Some basic factors essential to autogeneic nonvascularized onlay bone grafting to the craniofacial skeleton.

The aim of this review is to provide a background on the experiences gained experimentally with autogeneic nonvascularized onlay bone transplantation, survey the most essential information in the medical literature, and to present modern trends and future expectations in bone graft science.     

Biology of cancellous bone grafts

Despite 30 years of experimental bone grafting research, the fresh cancellous bone graft remains the most osteogenic and reliable bone grafting material. Recent experimental data suggest that modification of the graft-host interaction by antigen matching or immune manipulation may allow increasingly successful use of allografts.     

The use of bone grafts in the upper craniomaxillofacial skeleton

While a plethora of new biologic and alloplastic materials are available for reconstruction of defects in the upper craniomaxillofacial skeleton, the role of free non-vascularized bone grafts remains an important one. In this review, this role will be defined in detail using case presentations to demonstrate a variety of ways in which such bone grafts may be helpful in reconstructing various facial skeletal defects.     

The fate of onlay membranous bone grafts in different facial recipient sites

Summary The fate of onlay bone grafts was studied in the growing rabbit facial skeleton with regard to the depository and resorptive characteristics of bone surfaces. The nasal snout was chosen as the depository field and the vestibular surface of the mandibular ramus as the resorptive field. The membranous bone graft applied on a depository surface maintained its volume and morphology significantly better than the graft placed on a resorptive field. There was no evident difference between the fate of full-thickness and split-thickness membranous bone grafts in the different facial recipient beds. The authors suggest that the reconstructive procedures to improve the facial skeleton contour in growing children should be planned keeping in mind the depository or resorptive characteristics of the facial recipient site.     

The fate of onlay membranous bone grafts in different facial recipient sites

The fate of onlay bone grafts was studied in the growing rabbit facial skeleton with regard to the depository and resorptive characteristics of bone surfaces. The nasal snout was chosen as the depository field and the vestibular surface of the mandibular ramus as the resorptive field. The membranous bone graft applied on a depository surface maintained its volume and morphology significantly better than the graft placed on a resorptive field. There was no evident difference between the fate of full-thickness and split-thickness membranous bone grafts in the different facial recipient beds. The authors suggest that the reconstructive procedures to improve the facial skeleton contour in growing children should be planned keeping in mind the depository or resorptive characteristics of the facial recipient site.     

Vascularized skull bone grafts in craniofacial surgery

Vascularized skull bone grafts based on a pedicle of temporalis muscle have been used in 30 zygomatic arch and malar reconstructions, 1 mandible reconstruction, and 1 palate reconstruction. The surgical technique, complications, and postoperative results are reviewed. Technetium bone scans obtained within one week of operation confirm blood supply to the transferred bone. After a mean follow-up of 13 months, there is no evidence of bone graft resorption. We have used a team approach and careful surgical technique, and no serious complications have been encountered.     

Sclerosing bone dysplasias with involvement of the craniofacial skeleton

In this review we provide a complete overview of the existing sclerosing bone dysplasias with craniofacial involvement. Clinical presentation, disease course, the craniofacial symptoms, genetic transmission pattern and pathophysiology are discussed. There is an emphasis on radiologic features with a large collection of CT and MRI images. In previous reviews the craniofacial area of the sclerosing bone dysplasias was underexposed. However, craniofacial symptoms are often the first symptoms to address a physician. The embryology of the skull and skull base is explained and illustrated for a better understanding of the affected areas.     

Update on cranial bone grafts in craniofacial surgery

A large series of cranial bone grafts performed during a 6-year period is presented. The types of grafts are discussed and the techniques of taking the grafts are described. The complications have been few. Full-thickness skull penetration occasionally occurs but should not be a cause for concern. The skull has gradually become our main bone graft donor site.     

Metallic plate stabilisation of bone grafts in craniofacial surgery

The use of Champy miniplates to stabilise bone grafts in osseous defects following craniofacial and orbital osteotomies is discussed. The advantages of these methods are decrease in operating time, accurate fit of the bone graft and the fixation of the bone graft in the plane of the plate, thus placing it exactly into the correct position in relation to the osteotomy. Total stability is obtained and, in maxillary advancement, intermaxillary fixation may not be necessary. This is useful in children and at all ages adds to the postoperative safety. There may be less relapse with this rigid internal fixation. Long term follow-up will be required to determine whether this statement is true. Although the plates are expensive, it is felt that the reduction in operating time outweighs this.     

The role of free periosteal grafts in improving the survival of autogenous onlay bone grafts to the facial bones in rabbits

Summary Comparison is made between the survival of two groups of autogenous onlay bone grafts with periosteum taken from the ilium and applied to the nasal bones, in rabbits. In one group the periosteum on the graft surface was left undisturbed, while in the other an overlay of free periosteum was applied to the de-periostealised bone graft at the recipient site.Using serial radiographic recording of the bone grafts for periods up to one year, together with terminal histological examination, it was found that the overlay group survived better at all stages. This is attributed to increased rapidity of vascularisation and osteogenic activity in the periosteal osteoblasts in those grafts having a superimposed free graft of periosteum, with increased production of periosteal new bone more rapidly replacing the underlying bone of the graft.It is suggested that clinical application of these findings might allow accurate contour sculpturing of onlay bone grafts, while in no way impairing graft survival.Presented to the Swiss Association of Plastic and Reconstructive Surgery, on 3rd October, 1975 at Murten, Switzerland     

经股骨头开瓣植骨术治疗股骨头缺血性坏死

目的：观察和分析经股骨头开瓣植骨术治疗股骨头缺血性坏死的疗效。方法：对8例成人非创伤性股骨头坏死进行Ficat分期Ⅱ-Ⅲ，其中Ⅱa期2例，Ⅱb期4例，Ⅲ期2例，均采用经股骨头负重区开瓣死骨清除，取髂骨植骨术进行治疗，结果：平均随访32个月，根据Harris临床评分，Ⅱ b期前6例效果优良，结果：经股骨头开瓣植骨术对于Ficat分期Ⅱb期以前软骨面较完好的病人效果优良。     

Greatly increased cancellous bone formation with rapid improvements in bone structure in the rat maternal skeleton after lactation.

There is a decrease in cancellous bone mass and strength during lactation but these are partially or completely reconstituted in the postlactational period. The purpose of this study was to determine changes in cancellous bone structure and formation after lactation in established breeder rats. For this, rats were taken at the end of the second pregnancy (Preg-2) and second lactation (Lac-2) and 2, 4, and 6 weeks after weaning. Nulliparous (NP) groups were included for comparisons. Bone structure was measured using morphometric methods and bone dynamics by histomorphometry. Tibial metaphyseal cancellous bone was lost during the first reproductive cycle, as expected, and again depleted during the Lac-2. Bone formation indices were elevated at the end of Lac-2, compared with those at the end of the second pregnancy or in the nulliparous animals. Within 2 weeks after the second weaning, the amount of double-labeled surface (dLS) increased approximately 800%, the mineralizing surface (MS) increased >400% with similar increases in bone formation rates (BFRs), compared with already elevated bone formation measured at the end of Lac-2. From 2 to 4 weeks after lactation, there were commensurate increases in cancellous bone mass and structural indices with essentially complete restoration of cancellous bone volume and structure compared with that measured at the end of Preg-2. The results show rapid and substantial increases in bone formation with reconstitution of cancellous bone mass and structure after lactation in rats. The skeletal changes that occur during the postlactational period may serve to prepare and protect the maternal skeleton for subsequent reproductive cycles.     

膜状成骨与软骨成骨贴附移植后的组织学观察及骨计量学分析

目的深入探讨骨贴附移植后的变化及不同胚胎来源骨质（膜状成骨和软骨成骨）移植后的差异。方法应用新西兰兔、恒河猴采用荧光素双标记法,在不脱钙骨切片上,选用类骨质宽度、骨质矿化沉积率、荧光标记率等骨动力学指标对骨移植后的再生和改建进行计算机图像分析和定量测量。结果骨体积存留率：膜状成骨为（７８４±３５）％,软骨成骨为（５６±５１）％;骨矿化沉积率：膜状成骨为（３６０±０８）μｍ／ｄ,软骨成骨为（０９２±０３３）μｍ／ｄ;类骨质宽度;膜状成骨为（１４５６±２６９）μｍ,软骨成骨为（７３８±２２０）μｍ;荧光标记率：膜状成骨为（９１２２±２６９）％,软骨成骨为（５１２８±４１１）％。结论膜状成骨移植后较软骨成骨可保持更多的骨质体积,有更为明显的成骨再生能力且可诱导宿主骨成骨的能力不同,膜状成骨优于软骨成骨。     

膜状成骨与软骨成骨贴附移植后的组织学观察及骨计量学分析

目的深入探讨骨贴附移植后的变化及不同胚胎来源骨质(膜状成骨和软骨成骨)移植后的差异。方法应用新西兰兔、恒河猴采用荧光素双标记法,在不脱钙骨切片上,选用类骨质宽度、骨质矿化沉积率、荧光标记率等骨动力学指标对骨移植后的再生和改建进行计算机图像分析和定量测量。结果骨体积存留率:膜状成骨为(78.4±3.5)%,软骨成骨为(56±5.1)%;骨矿化沉积率:膜状成骨为(3.60±0.8)μm/d,软骨成骨为(0.92±0.33)μm/d;类骨质宽度;膜状成骨为(14.56±2.69)μm,软骨成骨为(7.38±2.20)μm;荧光标记率:膜状成骨为(91.22±2.69)%,软骨成骨为(51.28±4.11)%。结论膜状成骨移植后较软骨成骨可保持更多的骨质体积,有更为明显的成骨再生能力且可诱导宿主骨成骨的能力不同,膜状成骨优于软骨成骨。     

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。     

Absorption of onlay bone grafts in immature rabbits: membranous versus enchondral bone and bone struts versus paste

The absorption of onlay membranous and enchondral bone graft struts and paste was studied in immature New Zealand rabbits using a volume-displacement technique to determine the volume change in the grafts 8 weeks and 21 weeks after grafting. Membranous and enchondral bone paste does not survive as an onlay graft. Both enchondral and membranous bone graft struts undergo significant resorption (78% decreased volume in the enchondral grafts and 50% in the membranous bone grafts). These data support the clinical experience that both types of onlay bone grafts lose significant volume, and are in relative contradistinction to prior animal studies comparing membranous and enchondral onlay bone grafts.     

Bone lengthening in the craniofacial skeleton

The process of bone lengthening by cortical fracture and gradual distraction of callus has become well established in the enchondral bones of the extremities. In this study the principles of bone lengthening were applied to the membranous bone of the craniofacial skeleton using the growing dog mandible as a model. Six mongrel dogs five months of age were studied. A unilateral, periosteal-preserving angular corticotomy was performed, and an external minilengthening device was fixed to the mandible perpendicular to the corticotomy. After 10 days of external fixation, the mandible was lengthened 1 mm/day for 20 days and then held in external fixation for 56 days (8 weeks) after which all dogs were killed. Anthropometric measurements and histological analysis of the specimens confirmed that bone lengthening had occurred and that new cortical bone was formed in the expanded areas.