疗塌陷前期（FicatⅠ～Ⅱ期）的股骨头坏死效果满意,中、远期疗效有待进一步观察.     

Harvesting bone graft from the posterior iliac crest by less traumatic,midline approach

Complications of the donor site after the harvest of corticocancellous bone graft from the posterior iliac crest are very common. The most common are chronic donor site pain, tenderness, and sensory disturbances. This study investigates the results of the midline, lumbar fascia splitting approach for harvesting bone graft in lower lumbar spine fusion and compares them with the classic separate incision approach. A retrospective study of 107 patients compares two groups. The first group of 56 patients (35 males and 21 females with an average age of 41.8 years) had bone graft taken by splitting the two layers of the lumbar fascia down to their attachment to the iliac crest. The second group of 51 patients (29 males and 22 females with an average age of 43.7 years) had a separate incision over the iliac crest. In the first group, 82.1% had no tenderness, 8.9% mild, 7.1% moderate, and only 1.8% severe tenderness over the donor site. In the second group, 45.1% had no tenderness, 21.6% mild, 17.6% moderate, and 15.7% severe tenderness over the donor site. Five patients of the separate incision group (9.8%) had a lump in the donor site compared with none in the "same incision" group. Sensory disturbances over the donor site were found in 5.4% of the first group and in 21.6% of the second group. Harvesting bone graft from the posterior iliac crest for lower lumbar spine fusion through a midline, fascia splitting approach was found superior to the traditional, separate incision approach.     

Colon hernia through a defect in the iliac crest after bone graft harvesting]

A case of a patient with an hernia through a defect in the iliac crest after bone graft harvesting is described. The osseous defect provides a rigid ring against which repeated sudden elevations in abdominal pressure can result in disruption of soft tissue and herniation of abdominal contents. Standard plain radiographs and barium studies are of limited interest and may even be misleading in diagnosing the herniation. Findings on computed tomography led to detection of this abnormality, and should be the first line exam in these cases.