Sternal cancellous bone graft harvest for anterior cervical discectomy and fusion with interbody cage devices

Study design

Retrospective chart review, technical note, cohort study.

Objective

To describe the clinical outcome of a modified method of obtaining cancellous autograft from the manubrium of the sternum for use in interbody cages during anterior cervical fusions.

Summary of background data

Harvest of structural grafts from the anterior iliac crest (AIC) for anterior cervical fusion has well-established morbidities. In an effort to minimize morbidity and maximize fusion, we utilized interbody cages filled with autologous cancellous bone. In cases needing corpectomy, local bone graft from the corpectomy is used to fill the cage. In cases needing discectomy alone, no local bone is resected and therefore alternative donor sources must be used if autograft is to be used and the complications of AIC harvest are to be avoided. This technique is especially useful in countries where allograft is either not available or available in limited quantity.

Methods

We have developed a modified technique for the harvest of autologous cancellous graft from the sternum which can be used as a fusion substrate with cervical interbody cages. This technique incorporates either a small incision just above the sternal notch or subcutaneous tunneling from the discectomy incision and use of a bone graft harvester. We retrospectively analyze the clinical outcome and fusion rates.

Results

Using the described technique, one-hundred sternal graft harvests (n = 100) have resulted in three minor complications: one wound hematoma which resolved with observation, and two superficial wound infections which required treatment with oral antibiotics. All the patients were satisfied by the cosmetic appearance of the incision. Spinal fusion was achieved in all patients at the end of 12 months.

Conclusions

We describe a modified technique of harvesting the sternal graft and also for the first time describe the long-term clinical outcome of using sternal autograft for ACDF. The sternal manubrium provides a viable alternative to AIC grafting. It confers the advantages of autograft fusion without the complications associated with AIC graft harvesting.     

Mechanical testing and osteointegration of titanium implant with calcium phosphate bone cement and autograft alternatives

The purpose of this study was to evaluate the osteointegration of a titanium (Ti) implant with the calcium phosphate cement (CPC) and autograft prostheses by pull-out test and histological examination. Stems of sixty Ti cylinders were bilaterally inserted into femoral medullary canals in 30 rabbits at the 1st, 4th, 12th, 26th and 70th postoperative weeks. The bone autograft and CPC were filled into the pre-trimmed bone marrow cavity with a polymethyl methacrylate retarder in the distal end, and then a Ti cylinder was inserted into femurs. The CPC group was significantly (p<0.05) associated with a larger pull-out force at 4th (37%) and 12th (62%) weeks compared to the autograft group. The bone area and the bone-to-implant contact ratios of the CPC groups were significantly higher than that of the autograft groups at early healing stage. The histological exams suggest that the CPC enhanced the earlier bone formation around the implant at a period not longer than 12 weeks postoperation. We conclude that CPC graft has the higher ability to facilitate the osteointegration and stabilize the Ti implant at a relatively early stage than the autograft in vivo.     

Muscle recovery after repair of short and long peripheral nerve gaps using fibrin conduits

Peripheral nerve injuries with loss of nervous tissue are a significant clinical problem and are currently treated using autologous nerve transplants. To avoid the need for donor nerve, which results in additional morbidity such as loss of sensation and scarring, alternative bridging methods have been sought. Recently we showed that an artificial nerve conduit moulded from fibrin glue is biocompatible to nerve regeneration. In this present study, we have used the fibrin conduit or a nerve graft to bridge either a 10 mm or 20 mm sciatic nerve gap and analyzed the muscle recovery in adult rats after 16 weeks. The gastrocnemius muscle weights of the operated side were similar for both gap sizes when treated with nerve graft. In contrast, muscle weight was 48.32 ± 4.96% of the contra-lateral side for the 10 mm gap repaired with fibrin conduit but only 25.20 ± 2.50% for the 20 mm gap repaired with fibrin conduit. The morphology of the muscles in the nerve graft groups showed an intact, ordered structure, with the muscle fibers grouped in fascicles whereas the 20 mm nerve gap fibrin group had a more chaotic appearance. The mean area and diameter of fast type fibers in the 20 mm gap repaired with fibrin conduits were significantly (P < 0.01) worse than those of the corresponding 10 mm gap group. In contrast, both gap sizes treated with nerve graft showed similar fiber size. Furthermore, the 10 mm gaps repaired with either nerve graft or fibrin conduit showed similar muscle fiber size. These results indicate that the fibrin conduit can effectively treat short nerve gaps but further modification such as the inclusion of regenerative cells may be required to attain the outcomes of nerve graft for long gaps.     

A porcine model of full-thickness burn, excision and skin autografting

Acute burn wounds often require early excision and adequate coverage to prevent further hypothermia, protein and fluid losses, and the risk of infection. Meshed autologous skin grafts are generally regarded as the standard treatment for extensive full-thickness burns. Graft take and rate of wound healing, however, depend on several endogenous factors. This paper describes a standardized reproducible porcine model of burn and skin grafting which can be used to study the effects of topical treatments on graft take and re-epithelialization.Procedures provide a protocol for successful porcine burn wound experiments with special focus on pre-operative care, anesthesia, burn allocation, excision and grafting, postoperative treatment, dressing application, and specimen collection. Selected outcome measurements include percent area of wound closure by planimetry, wound assessment using a clinical assessment scale, and histological scoring.The use of this standardized model provides burn researchers with a valuable tool for the comparison of different topical drug treatments and dressing materials in a setting that closely mimics clinical reality.     

带蒂结膜瓣自体角膜缘干细胞移植术治疗翼状胬肉210例效果观察及护理

目的:探讨带蒂结膜瓣自体角膜缘干细胞移植术治疗翼状胬肉的效果及护理方法。方法:对210例翼状胬肉患者行带蒂结膜瓣自体角膜缘干细胞移植术,并对其实施完善、周密的护理。结果:本组患者植片愈合好,角膜创面光滑透明,无角膜新生血管形成,术后6个月内无复发及其它并发症,1年后复发者4例。结论:对翼状胬肉患者行带蒂结膜瓣自体角膜缘干细胞移植术,并给予术前安全管理、协助完善术前检查、充分的心理护理、术后细致的眼部护理、详尽的出院指导,可促进患者康复,取得满意效果。     

Arthroscopic Autologous Coracoacromial Ligament Augment Technique for Particle Thickness of Rotator Cuff with at Least Two Years Follow-Up

Objective

Patch technology has been the new technique in the treatment of partial thickness of the rotator cuff tear (PTRCTs) to address the limitation of traditional techniques. Compared with allogeneic patches and artificial materials, coracoacromial ligament is obviously closer to their own biology. The purpose of the study was to evaluate the functional and radiographic outcomes following arthroscopic autologous coracoacromial ligament augment technique for treatment of PTRCTs.

Method

This study included three female patients with PTRCTs who underwent arthroscopy operation in 2017 with an average age of 51 years (range from 50 to 52 years). The coracoacromial ligament implant was attached to the bursal side surface of the tendon. The clinical results were evaluated by American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), acromiohumeral distance (AHD) and muscle strength before and 12 months after operation. Magnetic resonance imaging (MRI) was performed 24 months after operation to assess the integrity of the anatomical structure of the original tear site.

Result

The average ASES score improved significantly from 57.3 preoperatively to 95.0 at 1-year follow-up. The strength improved significantly from grade 3 preoperatively to grade 5 at 1 year. Two of three patients underwent the MRI at 2-year follow-up. Radiographic released the complete healing of rotator cuff tear. No implant-related serious adverse events were reported.

Conclusion

The new technique of using autogenous coracoacromial ligament patch augment provides good clinical results on patients with PTRCTs.     

肋软骨颗粒填充鼻翼基底术中快速填装的方法

鼻翼基底术是一种治疗前上颌骨骨质丢失所致的鼻底凹陷的有效方法。鼻基底填充术因其创伤 小、前上颌骨量增加、疗效明确等优点而被广泛应用于鼻面部畸形的修复，目前已有很多相关文献对其进 行了深入讨论。现结合近年来国内外涉及鼻基底填充术的文献，对鼻基底填充术的快速填装方法进行总 结，以期为临床治疗鼻翼基底凹陷提供新思路。