Technique of olecranon bone grafting for surgical fixation of scaphoid fractures

Currently described sources of bone graft, such as iliac crest and distal radius, for supplemental fixation of scaphoid fractures are suboptimal. In our experience, olecranon bone has the advantage of providing a convenient source of corticocancellous block graft that can be harvested within the same sterile operative field used for fixation of the scaphoid fracture, and it also causes less postoperative pain compared to that obtained from iliac crest. Here, we describe our surgical technique for harvest and use of olecranon bone graft for fixation of scaphoid fractures.     

Surgical treatment of proximal ulna nonunion

We reviewed our experience in the surgical treatment of 12 cases of proximal ulna nonunion. The primary injuries were 2 fracture-dislocations of the olecranon, 6 Monteggia lesions and 3 isolated fractures of the proximal ulna. According to the type of primary injury and its anatomical site, the nonunions were classified into 2 groups, considering that the nonunions nearest to the humerus-ulna joint present a more disabling clinical profile and are more difficult to treat: group A (6 patients — nonunion within 5 cm from the olecranon tip of the olecranon) and group B (6 patients — nonunion between 5 and 10 cm from the olecranon tip of the olecranon). In all cases, after fibrous callus debridement and bone surface remodelling, fixation was performed with plate and screws and homoplastic cortical bone graft (orthogonal or parallel to the plate) and an intercalary bone cylinder when the bone defect was severe. In 3 patients (group A), where the defect was smaller than 1 cm, fixation of the ulna was combined with a resection of the radial neck. Clinical-radiographic healing was achieved in all patients followed for a mean of 27 months. Complications included a case of nonunion due to failure of the intercalary graft with plate breakage. The patient healed after a new surgery performed with same technique. The score, according to the Broberg-Morrey scoring system, was 78 in group A patients and 93 in group B patients. The use of homoplastic cortical bone graft represents an effective technique to improve the mechanical properties of the fixation and supports biological union, even when the bone defect is severe.     

膜内成骨与软骨成骨贴敷移植的早期血管化比较研究

目的采用 Wistar 大鼠对颅骨(膜内成骨)和髂骨(软骨成骨)贴敷移植后早期再血管化进行了观察研究。方法用计算机图像处理进行定量分析。结果骨移植7天后,软骨成骨与膜内成骨血管密度分别为:22.33%和11.88%;14天时分别为34.93%和15.93%。结论软骨成骨移植后较膜内成骨有更加迅速的血管化。文中对骨移植后骨质结构,血管化以及骨质体积存留之间的关系进行了讨论。     

Bone graft harvesting from the distal radius, olecranon, and iliac crest: a quantitative analysis

The purpose of this study was to quantify the volume and density of cancellous bone available from 3 commonly used bone graft sites in upper extremity surgery: the distal radius, olecranon process, and anterior iliac crest. Sixteen cadavers (age range, 59-98 years) with no prior history of bone harvest or metabolic conditions affecting bone were used. Cancellous graft was obtained using standardized techniques designed to simulate the clinical setting. Packed cancellous bone volume was determined as the volume occupied by the harvested bone after compression packing with a uniform load. Defect volume was determined by measuring the volume of the site from which bone was harvested. The distal radius and olecranon provided similar volumes of packed cancellous bone (2.7 and 2.8 cc, respectively). The anterior iliac crest provided approximately twice this amount (5.3 cc). The packed cancellous bone volume/defect volume ratio was not different between the 3 sites studied. Male gender was associated with a significantly greater amount of packed cancellous bone volume for all sites. We believe the olecranon to be an alternative to the distal radius as a source of bone graft for upper extremity procedures. We suggest using the anterior iliac crest when a large volume of cancellous bone is required.     

血管化骨-重组异种骨移植修复骨缺损

目的 探讨血管化骨-重组异种骨(RBX)移植修复骨缺损的意义。方法 27例骨缺损随机分成3组，A组为血管化骨-RBX移植修复组(9例)；B组为血管化骨移植修复组(10例)；C组为RBX移植修复组(8例)。临床评价以术后3个月、6个月、12个月随访的X线片来判断骨缺损是否修复、骨愈合时间长短以及是否再吸收等。结果 术后3个月A组8例、B组6例、C组3例骨愈合，6个月A组1例、B组3例、C组3例骨愈合，12个月B组1例、C组2例发生骨移植区部分再吸收。结论 血管化骨一重组异种骨移植的骨折愈合率明显优于单纯重组异种骨移植。     

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects

Summary In cranioplasty complexity is proportional to the size of the defect, particularly if greater than 50 cm². If the patient's own bone flap is not available, allogenic frozen bone graft can be used instead.Between June 1990 and June 1995 twenty cranioplasties with allogenic frozen bone grafts were performed. Age of patients ranged between 23 and 63 years (average 38.4 years). Male/female ratio was 2 1.7. Size of craniectomy ranged between 65 and 150 cm² (average 83.3 cm²). Follow-up ranged between 10 and 58 months (average 41 months).Donors were tested to rule out transmissible diseases, infections, sepsis and/or cancer. Bone grafts were removed under aseptic conditions, microbiological cultures were taken, wrapped in a gauze soaked with Gentamicin sulphate and Bacitracin, sealed in three sterilised vinyl plastic bags, and stored in a deep freezer for a minimum of 30 days (range 36–93 days, average 67 days), at a temperature of –80 °C.Grafts were placed in the defect after a step was carved on its borders to facilitate the contact between host and graft. Vancomycin 1 g. IV/12 hours and Ceftriaxone 1 g. IV/12 hours were administered for five days.Grafts were covered by means of scalp flaps. Only one required a musculocutaneous free flap. None was exposed, extruded or had to be removed.Plain skull X-ray studies showed progressive remodelling of the grafts. Partial resorption was observed in two (2/20, 10%) and loss of thickness in another 3/20 (15%), but with no changes in the contour.Biopsies were taken in 3/20 (15%) cases at a second surgical procedure. Areas of osteoclastic resorptive activity mixed with others of osteoblastic bone apposition, showed replacement with new bone.We conclude that cranial vault frozen allografts are a good alternative to autologous bone when the latter is absent or not present in sufficient amount.     

膜内成骨与软骨成骨贴敷移植的早期血管化比较研究

目的采用Ｗｉｓｔａｒ大鼠对颅骨（膜内成骨）和髂骨（软骨成骨）贴敷移植后早期再血管化进行了观察研究。方法用计算机图像处理进行定量分析。结果骨移植７天后,软骨成骨与膜内成骨血管密度分别为：２２３３％和１１８８％;１４天时分别为３４９３％和１５９３％。结论软骨成骨移植后较膜内成骨有更加迅速的血管化。文中对骨移植后骨质结构,血管化以及骨质体积存留之间的关系进行了讨论。     

Osteolysis after the use of a silicon-stabilized tricalcium phosphate-based bone substitute in a radius fracture: a case report

Skelite, a silicon-stabilized tricalcium phosphate-based bone substitute, is a synthetic alternative to the autogenous bone graft. We present a foreign body inflammatory reaction resulting in extensive osteolysis that occurred after use of Skelite as a void filler in the surgical reconstruction of a distal radius fracture.     

Calcium phosphate ceramics as bone graft substitutes in filling bone tumor defects

Background:

Synthetic bio-inert materials are currently used as an alternative to autogenous bone graft. Calcium hydroxyapatite (HA) and Beta tri-calcium phosphate (β-TCP), which belong to the calcium phosphate ceramics group, are biocompatible and osteo-conductive. The purpose of this study is to analyse the use of HA and β-TCP in their ceramic forms as a bone graft substitute in filling bone voids after curettage of benign bone tumors.

Materials and Methods:

Twenty-four patients in the age range of 3.5-55 years (mean 14.3 years) having benign bone tumors with bone defects were filled with bone graft substitute following curettage. In 20 patients bone defects were filled with block/granules of HA ceramic and in four with β-TCP. Fibular strut graft was packed with HA in four patients. The patients were followed up for an average of 18 months (range 12-36 months).

Results:

The functional status of the patients at follow-up was evaluated and compared with preoperative functional status. Early incorporation of graft substitutes became evident radiologically between 6 and 10 weeks (Stage I). Complete incorporation (Stage III) was observed in an average of nine months (6-18 months). Clinical healing was observed before radiological healing. The average time taken to return to preoperative function was 14 weeks. There was no recurrence of lesion or growth retardation.

Conclusion:

Calcium hydroxyapatite and β-TCP are excellent bone graft substitutes for autogenous bone graft in filling voids after curettage of benign bone tumors.     

后颅窝减压加枕颈植骨融合内固定术治疗寰枕畸形

目的探讨后颅窝减压加枕颈植骨融合内固定术治疗寰枕畸形的可行性及疗效。方法12例寰枕畸形患者行后颅窝减压加枕颈植骨融合内固定术。结果术后症状明显改善。均获随访,平均18（6-36）个月。按Symon和Lavender标准,治愈4,好转7例,无效1例;总有效率91.7%。结论寰枕畸形的治疗中手术减压和稳定性重建应该并重。     

Chronic triceps insufficiency managed with extensor carpi radialis longus and palmaris longus tendon grafts

Chronic triceps insufficiency, causing prolonged disability, occurs due to a missed diagnosis of an acute rupture. We report a 25 year old male with history of a significant fall sustaining multiple injuries. Since then, he had inability in extending his right elbow for which he sought intervention after a year. Diagnosis of triceps rupture was made clinicoradiologically and surgery was planned. Intraoperative findings revealed a deficient triceps with a fleck of avulsed bone from olecranon. Ipsilateral double tendon graft including extensor carpi radialis longus and palmaris longus were anchored to triceps and secured with the olecranon. Six-months follow revealed a complete active extension of elbow and a full function at the donor site.     

带蒂骨瓣移位术治疗距骨缺血性坏死

为探讨治疗距骨缺血性坏死的有效方法，采用带蒂骨瓣移位术治疗距骨缺血性坏死２４例，９例采用内踝前动脉蒂第１楔骨瓣，４例采用跗内侧动脉蒂第１楔骨瓣，１１例采用跗外侧动脉蒂骰骨瓣。术后随访３年～５年６个月，优１６例，良４例，差４例，有效率为８３．３％。认为，带蒂骨瓣移位术是治疗距骨缺血性坏死的有效方法     

CaP cement is equivalent to iliac bone graft in filling of large metaphyseal defects: 2 year prospective randomised study on distal radius osteotomies

The purpose of this prospective randomised study was to compare the clinical and radiological outcomes of injectable CaP bone cement with corticocancellous bone graft used to fill voids after corrective opening wedge osteotomies in the distal radius. 17 women/3 men, median age 56 (51.3; 61.0), underwent an open-wedge osteotomy of a dorsal malunion in the distal radius randomised to filling the defect either with bone graft (10) or CaP bone cement (10). Dorsal titanium locking plates were used and the wrist was plastered for 8 weeks. Follow-ups for 24 months included X-rays, CT scans, VAS on wrist and iliac crest, grip strength, ROM, Quick-DASH and Gartland & Werley scores. No difference was found between the 2 groups as to clinical outcome or radiological results with no loss of reduction. One bone graft patient developed a pseudarthrosis and one CaP patient suffered a plate fracture 6 months post-operatively. CaP bone cement is a good alternative to bone graft as a void filler in open-wedge osteotomies of the distal radius. The procedure is shorter, easier with the post-operative advantage of no donor site pain.Level of Evidence Randomised controlled trial. Level I evidence.     

不同植骨融合方式对胸腰椎爆裂性骨折疗效的影响

目的评价不同植骨融合方式治疗胸腰椎爆裂性骨折的临床疗效,探讨最佳的植骨融合方式。方法 2000年6月-2009年6月,采用一期后路短节段内固定植骨融合治疗126例胸腰椎爆裂性骨折患者。均为急性脊柱脊髓损伤,损伤节段T11～L2;均合并不同程度脊髓神经功能损伤,Frankel分级在D级以下。将患者随机分成A、B、C 3组,分别辅以椎体加椎间植骨(A组)、后外侧植骨(B组)及360°环形植骨(C组)3种植骨融合方式进行治疗,观察各组患者术后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率、Oswestry功能障碍指数(ODI)及Frankel分级情况等的变化,评价不同植骨融合方式的疗效。结果 126例患者均获随访,随访时间24～32个月,平均28个月。C组手术时间和术中出血量均多于A、B组(P<0.05),A、B组间差异无统计学意义(P>0.05)。术后2年及末次随访时B组Cobb角及矫正丢失度均显著大于A、C组,比较差异有统计学意义(P<0.05),A、C组间差异无统计学意义(P>0.05)。末次随访时A组骨性融合率及内固定失效率分别为100%、0,B组分别为78.6%、21.4%,C组分别为97.5%、0,B组与A、C组比较差异均有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。术后各组ODI及Frankel分级均较术前有明显改善(P<0.05),末次随访时B组与A、C组比较差异有统计学意义(P<0.05),A、C组间比较差异无统计学意义(P>0.05)。结论椎体加椎间植骨融合符合人体生物力学特点,能获得最佳的节段性骨性融合,是一种较优的骨性融合方式;后外侧植骨不符合人体生物力学特点,内固定失效率高,不是一种适宜的植骨融合方式;360°环形植骨并未表现出最佳的骨性融合率,而且性价比低,可能并不是一种必需的植骨融合方式。     

Natural Course of Local Bone Mineralization After Treatment of Benign or Borderline Bone Tumors and Cysts With a Composite Ceramic Bone Graft Substitute

After surgical bone tumor removal, filling of the bone defect is frequently performed using a bone graft or bone graft substitute. During follow-up, precise quantification of changes in bone mineral density, within the treated bone defect, is very difficult using conventional X-ray examinations. The objectives of this study were to characterize the pattern of resorption/biodegradation of a composite calcium sulfate/hydroxyapatite bone graft substitute and to quantify the bone defect healing with repeated dual-energy X-ray absorptiometry (DXA) measurements. Seventeen patients treated for 18 benign bone lesions, with subsequent defect filling using 2 variants of a composite ceramic bone graft substitute (CERAMENT?|BONE VOID FILLER or CERMAMENT?|G, BONESUPPORT AB, Lund, Sweden), were scanned postoperatively and after 2, 6, 12, 26, and 52?wk using DXA. After an initial increase in bone mineral density after implantation of the bone graft substitute, bone mineral density decreased in the bone defect region throughout the 52?wk: rapidly in the first 12?wk and slower in the remaining weeks. Despite this continuous decrease, bone mineral density remained, on average, 25% higher in the operated extremity, compared with the nonoperated extremity, after 52 wk. The observed pattern of reduction in bone mineral density is consistent with the anticipated resorption of calcium sulfate within the bone graft substitute during the first 12?wk after surgery. We believe the DXA technique provides a precise method for quantification of bone graft resorption, but for evaluation of new bone formation, 3-dimensional imaging is needed.     

自体颅骨移植在眶底重建中的应用

目的 评价自体颅骨移植在治疗面部外伤致眶底缺损中的作用。方法 对34例面部创伤眶底爆裂骨折（以下简称眶底骨折）有骨质缺损者,采用冠状切口取自休遭受,结膜切口加外眦切开入路进行骨移植修复缺损。结果 所有病例术后创口愈合良好,无感染。供骨区无并发症发生。1例术后3个月内有轻微下睑外翻,通过自行按摩半年后已不明显,8例术前有眶下区麻木者,术后1-6个月全部恢复,4例有复视者术后消失,通过半年至5年（平衡11个月）的随诊,移植骨成活良好,供受骨区切口瘢痕不明显,均取得了满意的临床疗效。结论 自体颅骨移植并发症少,对眶底的重建有许多优点。是眶底重建的理想移植材料。     

自锁式梭形植骨块在颈椎前路减压术中的临床应用

目的　报告采用自锁式梭形植骨块在颈椎前路减压术中的效果固定。方法　对 36例脊髓型颈椎病及颈间盘突出症实施彻底前路减压后 ,将减压骨窗两端椎体凿出圆台形小槽 ,然后将梭形自体髂骨骨块上端先放入上端小糟内 ,牵引头部。下端加力夯入下端小凹窝内。术后用颈椎围领固定。结果　随访 0 8～ 10年 ,平均 5 3年 ,均无移植骨块移位、脱出。术后 3个月复查X线片 ,见植骨块无移位、脱出。术后 3个月复查植骨块完全融合。结论　梭形植骨块植入后 ,具有稳定性强、抗屈伸、抗旋转和剪力应力。由于牢固稳定 ,使植骨块愈合快 ,同时术中术后避免骨块移动压迫脊髓等合并症的发生     

颈椎复合骨块融合的生物力学基础与疗效观察

目的 探讨颈椎前路复合骨植骨块融合的生物力学基础,为临床手术提供合理论依据。方法 利用6具颈椎新鲜标本,采用复合骨块与常规髂骨块制成颈前路减压植骨融合标本,以实验应力分析手段观察和评定颈椎的三维稳定性及术后颈椎强度等生物力学指标的变化。并对临床运用复合骨块行颈椎植骨融合21例进行回故并与常规植骨融合病例对照。结果 复合骨块融合组的生物力学性能均优于常规髂骨融合组。（P＜0．01）。结论 颈椎前路复合骨块融合方便、稳定。是目前较好的植骨融合方法之一。     

后路椎体间微粒骨打压植骨融合

目的探讨后路椎体间微粒骨打压植骨的手术技术和临床可行性。方法对28例60岁以上腰椎退变性疾病患者、2例L1骨折脱位患者和1例T12硬脊膜瘤患者行后路椎体间微粒骨打压植骨融合。观察手术前后症状、体征、X线片腰椎前凸角、椎间隙高度指数的变化,以及手术后CT检查椎体间植骨面积。结果随访6~26个月。术前症状及体征均缓解,腰椎前凸角、椎间隙高度指数均有明显恢复,脊柱融合率达96.1%。未发生植入骨的吸收、移位和沉陷。主要有手术中硬脊膜撕裂、神经根牵拉以及手术出血等并发症。结论后路椎体间微粒骨打压植骨融合是一种可行的椎体间融合方法。