Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing techn...Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.展开更多
Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young ch...Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.展开更多
Objective: Severe craniomaxillofacial injuries and craniomaxillofacial tumors can lead to craniomaxillofacial bone defects and deformities. Seriously affect the patients’ appearance and quality of life. So one-stage ...Objective: Severe craniomaxillofacial injuries and craniomaxillofacial tumors can lead to craniomaxillofacial bone defects and deformities. Seriously affect the patients’ appearance and quality of life. So one-stage repair and reconstruction of craniomaxillofacial bone defects is of great significance. The current study summarizes the clinical experience of one-stage repair and reconstruction of craniomaxillofacial bone defects. Material and Methods: Data in one-stage repair and reconstruction of?craniomaxillofacial bone defects performed on 13 patients were retrospectively analyzed out of 34 patients with?craniomaxillofacial injuries or tumors who received treatment at the outpatient department between January 2002 and March 2011. Surgical indications and approaches were explored after two typical cases were detected. Results: One-stage repair and reconstruction of bone defects was suitable for patients with craniomaxillofacial injuries and excised craniomaxillofacial benign tumors. Adjacent autogenous bones and artificial materials (such as titanium plates, titanium mesh, and so on) work well for the repair of the craniomaxillofacial bone frame and restoration of facial features. Conclusions: Surgical indications should be strictly selected in one-stage repair and reconstruction of craniomaxillofacial bone defects and deformities. Furthermore, the adoption of autogenous bones and artificial materials is a good choice in restoring the craniofacial features.展开更多
Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the aceta...Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.展开更多
We investigated the osteogenic characteristic and biodegradation behavior of porous beta-tricalcitum phosphate （ β- TCP ） and bone morphogenetic protein/beta-tricalcium phosphate （ BMP/ β- TCP ） complex in mand...We investigated the osteogenic characteristic and biodegradation behavior of porous beta-tricalcitum phosphate （ β- TCP ） and bone morphogenetic protein/beta-tricalcium phosphate （ BMP/ β- TCP ） complex in mandibular reconstruction and evaluated the advantages of BMP / β- TCP complex in repairing bone defects. Bone defects created in the lower margin of bilateral mandible bodies in 12 rabbits were repaired with β- TCP （ control group ） and BMP/ β- TCP complex （ experimental group ） respectively. The rabbits were euthanized after 2, 4, 8 and 12 weeks and examined by macroscopy, radiography, histology, histomorphometry and image analysis. 2 weeks after surgery, ossftcation of newly-generated tissue in BMP/ β- TCP complex group appeared and after 12 weeks, massive new bone and ossification maturation were seen. However, in β- TCP group without BMP , ossification was not found until 12 weeks after operation. Image analysis showed that bone regeneration rate of BMP/ β- TCP was 30%-40% higher and the degradation rate was 20%- 30% higher than that of β- TCP. Therefore, as a reconstructive material for bone defects, BMP/ β-TCP complex is superior to β-TCP and can be used in oral and maxillofacial surgery.展开更多
AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss ...AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo(range 27-56 mo). RESULTS The infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases. CONCLUSION Distraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.展开更多
A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was valida...A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.展开更多
Objective:To explore the clinical value of autologous skull transplantation in the treatment of skull defects.Methods:Sixty-six patients who underwent skull defect reconstruction treatment in our hospital from January...Objective:To explore the clinical value of autologous skull transplantation in the treatment of skull defects.Methods:Sixty-six patients who underwent skull defect reconstruction treatment in our hospital from January 2022 to March 2024 were selected and divided into an autologous skull transplantation group(n=31)and an artificial bone transplantation material group(n=35)based on different bone transplantation materials.The two groups of patients were followed up for 12 months to observe the bone healing and the incidence of postoperative complications.Results:After 9 months of treatment,the bone healing performance of the autologous skull transplantation group was better than that of the artificial bone transplantation material group(P<0.05).By the end of the last follow-up,the incidence of bony postoperative complications in the autologous skull transplantation group was lower than that in the artificial bone transplantation material group(P<0.05).Conclusion:Autologous skull repair for skull defects has good biocompatibility,can promote bone healing,and reduce the incidence of postoperative complications.展开更多
Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasin...Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.展开更多
Reconstruction after resection has always been an urgent problem in the treatment of bone tumours.There are many methods that can be used to reconstruct bone defects;however,there are also many complications,and it is...Reconstruction after resection has always been an urgent problem in the treatment of bone tumours.There are many methods that can be used to reconstruct bone defects;however,there are also many complications,and it is difficult to develop a safe and effective reconstruction plan for the treatment of bone tumours.With the rapid development of digital orthopaedics,three-dimensional printing technology can solve this problem.The three-dimensional printing of personalised prostheses has many advantages.It can be used to print complex structures that are difficult to fabricate using traditional processes and overcome the problems of stress shielding and low biological activity of conventional prostheses.In this study,12 patients with bone tumours were selected as research subjects,and based on individualised reverse-engineering design technology,a three-dimensional model of each prosthesis was designed and installed using medical image data.Ti6Al4V was used as the raw material to prepare the prostheses,which were used to repair bone defects after surgical resection.The operation time was 266.43±21.08 minutes(range 180-390 minutes),and intraoperative blood loss was 857.26±84.28 mL(range 800-2500 mL).One patient had delayed wound healing after surgery,but all patients survived without local tumour recurrence,and no tumour metastasis was found.No aseptic loosening or structural fracture of the prosthesis,and no non-mechanical prosthesis failure caused by infection,tumour recurrence,or progression was observed.The Musculo-Skeletal Tumour Society(MSTS)score of limb function was 22.53±2.09(range 16-26),and ten of the 12 patients scored≥20 and were able to function normally.The results showed that three-dimensional printed prostheses with an individualised design can achieve satisfactory short-term clinical efficacy in the reconstruction of large bone defects after bone tumour resection.展开更多
基金This work is supported by National Key Research and Development Program of China(2016YFC1100600)the National Natural Science Foundation of China(81972058 and 81902194)the Multicenter Clinical Research Project of Shanghai Jiao Tong University School of Medicine(DLY201506).
文摘Complicated and large acetabular bone defects present the main challenges and difficulty in the revision of total hip arthroplasty(THA).This study aimed to explore the advantages of three-dimensional(3D)printing technology in the reconstruction of such acetabular bone defects.We retrospectively analyzed the prognosis of four severe bone defects around the acetabulum in three patients who were treated using 3D printing technology.Reconstruction of bone defect by conventional methods was difficult in these patients.In this endeavor,we used radiographic methods,related computer software such as Materialise's interactive medical image control system and Siemens NX software,and actual surgical experience to estimate defect volume,prosthesis stability,and installation accuracy,respectively.Moreover,a Harris hip score was obtained to evaluate limb function.It was found that bone defects could be adequately reconstructed using a 3D printing prosthesis,and its stability was reliable.The Harris hip score indicated a very good functional recovery in all three patients.In conclusion,3D printing technology had a good therapeutic effect on both complex and large bone defects in the revision of THA.It was able to achieve good curative effects in patients with large bone defects.
文摘Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.
文摘Objective: Severe craniomaxillofacial injuries and craniomaxillofacial tumors can lead to craniomaxillofacial bone defects and deformities. Seriously affect the patients’ appearance and quality of life. So one-stage repair and reconstruction of craniomaxillofacial bone defects is of great significance. The current study summarizes the clinical experience of one-stage repair and reconstruction of craniomaxillofacial bone defects. Material and Methods: Data in one-stage repair and reconstruction of?craniomaxillofacial bone defects performed on 13 patients were retrospectively analyzed out of 34 patients with?craniomaxillofacial injuries or tumors who received treatment at the outpatient department between January 2002 and March 2011. Surgical indications and approaches were explored after two typical cases were detected. Results: One-stage repair and reconstruction of bone defects was suitable for patients with craniomaxillofacial injuries and excised craniomaxillofacial benign tumors. Adjacent autogenous bones and artificial materials (such as titanium plates, titanium mesh, and so on) work well for the repair of the craniomaxillofacial bone frame and restoration of facial features. Conclusions: Surgical indications should be strictly selected in one-stage repair and reconstruction of craniomaxillofacial bone defects and deformities. Furthermore, the adoption of autogenous bones and artificial materials is a good choice in restoring the craniofacial features.
文摘Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.
文摘We investigated the osteogenic characteristic and biodegradation behavior of porous beta-tricalcitum phosphate （ β- TCP ） and bone morphogenetic protein/beta-tricalcium phosphate （ BMP/ β- TCP ） complex in mandibular reconstruction and evaluated the advantages of BMP / β- TCP complex in repairing bone defects. Bone defects created in the lower margin of bilateral mandible bodies in 12 rabbits were repaired with β- TCP （ control group ） and BMP/ β- TCP complex （ experimental group ） respectively. The rabbits were euthanized after 2, 4, 8 and 12 weeks and examined by macroscopy, radiography, histology, histomorphometry and image analysis. 2 weeks after surgery, ossftcation of newly-generated tissue in BMP/ β- TCP complex group appeared and after 12 weeks, massive new bone and ossification maturation were seen. However, in β- TCP group without BMP , ossification was not found until 12 weeks after operation. Image analysis showed that bone regeneration rate of BMP/ β- TCP was 30%-40% higher and the degradation rate was 20%- 30% higher than that of β- TCP. Therefore, as a reconstructive material for bone defects, BMP/ β-TCP complex is superior to β-TCP and can be used in oral and maxillofacial surgery.
文摘AIM To evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODS Twenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo(range 27-56 mo). RESULTS The infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases. CONCLUSION Distraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.
基金National Natural Science Foundation of China[Grant Numbers 81802174,81900726&82072456]Department of Science and Technology of Jilin Province,P.R.C[Grant Numbers 20200404202YY,20200403086SF&20200201453JC]+8 种基金Jilin Province Development and Reform Commission,P.R.C[Grant Number 2018C010]Education Department of Jilin Province,P.R.C[GrantNumber JJKH20180106KJ]Administration of Traditional Chinese Medicine of Jilin Province P.R.C[Grant Number 2018115]10th Youth Project of the First Hospital of Jilin University[Grant Number JDYY102019025]Department of Finance in Jilin Province[Grant Number 2019SCZT046]Undergraduate Teaching Reform Research Project of Jilin University[Grant Number 4Z2000610852]Key training plan for outstanding young teachers of Jilin University[Grant Number 419080520253]Bethune plan of Jilin University[Grant Number 470110000692]The major participant is Qing Han.
文摘A novel reconstructive prosthesis was designed with topological optimization(TO)and a lattice structure to enhance biomechanical and biological properties in the proximal tibia.The biomechanical performance was validated through finite element analysis(FEA)and biomechanical tests.The tibia with inhomogeneous material properties was reconstructed according to computed tomography images,and different components were designed to simulate the operation.Minimum compliance TO subject to a volume fraction constraint combined with a graded lattice structure was utilized to redesign the prosthesis.FEA was performed to evaluate the mechanical performances of the tibia and implants after optimization,including stress,micromotion,and strain energy.The results were analyzed by paired-samples t tests,and p<0.05 was considered significant.Biomechanical testing was used to verify the tibial stresses.Compared to the original group(OG),the TO group(TOG)exhibited lower stress on the stem,and the maximum von Mises stresses were 87.2 and 53.1 MPa,respectively,a 39.1%reduction(p<0.05).Conversely,the stress and strain energy on the tibia increased in the TOG.The maximum von Mises stress values were 16.4 MPa in the OG and 22.9 MPa in the TOG with a 39.6%increase(p<0.05),and the maximum SED value was 0.026 MPa in the OG and 0.042 MPa in the TOG,corresponding to an increase of 61.5%(p<0.05).The maximum micromotions in the distal end of the stem were 135μm in the OG and 68μm in the TOG,almost a 50%reduction.The stress curves of the biomechanical test coincided well with the FEA results.The TO approach can effectively reduce the whole weight of the prosthesis and improve the biomechanical environment of the tibia.It could also pave the way for next-generation applications in orthopedics surgery.
文摘Objective:To explore the clinical value of autologous skull transplantation in the treatment of skull defects.Methods:Sixty-six patients who underwent skull defect reconstruction treatment in our hospital from January 2022 to March 2024 were selected and divided into an autologous skull transplantation group(n=31)and an artificial bone transplantation material group(n=35)based on different bone transplantation materials.The two groups of patients were followed up for 12 months to observe the bone healing and the incidence of postoperative complications.Results:After 9 months of treatment,the bone healing performance of the autologous skull transplantation group was better than that of the artificial bone transplantation material group(P<0.05).By the end of the last follow-up,the incidence of bony postoperative complications in the autologous skull transplantation group was lower than that in the artificial bone transplantation material group(P<0.05).Conclusion:Autologous skull repair for skull defects has good biocompatibility,can promote bone healing,and reduce the incidence of postoperative complications.
文摘Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.
基金This study was supported by the National Natural Science Foundation of China(No.81904231).
文摘Reconstruction after resection has always been an urgent problem in the treatment of bone tumours.There are many methods that can be used to reconstruct bone defects;however,there are also many complications,and it is difficult to develop a safe and effective reconstruction plan for the treatment of bone tumours.With the rapid development of digital orthopaedics,three-dimensional printing technology can solve this problem.The three-dimensional printing of personalised prostheses has many advantages.It can be used to print complex structures that are difficult to fabricate using traditional processes and overcome the problems of stress shielding and low biological activity of conventional prostheses.In this study,12 patients with bone tumours were selected as research subjects,and based on individualised reverse-engineering design technology,a three-dimensional model of each prosthesis was designed and installed using medical image data.Ti6Al4V was used as the raw material to prepare the prostheses,which were used to repair bone defects after surgical resection.The operation time was 266.43±21.08 minutes(range 180-390 minutes),and intraoperative blood loss was 857.26±84.28 mL(range 800-2500 mL).One patient had delayed wound healing after surgery,but all patients survived without local tumour recurrence,and no tumour metastasis was found.No aseptic loosening or structural fracture of the prosthesis,and no non-mechanical prosthesis failure caused by infection,tumour recurrence,or progression was observed.The Musculo-Skeletal Tumour Society(MSTS)score of limb function was 22.53±2.09(range 16-26),and ten of the 12 patients scored≥20 and were able to function normally.The results showed that three-dimensional printed prostheses with an individualised design can achieve satisfactory short-term clinical efficacy in the reconstruction of large bone defects after bone tumour resection.
