自体骨移植与骨替代物手术治疗胫骨平台骨折的Meta分析

目的：通过Meta分析系统评价自体骨移植和骨替代物治疗胫骨平台骨折的临床疗效。方法：计算机检索2005年1月至2022年8月PubMed、Web of Science、中国知网、万方等数据库已发表的关于自体骨移植和骨替代物治疗胫骨平台骨折的病例对照研究文献。根据纳排标准进行文献筛选及数据提取,对入选的随机对照研究（randomized controlled trial,RCT）采用Cochrane手册中的干预性Meta分析标准进行质量评价。采用RevMan 5.3软件对两种方法的关节凹陷、关节面二次塌陷率、失血量、手术时间和感染率进行Meta分析。结果：共纳入7项RCT研究,424例患者,其中骨替代物组296例,自体骨移植组128例。两组手术时间[MD=-16.79,95%CI(-25.72,-7.85),P=0.000 2],出血量[MD=-70.49,95%CI(-79.34,-61.65),P<0.000 01]比较,差异有统计学意义。而关节凹陷[MD=-0.17,95%CI(-0.91,0.58),P=0.66],关节面二次塌陷率[RR=-0.74,95%CI(0.35,...     

Impact of osteoporosis in dental implants: A systematic review

AIM: To assess the failure and bone-to-implant contact rate of dental implants placed on osteoporotic subjects.METHODS: Extensive examination strategies were created to classify studies for this systematic review. MEDLINE (via PubMed) and EMBASE database were examined for studies in English up to and including May 2014. The examination presented a combination of the MeSH words described as follow: “osteoporosis” or “osteopenia” or “estrogen deficiency” AND “implant” or “dental implant” or “osseointegration”. Assessment of clinical and/or histological peri-implant conditions in osteoporosis subjects treated with titanium dental implants. The examination included a combination of the MeSH terms described as follow: “osteoporosis” or “osteopenia” or “estrogen deficiency” AND “implant” or “dental implant” or “osseointegration”.RESULTS: Of 943 potentially eligible articles, 12 were included in the study. A total of 133 subjects with osteoporosis, 73 subjects diagnosed with osteopenia and 708 healthy subjects were assessed in this systematic review. In these subjects were installed 367, 205, 2981 dental implants in osteoporotic, osteopenic and healthy subjects, respectively. The failure rate of dental implant was 10.9% in osteoporotic subjects, 8.29% in osteopenic and 11.43% in healthy ones. Bone-to-implant contact obtained from retrieved implants ranged between 49.96% to 47.84%, for osteoporosis and non-osteoporotic subjects.CONCLUSION: Osteoporotic subjects presented higher rates of implant loss, however, there is a lower evidence to strengthen or refute the hypothesis that osteoporosis may have detrimental effects on bone healing. Consequently, final conclusions regarding the effect of osteoporosis in dental implant therapy cannot be made at this time. There are no randomized clinical trial accessible for evaluation and the retrospective nature of the evaluated studies shall be taken in account when interpreting this study.     

Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants

Introduction In view of the increase in the life expectancy of humans and in edentulism of the population above 50 years of age, in which the prevalence of osteoporosis is also higher, it is fundamental to better understand the effects of systemic bone mass loss on the healing process of dental implants and to determine the quality of the bone that surrounds them. The objective of the present study was to compare systemic osteoporosis (axial and femoral) and parameters of mandibular bone quality, and to evaluate osseointegration in postmenopausal women receiving dental implants. Methods The sample consisted of 39 women aged 48–70 years, 19 with a densitometric diagnosis of osteoporosis in the lumbar spine and femoral neck and 20 controls with a normal densitometric diagnosis. Bone mineral density was measured in the patients and controls by dual-energy X-ray absorptiometry. Eighty-two osseointegrated dental implants were placed in the mandible, 39 of them in the osteoporosis group and 43 in the control group. Mandibular bone quality was evaluated by classifying mandibular inferior cortical and trabecular bone on panoramic radiographs and by histomorphometric analysis of a mandibular bone biopsy. Osseointegration was analyzed after 9 months. Results No significant difference was observed between patients with osteoporosis and controls when comparing individuals with a normal cortex and those with a severely or moderately eroded cortex determined on panoramic radiographs. Histomorphometric analysis also revealed no difference in the parameters of bone formation or resorption between the two groups. Implant failure was observed in only one case. Conclusion We conclude that there is no association between systemic osteoporosis (axial and femur) and parameters of poor mandibular bone quality. The loss of one implant (1.2%) is compatible with the literature and cannot be attributed to systemic osteoporosis. An erratum to this article can be found at     

Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants

INTRODUCTION: In view of the increase in the life expectancy of humans and in edentulism of the population above 50 years of age, in which the prevalence of osteoporosis is also higher, it is fundamental to better understand the effects of systemic bone mass loss on the healing process of dental implants and to determine the quality of the bone that surrounds them. The objective of the present study was to compare systemic osteoporosis (axial and femoral) and parameters of mandibular bone quality, and to evaluate osseointegration in postmenopausal women receiving dental implants. METHODS: The sample consisted of 39 women aged 48-70 years, 19 with a densitometric diagnosis of osteoporosis in the lumbar spine and femoral neck and 20 controls with a normal densitometric diagnosis. Bone mineral density was measured in the patients and controls by dual-energy X-ray absorptiometry. Eighty-two osseointegrated dental implants were placed in the mandible, 39 of them in the osteoporosis group and 43 in the control group. Mandibular bone quality was evaluated by classifying mandibular inferior cortical and trabecular bone on panoramic radiographs and by histomorphometric analysis of a mandibular bone biopsy. Osseointegration was analyzed after 9 months. RESULTS: No significant difference was observed between patients with osteoporosis and controls when comparing individuals with a normal cortex and those with a severely or moderately eroded cortex determined on panoramic radiographs, although patients with MEC/SEC had lower femoral neck BMD than those with NC (0.688 +/- 0.17 vs. 0.814+/- 0.144 g/cm2, P<0.012). Histomorphometric analysis also revealed no difference in the parameters of bone formation or resorption between the two groups. Implant failure was observed in only one case. CONCLUSION: We conclude that there is an association between low femoral neck BMD and poor mandibular bone quality as assessed by panoramic radiography. The loss of one implant (1.2%) is compatible with the literature and cannot be attributed to systemic osteoporosis.     

关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤临床疗效分析

目的 探讨关节镜下双袢固定自体髂骨修复合并严重骨缺损的Bankart损伤患者肩关节临床功能改善及肩胛盂骨缺损修复情况.方法 回顾性分析2015年7月至2018年7月在南方医科大学第三附属医院运动医学科采用关节镜下双袢固定自体髂骨植骨术治疗的17例合并严重骨缺损的Bankart损伤患者.在术前和术后使用美国肩肘外科协会(...     

Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

Background The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature.Methods Seventy-nine consecutive patients were operated on using the Smith–Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years.Results The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one- and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and non-smokers in the rate or course of fusion as previously reported.     

Comparison of sartorius muscle-pedicle and circumflex iliac deep bone flap grafts in the treatment of early non-traumatic osteonecrosis of femoral head in young adults

ObjectiveThe aim of this study was to retrospectively compare and evaluate the midterm curative effect of two different bone flap grafts in the treatment of early non-traumatic osteonecrosis of the femoral head (ONFH).MethodsA total of 180 patients (199 hips) with early non-traumatic ONFH received surgical treatment by sartorius muscle-pedicle bone flap graft (SMBF) (104 patients, 64 males and 40 females; mean age 34.67 ± 3.24 years) or circumflex iliac deep bone flap graft (CIDBF) (76 patients, 44 males and 32 females; mean age: 35.54 ± 3.37 years) from July 2004 to July 2009. The comparison between the groups was made with Harris score before and after surgery, length of incision, operative time, amount of bleeding, postoperative X-ray. Association Research Circulation Osseous (ARCO) staging was performed.ResultsThe preoperative Harris hip score of two groups were 68.26 ± 1.26 and 69.35 ± 1.31, respectively. Patients' ARCO staging indicated 36 hips of stage IIa, 115 hips of stage IIb and 48 hips of stage IIc. The etiology of ONFH mainly including hormones (93 patients), alcohol (64 patients) and other (23 patients). The mean follow-up time of SMBF and CIDBF groups were (51.78 ± 2.35) and (52.73 ± 3.71) months, respectively. The time of removing sutures, operation time, amount of bleeding and length of incision in SMBF group were superior to those in the CIDBF group, and those differences between the SMBF and CIDBF groups were not significant (all p values > 0.28). The Harris score between the two groups was similar after operation and postoperative 12 month, and the difference was not statistically significant (p > 0.05), whereas the difference of the postoperative 24 and 48 months was statistically significant (p ˂ 0.05). X-ray analysis showed improvement of osteonecrosis in both two groups after surgery, and as time went on, the total hip amount decreased, the replacement amount increased.ConclusionBoth bone flap grafts appear to be effective methods for treatment of early osteonecrosis of femoral head (ARCOⅡ), and the SMBF is a relatively simple technique and easy for mastering, and it is a reliable method for clinical application.Level of evidenceLevel III, Therapeutic Study.     

切除家兔性腺对骨代谢的影响

本文选用家兔为实验模型，切除性腺后分成两组，即卵巢切除组１２只，睾丸切除组１２只，通过对钙、磷、碱性磷酸酶、尿羟脯氨酸及骨计量学、骨矿物质测定，分别观察术后４周、７周及１０周对骨质的影响。结果表明，卵巢切除后家兔骨质丢失明显增加，各指标与睾丸切除组比较有明显差异，说明卵巢功能障碍可导致骨质疏松，而睾丸功能障碍对骨质影响较小。     

髂骨移植合并张力带固定治疗粉碎性尺骨鹰嘴骨折

2001年3月～2010年5月,我院采用髂骨移植合并张力带固定治疗10例严重粉碎性尺骨鹰嘴骨折患者,取得良好效果。1材料与方法1.1病例资料本组10例,均为男性,年龄21～48岁。2例为闭合骨折,8例     

同种异体骨与自体骨在颈椎结核植骨融合中的应用比较

目的通过与自体骨比较,评价同种异体骨在颈椎结核前路椎间植骨融合中的疗效。方法 2000年1月-2008年1月,对30例下颈椎结核行前路彻底清除病灶、植骨及内固定术,根据植骨材料不同,分为同种异体冷冻干燥骨组(A组)和自体髂骨组(B组)。A组15例,男8例,女7例;平均年龄38岁。病程6～14个月。术前后凸Cobb角(8.6±11.3)°,神经功能按日本骨科协会(JOA)评分为(13.0±3.1)分;术中植骨长度平均32 mm。B组15例,男9例,女6例;平均年龄42岁。病程4～17个月。术前后凸Cobb角(4.9±7.4)°,JOA评分为(12.3±4.2)分;术中植骨长度平均34 mm。两组患者一般资料比较差异均无统计学意义(P>0.05),有可比性。结果 A组手术时间及术中出血量均少于B组,比较差异有统计学意义(P<0.05)。A组术后2例切口渗液,其余患者切口均Ⅰ期愈合;B组无感染发生,切口均Ⅰ期愈合。A组13例获随访,随访时间12～48个月;B组14例获随访,随访时间13～46个月。A组植骨融合时间为(7.6±2.1)个月,与B组(4.2±1.1)个月比较差异有统计学意义(t=2.773,P=0.005)。两组术后6个月及末次随访时后凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05);术后各时间点两组间后凸Cobb角比较差异均无统计学意义(P>0.05)。术后6个月两组JOA评分分别为(14.1±2.6)分和(14.3±2.4)分,比较差异无统计学意义(t=1.655,P=0.162)。A、B组术后有效改善率分别为83.7%和87.8%,差异无统计学意义(χ2=3.150,P=0.071)。两组内固定物均牢靠无松动,随访期间均无结核复发。B组5例出现髂骨取骨区疼痛。植骨融合采用Bridwell等的标准评价,A组满意11例(84.6%),不满意2例(15.4%);B组满意14例(100%);A、B组植骨融合满意率比较差异无统计学意义(χ2=2.680,P=0.115)。结论与自体骨相比,同种异体骨在颈椎结核前路植骨融合中疗效满意,可有效修复颈椎结核病灶清除术后的骨缺损。     

腰椎滑脱症后路自体、同种异体混合骨泥植骨效果分析

[目的]选用自体、同种异体冻干骨泥混合,作为腰椎滑脱症(lumbar spondylolisthesis,LS)椎体间植骨材料。并进行随访,以探讨其骨性融合效果。[方法]随机选取LS病例86例,全部病例按照植骨材料的不同分为自体骨泥组、混合骨泥组。采用腰椎后路椎体间植骨融合术(posterior lumbar interbody fusion,PLIF)。随访时间2年2个月~4年3个月,平均2年5个月。在术前、术后第3个月复查时统计患者VAS评分、Oswestry功能障碍指数(ODI,下同),同时参照JOA腰椎部分评分标准行JOA评分。同时在术后第3、12、24个月复查腰椎X线片、腰椎CT,参考Suk法进行椎体融合评价。[结果]自体骨泥组和混合骨泥组的手术时间和术中出血量没有显著差异。JOA评分示自体骨泥组的优良率达96.77%(30/31例),混合骨泥组优良率达93.02%(40/43例)。术后3个月腰椎X线片示腰椎滑脱解剖复位率为83.78%(62/74例)。83.87%(26/29例)的自体骨泥组患者和79.07%(34/43例)的混合骨泥组患者在12个月内达到骨性愈合标准。两组骨性融合效果没有显著差异。[结论]腰椎滑脱症后路自体、同种异体混合骨泥植骨可以达到较高的融合效果,临床应用效果肯定。     

Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

Background:Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals.Results:The mean followup is 12.5 years (range 3-35). The union of fractures occurred in 202 (82.8%), delayed union in 18 (7.3%), and established nonunion in 24 (9.8%) patients. Full weight bearing was permitted at 16–22 weeks after union of fractures. Mean Harris hip score at the longest followup was 85.5. Among the complications, superficial wound infection occurred in 20 (8.2%), deep infection in seven (2.9%), and coxa vara in 39 (16%) patients. Preoperative radiodensity of femoral head disappeared mostly after the union of fracture whereas fresh radiodensity of femoral head appeared in 20 (8%) patients; nine (45%) of them developed segmental collapse.Conclusion:Ununited femoral neck fractureis characterized by absorption of femoral neck, posterior cortical defect, smoothening and overriding of fracture surfaces with intervening fibrous tissues associated with or without AVN of femoral head. The above method of osteosynthesis rectified the above pathology and provided satisfactory results with union of fractures in 90.1% patients at long term followup.     

阿魏酸治疗对去卵巢雌性大鼠骨量流失的保护作用机制研究

目的 研究阿魏酸(ferulic acid)对去卵巢大鼠骨量流失的影响,并探讨可能的机制.方法 通过双侧去卵巢建立骨质疏松大鼠模型;随后随机分为假手术组(Sham)、去卵巢组(OVX)以及阿魏酸组,每组10只;其中阿魏酸组大鼠每天给予阿魏酸(20 mg/kg)灌胃治疗;待12周治疗结束后使用Micro-CT、HE染色切...     

Use of vascularized pedicle iliac bone graft in the treatment of avascular necrosis of the femoral head

A vascularized pedicle iliac bone graft was performed in patients with extensive necrosis in whom the necrotic area occupied more than two-thirds of the femoral head. The purpose of this procedure is to supply vascularity and mechanical strength to the avascular femoral head. Our series consisted of 18 hips. The patients’ age at surgery ranged from 21 to 55 years. Fourteen hips were identified as stage II and 4 hips as stage III. Iliac bone graft alone was performed in 4 stage II joints. Transtrochanteric anterior rotational osteotomy of the femoral head was done additionally in 10 stage II joints and 4 stage III joints. In the group who underwent iliac bone graft alone, the mean Japanese Orthopedic Association (JOA) score improved from 58.5 to 63.8 (mean follow-up 52 months). In the group who underwent combination procedure with osteotomy, the mean JOA score improved from 71.7 to 85.0 (mean follow-up 43 months). Stage progression was noted in 3 of 4 joints in the group who underwent iliac bone graft alone. In the group who underwent the combined procedure, stage progression was noted in 2 of 10 joints at more than 1 year after operation. A vascularized pedicle iliac bone graft to treat avascular necrosis of the femoral head is considered promising for joint preservation. Received: 19 October 2000     

微型钢板内固定联合自体髂骨植骨治疗陈旧性跖骨骨折

目的探讨微型钢板内固定联合自体髂骨植骨治疗陈旧性跖骨骨折的方法及疗效。方法 2009年5月-2010年7月,收治7例外伤致陈旧性跖骨骨折患者。男5例,女2例;年龄25～43岁,平均33岁。多发跖骨骨折5例,单发跖骨骨折2例。伤后至该次手术时间为4～12周。X线片检查示骨折断端间有少量骨痂,伴短缩、成角或旋转移位。术中切开复位后,采用微型钢板内固定联合自体髂骨植骨,植骨量1.5～2.5 cm3。术后石膏外固定4～6周,平均5周。结果术后患者切口均Ⅰ期愈合。7例均获随访,随访时间8～18个月,平均13.5个月。骨折临床愈合时间为6～12周,平均8.4周。患者站立及行走时无明显足底疼痛。术后3个月参照美国矫形足踝协会(AOFAS)中前足评分标准,评分为75～96分,平均86.4分。结论微型钢板内固定联合自体髂骨植骨治疗陈旧性跖骨骨折内固定可靠、骨折愈合率高、术后并发症少,是一种有效的治疗方法。     

Experimental study of vascularized bone grafts in rat: Effect of mechanical loading on bone dynamics

We studied the etiology of postoperative hypertrophy of vascularized bone grafts in a murine experimental model. Syngeneic grafting of revascularized ulna to rat tibia was performed with (group 1) or without (group 2) mechanical loading. The effect of simple overloading on intact bone was studied by segmental resection of the radius (group 3). Bone dynamics were examined by histomorphological measurements. Significant hypertrophy was observed in the early postoperative period in both groups 1 and group 2. After the initial phase, bone growth continued and extensive remodeling was observed in group 1, while marked bone resorption was observed in group 2. Adaptive remodeling was also observed in group 3 after surgery, but was slower than that in groups 1 and 2. Early hypertrophy of vascularized grafts did not correspond to mechanical loading. These results suggest that mechanical loading is the principal factor responsible for remodeling in vascularized bone grafts for their adaptation to a new environment.     

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。     

改良髂骨骨皮瓣游离移植治疗掌背复合组织缺损

目的总结游离改良的以旋髂浅动脉为蒂的髂骨骨皮瓣重建掌背骨与软组织缺损体会。方法2009年3月-2012年3月,应用骨皮瓣修复掌背复合组织缺损7例,平均年龄42．9岁。伤肢均为右手．合并不同程度伸肌腱损伤2例：合并腕骨骨折、脱位2例;掌指关节损伤3例;指骨骨折3例。受伤至再手术时间平均为18．6d。术后7d开始功能练习。定期复查,了解植骨愈合、关节活动度、握力大小、皮瓣感觉恢复及供区副损伤,完成患肢手臂肩残疾问卷表及供区可视疼痛评估表。结果本组皮瓣全部成活．5例甲级愈合,2例乙级愈合。平均骨愈合时间：植骨远端2．3个月,近端2．7个月。随访12～24个月,腕关节平均掌屈38．6°,背伸42．9°,尺偏21．4°,桡偏22．9°。受累掌指关节平均活动度35．7°。患侧平均握力13．9kg。3例皮瓣平均静态两点辨别觉13．7mm,余皮瓣仅恢复深触觉。平均手臂肩残疾问卷评分12．1分。所有患者术后2周可行走,术后3个月轻微疼痛1例,术后1年供区瘢痕平软,无疼痛。结论游离改良的以旋髂浅动脉为蒂的髂骨骨皮瓣可成功治疗掌背部骨与软组织缺损,供区损伤较小。     

Efficacy comparison of Accell Evo3 and Grafton demineralized bone matrix putties against autologous bone in a rat posterolateral spine fusion model

Background Context

Spinal fusion procedures are intended to stabilize the spinal column for a multitude of disorders including abnormal curvature, traumatic instability, degenerative instability, and damage from infections or tumors. As an aid in the bone healing response, bone graft materials are used to bridge joints for arthrodesis and promote unions in pseudoarthrosis. Currently, the gold standard for stabilizing fusion masses in spinal procedures involves using the osteogenic, osteoinductive, and osteoconductive properties of autologous iliac crest corticocancellous bone. However, considerable morbidity is associated with harvesting the autologous graft. Donor site complications including infection, large hematomas, and pain have been reported at rates as high as 50% (Boden and Jeffrey, 1995). Biologically, the rate of bone repair dictates the rate at which the fusion mass will unite under autologous graft conditions.

Use of an autologous cortical bone graft sandwiched between two intervertebral spacers in posterior lumbar interbody fusion

Various intervertebral spacers with or without posterior instrumentation use pedicle screw fixation in posterior lumbar interbody fusion (PLIF). Recently we harvested an autologous cortical bone graft from a spinous process by en bloc resection and inserted it between two intervertebral spacers during PLIF surgery. Due to better balance, this procedure provides greater mechanical strength, larger contact area, and better bilateral restoration of disc height than PLIF using intervertebral spacers only, and there is no need to take a bone graft from the iliac crest. This technique appears to result in effective spinal fusion in PLIF surgery. Received: 19 September 2000 / Accepted: 15 November 2000