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Bone graft is the second most common transplantation tissue, with blood being by far the commonest. Autograft is considered ideal for grafting procedures, providing osteoinductive growth factors, osteogenic cells and an osteoconductive scaffold. Limitations, however, exist regarding donor site morbidity and graft availability. Allograft on the other hand poses the risk of disease transmission. Synthetic graft substitutes lack osteoinductive or osteogenic properties. Composite grafts combine scaffolding properties with biological elements to stimulate cell proliferation and differentiation and eventually osteogenesis. We present here an overview of bone graft substitutes available for clinical application in large cancellous voids. 相似文献
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William Robert Walsh F. Vizesi G. B. Cornwall D. Bell R. Oliver Y. Yu 《European spine journal》2009,18(11):1610-1620
Choosing the appropriate graft material to participate in the healing process in posterolateral spinal fusion continues to
be a challenge. Combining synthetic graft materials with bone marrow aspirate (BMA) and autograft is a reasonable treatment
option for surgeons to potentially reduce or replace the need for autograft. FormaGraft, a bone graft material comprising
12% bovine-derived collagen and 88% ceramic in the form of hydroxyapatite (HAp) and beta tricalcium phosphate (β-TCP) was
evaluated in three possible treatment modalities for posterior spinal fusion in a standard rabbit model. These three treatment
groups were FormaGraft alone, FormaGraft soaked in autogenous BMA, and FormaGraft with BMA and iliac crest autograft. No statistically
demonstrable benefits or adverse effects of the addition of BMA were found in the current study based on macroscopic, radiology
or mechanical data. This may reflect, in part, the good to excellent results of the collagen HA/TCP composite material alone
in a well healing bony bed. Histology did, however, reveal a benefit with the use of BMA. Combining FormaGraft with autograft
and BMA achieved results equivalent to autograft alone. The mineral and organic nature of the material provided a material
that facilitated fusion between the transverse processes in a standard preclinical posterolateral fusion model. 相似文献
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F. B. Christensen M. Lind S. P. Eiskjær K. Thomsen E. S. Hansen C. E. Bünger 《European spine journal》1999,8(1):54-60
The capacity of the individual patient to initiate osteoblast proliferation as a predictor for successful lumbar spinal fusion
has not yet been reported. The objectives of this study were, first, to analyze the relationship between in vitro osteoblast
proliferation and clinical bony fusion in the individual patient in order to predict the fusion outcome and, second, to measure
the effect of preoperative tobacco smoking on osteoblast proliferation. Sixty-one patients (mean age 46 years) underwent posterolateral
lumbar fusion in the period 1994–1995. Thirty-eight patients received CD pedicle screw implants and 23 received posterolateral
fusions alone. During surgery, autogenous iliac bone was harvested and 1 g of trabecular bone without blood or bone marrow
was then isolated for cell culturing. The cultures were classified as excellent (confluence within 4 weeks), good (confluence
between 4 and 6 weeks) and poor (no or poor growth). Spine fusion was evaluated by two independent observers from plain anterior-posterior,
lateral, and flexion/extension radiographs taken 1 year postoperatively, and the functional outcome was measured by the Dallas
Pain Questionnaire (DPQ). Twenty-three patients had excellent, 19 good, and 19 poor in vitro osteoblast proliferation. Bony
fusion was obtained in 77% of patients: 83% in the CD instrumentation group and 70% in the non-instrumentation group (NS).
There was no significant correlation between osteoblast proliferation and spinal fusion or functional outcomes when analyzing
the CD instrumentation and non-instrumentation groups together or separately. Elderly patients had a significantly poorer
osteoblast proliferation than younger patients (P < 0.008). Preoperative tobacco consumption had no discernible effect on osteoblast proliferation, and no correlation between
smoking and fusion was found. Further refinement of autologous osteoblast culturing may provide a biological tool for selection
of patients who require biological enhancement of their bone fusion capacity. The poorer osteoblast proliferation related
to advanced age supports the important negative biological influence of age on bony fusion. However, with more sensitive testing
and better discrimination, other results are possible – or can in any event not be excluded.
Received: 17 April 1998 Revised: 10 September 1998 Accepted: 12 October 1998 相似文献
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Currently, a number of bone grafting materials are available in the clinical setting to enhance bone regeneration, varying from autologous bone to several bone graft substitutes. Although autologous bone remains the "gold standard" for stimulating bone repair and regeneration, the morbidity from its harvesting and its restricted availability generated the need for the development of other materials or strategies either to substitute autologous bone graft or expand its limited supply. Bone graft substitutes can possess one or more components: an osteoconductive matrix, acting as a scaffold; osteoinductive proteins and other growth factors to induce differentiation and proliferation of bone-forming cells; and osteogenic cells for bone formation. Based on their distinct properties, all these bone grafting alternatives have specific indications, and can be used either alone or in combination. In this review, we summarise the available bone grafting materials, focussing mainly on the various bone substitutes and their characteristics, in an effort to specify the indications for their use. 相似文献
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《Injury》2017,48(10):2119-2124
IntroductionBeside serious and potentially fatal injuries, the majority of pediatric trauma patients present with minor injuries to emergency departments. The aim of this study was to evaluate age-related injury pattern, trauma mechanism as well as the need for surgery in pediatric patients.Patients and methodsRetrospective Study from 01/2008 to 12/2012 at a level I trauma center. All patients <18 years of age following trauma were included. Injury mechanism, injury pattern as well as need for surgery were analyzed according to different age groups (0–3 years, 4–7 years, 8–12 years and 13–17 years). Major injuries were defined as fractures, dislocations and visceral organ injuries. Minor injuries included contusions and superficial wounds.ResultsOverall, 15300 patients were included (59% male, median age 8 years). A total of 303 patients (2%) were admitted to the resuscitation room and of these, 69 (0.5% of all patients) were multiply injured (median Injury Severity Score (ISS) 20 pts). Major injuries were found in 3953 patients (26%). Minor injuries were documented in 11347 patients (74%). Of those patients with a major injury, 76% (2991 patients) suffered a fracture, 3% (132 patients) a dislocation and 3% (131 patients) an injury of nerves, tendons or ligaments. The majority of fractures were located in the upper extremity (73%) (elbow fractures 16%; radius fractures 16%; finger fractures 14%). Patients with minor injuries presented with head injuries (34%), finger injuries (10%) and injuries of the upper ankle (9%). The most common trauma mechanisms included impact (41%), followed by falls from standing height (24%), sport injuries (15%) and traffic accidents (9%). Overall, 1558 patients (10%) were operated. Of these, 61% had a major and 39% a minor injury.ConclusionAlmost 75% of all children, who presented to the emergency department following trauma revealed minor injuries. However, 25% suffered a relevant, major injury and 0.5% suffered a multiple trauma with a median ISS of 20. Overall, 10% had to be operated. The most frequently found major injuries were extremity fractures, with elbow fractures as the most common fracture. 相似文献
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《Injury》2016,47(12):2606-2613
Xenogeneic bone graft materials are an alternative to autologous bone grafting. Among such implants, coralline-derived bone grafts substitutes have a long track record as safe, biocompatible and osteoconductive graft materials. In this review, we present the available literature surrounding their use with special focus on the commercially available graft materials. Corals thanks to their chemical and structural characteristics similar to those of the human cancellous bone have shown great potential but clinical data presented to date is ambiguous with both positive and negative outcomes reported. Correct formulation and design of the graft to ensure adequate osteo-activity and resorption appear intrinsic to a successful outcome. 相似文献
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Iwamoto Y 《Journal of orthopaedic science》2012,17(1):1-2
On March 11, 2011, Japan was consecutively hit by three unprecedented disasters caused by The Great East Japan (Tohoku) Earthquake: an earthquake of magnitude 9.0, an incredibly powerful tsunami, and a nuclear power plant breakdown. As Japan had experienced The Great Hanshin-Awaji Earthquake in 1995, we were prepared to provide the victims with appropriate medical care to some extent. Nevertheless, providing medical treatment after the Tohoku earthquake was extremely difficult due to the fact that the types of injuries in Tohoku were quite different from those in Hanshin. Based on our experiences in Hanshin and Tohoku, I would like to send a message to the world concerning the role of orthopedic surgeons in catastrophic disasters. 相似文献
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Ay?e Karaman Selma Uysal Ramadan Dilek Gökharman Mahmut Kacar U?ur Ko?ar 《Journal of pediatric surgery》2010,45(9):1849-1855
Purpose
We investigated the efficacy of ultrasound in determining megarectum and fecal load and the response to treatment in constipation and tried to specify objective criteria in this study.Methods
A total of 66 cases were queried and divided into 2 groups as constipated (n = 35; mean age, 6.8 ± 2.9 years) and control (n = 31; mean age, 8.4 ± 3.8 years) according to Rome III criteria. After the clinical evaluation, pelvic ultrasonography (US) was performed by 2 separate radiologists. The bladder capacity and the transverse rectal diameter were measured with a full bladder. Then the rectal diameter and rectal anterior wall thickness were measured, and the presence of fecal load in the rectum and sigmoid colon was recorded with an empty bladder. The examination and ultrasound were repeated after treatment for a month in these patients.Results
Comparison of the US measurements of the 2 radiologists performing the US tests did not show any interobserver difference (r = 0.981; P < .001). We therefore believe our results are objective and reproducible. We found a positive correlation between the rectal diameters and the age, height, weight, and bladder capacity. The posturination mean rectal diameter was thicker in the constipated group (3.02 ± 1.04 cm) than in the control group (1.98 ± 0.64 cm) (P < .001). The cutoff point of rectal diameter for a diagnosis of constipation was determined as 2.44 cm (71% sensitive; 76% specific; area under curve, 0.825; P < .001). The rectal anterior wall thickness and fecal load were higher in the constipated patients (P < .001). There was a significant decrease in the constipation score and fecal load after treatment for a month (P < .001), but the rectal diameter had not reached normal limits yet despite the decrease (2.71 ± 0.77 cm) (P > .05).Conclusion
The use of US helps in making a correct diagnosis and in the follow-up with objective criteria and also convinces the patient and the family that the treatment needs to be continued. 相似文献18.
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《Liver transplantation》2003,9(9):S29-S35
With the extensive use of living donor liver grafts in adult patients, controversy over small-for-size syndrome has escalated in recent years. Although several symptoms have been suggested as manifestations of the syndrome, small-for-size syndrome remains difficult to diagnose because these symptoms are neither specific nor inevitable. The occurrence of small-for-size syndrome also seems to depend on a number of recipient and graft factors. Potential pathogenic mechanisms include persistent portal hypertension and portal overperfusion. At present, several techniques are being explored in an attempt to ameliorate the impact of small-for-size syndrome. Recent experience suggests that the occurrence of small-for-size syndrome is multifactorial and that complications relating to small-for-size grafts should be examined in relation to a variety of graft, recipient, and technical factors. (Liver Transpl 2003;9:S29-S35.) 相似文献