The efficacy of application of lyophilized, radiation-sterilized bone graft in orthopedic surgery

The purpose of this study is retrospective analysis of clinical application of lyophilized (freeze-dried), radiation-sterilized allografts in various orthopedic disorders. Grafts of this type have been produced by Polish tissue banks for many years, even before the production of deep-frozen grafts was started. This type of graft is still produced because of their easy storage, transportation, and distribution. Their application is successful in selected cases. Freeze-dried, radiation-sterilized cancellous or cortical-cancellous blocks, cancellous chips, or diaphyseal cortical struts were applied in 435 patients ranging from three to 74 years old. There were five main groups of procedures: posterior or anterior spine fusion, 224 cases; joint arthrodeses, 36 cases; reconstructive operations, 83 cases; filling of bone lesions, 59 cases; and posttraumatic reconstructive operations, 33 cases. The efficacy of application of lyophilized, radiation-sterilized allografts was estimated retrospectively on the basis of physical examination data and roentgenographic assessment collected during postoperative visits. Incorporation and rebuilding of the grafts as well as a satisfactory therapeutic effect were achieved in 394 (91%) patients. Excluding the cases of congenital and hypovascular pseudoarthroses, post-osteomyelitis gap and focuses, as well as Stage 2 bone lesions, it is suggested that lyophilized, radiation-sterilized allografts can be applied on the condition that intimate contact between the donor bone and host bed is complete and sustained.     

手术机器人在骨科领域中的应用及发展

手术机器人作为外科医生的一项新工具,目前已经逐步进入骨科领域。前期由于技术有限、设备笨重、成本高昂、市场需求不大等,骨科机器人的发展进入了很长时间的停滞期。近十年来随着人工智能技术在各行各业中的发展,研发经费的投入,生产成本的降低及对精准医疗、个体化医疗的需求,各种各样新颖而巧妙的机器人系统被提出、原型化并商业化,参与...     

Tourniquets in orthopedic surgery

Tourniquets are commonly used in limb surgeries, be it orthopedic or plastic surgeries. But the inflation pressures, the duration, and release guidelines are still not clear. According to a survey, majority of orthopedic surgeons inflate the tourniquet to fixed pressures for the upper and the lower limbs without considering the baseline blood pressure of the patient on whom the tourniquets are being applied. This review was designed to recall and review the safe use of tourniquets and the various techniques that can be employed to minimize the complications of tourniquet use. Google, science direct, and pubmed were searched for appropriate literature and relevant articles were identified.     

Thromboprophylaxis in orthopedic surgery

More than 2 million people undergo major orthopedic surgery each year, and this rate is expected to continue rising as our population ages. Our patients are at particularly high risk for deep vein thrombosis (DVT) and pulmonary embolism. The latest guidelines from the American College of Chest Physicians recommend thromboprophylaxis for high-risk orthopedic surgery patients. Although specific recommendations vary by type of surgery, low-molecular-weight heparin, fondaparinux, warfarin, and sometimes low-dose unfractionated heparin are effective alone or with mechanical prophylaxis. Goals of treatment are to prevent proximal and distal DVT, pulmonary death, chronic pulmonary hypertension, and postthrombotic syndrome.     

Computer-assisted orthopedic surgery

 Computer-assisted surgery (CAS) utilizing robotic or image-guided technologies has been introduced into various orthopedic fields. Navigation and robotic systems are the most advanced parts of CAS, and their range of functions and applications is increasing. Surgical navigation is a visualization system that gives positional information about surgical tools or implants relative to a target organ (bone) on a computer display. There are three types of surgical planning that involve navigation systems. One makes use of volumetric images, such as computed tomography, magnetic resonance imaging, or ultrasound echograms. Another makes use of intraoperative fluoroscopic images. The last type makes use of kinetic information about joints or morphometric information about the target bones obtained intraoperatively. Systems that involve these planning methods are called volumetric image-based navigation, fluoroscopic navigation, and imageless navigation, respectively. To overcome the inaccuracy of hand-controlled positioning of surgical tools, three robotic systems have been developed. One type directs a cutting guide block or a drilling guide sleeve, with surgeons sliding a bone saw or a drill bit through the guide instrument to execute a surgical action. Another type constrains the range of movement of a surgical tool held by a robot arm such as ACROBOT. The last type is an active system, such as ROBODOC or CASPAR, which directs a milling device automatically according to preoperative planning. These CAS systems, their potential, and their limitations are reviewed here. Future technologies and future directions of CAS that will help provide improved patient outcomes in a cost-effective manner are also discussed. Received: October 28, 2002 RID="*"     

Robot-assisted orthopedic surgery

The main advantages of robot-assisted orthopedic surgery over conventional orthopedic techniques are improved accuracy and precision in the preparation of bone surfaces, more reliable and reproducible outcomes, and greater spatial accuracy. Orthopedic surgery is ideally suited for the application of robotic systems. The ability to isolate and rigidly fix bones in known positions allows robotic devices to be securely fixed to the bone. As such, the bone is treated as a fixed object, simplifying the computer control of the robotic system. Commercially available robotic systems can be categorized as either passive or active devices, or can be categorized as positioning or milling/cutting devices. Computer assisted orthopedic surgery is a related area of technological development in orthopedics; however, robot-assisted orthopedic surgery can achieve levels of accuracy, precision, and safety not capable with computer assisted orthopedic surgery. Applications of robot-assisted orthopedic surgery currently under investigation include total hip and knee replacement, tunnel placement for reconstruction of knee ligaments, and trauma and spinal procedures. Several short-term studies demonstrate the feasibility of robotic applications in orthopedics, however, there are no published long-term data defining the efficacy of robot-assisted orthopedic surgery. Issues of cost, training, and safety must be addressed before robot-assisted orthopedic surgery becomes widely available. Robot-assisted orthopedic surgery is still very much in its infancy but it has the potential to transform the way orthopedic procedures are done in the future.     

Bone grafts in orthopedic surgery

In orthopedic surgery the demand for the use of bone grafts increases daily because of the increasing quantity and complexity of surgical procedures. At present, the gold standard is the autologous bone graft but the failure rate, morbidity of the donor site and limited availability have stimulated a proliferation for finding materials that work as bone graft substitutes. In order to have good success, we must know the different properties of these choices and the environment where the graft is going to be used. As bone graft substitutes and growth factors become clinical realities, a new gold standard will be defined. Tissue engineering and gene therapy techniques have the objective to create an optimum bone graft substitute with a combination of substances with properties of osteconduction, osteogenesis and osteoinduction.     

Non-metallic fixatives in orthopedic surgery

Summary Some materials obviously possess bone fixing properties and may hence be used in anchoring prostheses to the bone, in filling bone defects and even in the fixation of fractures. The commercial bone cements are an example of materials already used today, and their development and basic properties are known. Some newer materials, which seem to possess bone fixing properties of a different kind are also, described. The polycarboxylate cements used in dentistry adhere to bone and metals by complex formation. Some hydrophilic materials, which absorb water while setting, have a self-locking capacity. Very strong composite resins can be obtained by mixture of suitable materials. A firm fixation may result from the growth of bone into some porous materials implanted into bone. Biodegradable products disappear from the tissues after some length of time, thus allowing healing to take place by a normal regenerative process. It is concluded that newer and better cementing materials are needed and that such materials may be expected soon to become available.

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Zusammenfassung Einige Materialien scheinen knochenfixierende Eigenschaften zu haben, und sie können bei der Prothesenverankerung am Knochen verwendet werden, außerdem beim Ausfüllen von Knochendefekten und sogar bei der Fixierung von Frakturen. Die sich im Handel befindenden Knochenzemente sind ein Beispiel von Materialien, die bereits heutzutage im Einsatz sind, und ihre Entwicklung, wie auch ihre Grundeigenschaften sind vorgeführt werden. Einige neuere Materialien scheinen auch verschiedene knochenfixierende Eigenschaften zu haben, und ihre fixierenden Eigenschaften werden dargestellt. Die Polycarboxylat-Zemente, die in der Zahnmedizin verwendet werden, haben durch Komplexbildung adhesive Eigenschaften auf Knochen und Metalle. Einige hydrophile Materialien haben eine ineinandergreifende Fähigkeit, indem sie bei der Erhärtung Wasser absorbieren. Zusammengesetzte Harze können sehr stark gemacht werden, indem man passende, Materialien miteinander vermischt. Knochen kann in ein in Knochen eingepflanztes, poröses Material hineinwachsen, und auf diesem Wege kann eine feste Fixierung erreicht werden. Organisch abbaubare Produkte haben die spezielle Eigenschaft, nach einer gewissen Zeit aus dem Gewebe zu verschwinden, und geben auf these Weise dem Gewebe die Möglichkeit eines natürlichen und regenerativen Heilprozesses. Wir gelangen hiermit zu der Schlußfolgerung, daß neuere und bessere Zement-Materialien benötigt werden, und es besteht die starke Hoffnung, daß solche Materialien sehr bald erhältlich sein werden.