Objective To study the reparative and reconstructive for proximal humerus defect due to the excision of bone tumor with noninternal fixation non-vascularised fibular autografts. Methods From June 1991 toDecember 2003, 26 non-vascularised fibular grafts were used as substitutes for repair and reconstruction after resection for bone tumors on proximal humerus. Fifteen cases were given curettage and fibular supporting internal fixation, the other 11 cases were given tumor resection and joint reconstruction with proximal fibular graft. The age ranged from 6 to 41 years. Out of 26 patients, 5 had giant cell tumor, 9 had bone cysts, 8 had fibrous dysplasia and 4 had enchondroma. Results Twenty-six patients were followed up from 1 to 12 years (3.4 years on average). Local recurrence was found in 2 cases, and 1 of them died of lung metastasis. Both outlook and function of the reconstructed joints have good results in 15 proximal humeral joint surface reserved cases. Of them, 3 children gained normal shoulder function 3 weeks after operation. Part function were obtained in the other 11 fibular grafts substituted proximal humeral defect. Conclusion Non-vascularised fibular grafts is an appropriate treatment option for proximal humerus bone defect due to excision of bone tumor.
OBJECTIVE: To study the effect of simvastatin on the expression of bone morphogenetic protein-2 (BMP-2) and alkaline phosphates (ALP) activity in the primary cultured bone marrow stromal cells, and to elucidate the mechanism of the anabolic osteogenetic effect of simvastatin. METHODS: Bone marrow stromal cells in femur and tibia of adult mouse were cultured in vitro. after treated with different concentrations of simvastatin (0, 0.1, 0.2, 0.5 and 1.0 mumol/L) or recombinant human BMP-2 for 72 hours, ALP activity of bone marrow stromal cells was determined. BMP-2 expression of bone marrow stromal cells was analyzed by using immunocytochemistry and Western blotting. RESULTS: After treated with simvastatin for 72 hours, BMP-2 expression increased, while little BMP-2 expression could be observed in the control group. ALP activity also increased in a dose-dependent manner; t-test showed that ALP activity in the group which concentrations of simvastatin were 0.5 mumol/L (t = 2.35, P = 0.041), 1.0 mumol/L (t = 2.348, P = 0.041) had significant difference when compared with control group. CONCLUSION: Simvastatin lead to high expression of BMP-2 in bone marrow stromal cells, via the increased auto- or para-crine of BMP-2, and ALP activity increased. These may be parts of the mechanism on the anabolic osteogenetic effect of simvastatin.
Objective To investigate the clinical application of self-settingcalcium phosphate cement (CPC) in bone defect repair of extremities. Methods From May 1998 to January 2000, 32 cases of bone defect, in 36 sites, were repairedand reviewed, aged from 4 to 59 years old (24.7 years old on average), with bone defect 2 to 125 cm2 in size (13.1 cm2 on average). The causes of the bone defect werefracture, bone cyst, iliac bone harvesting, fibrous dysplasia, enchondroma and bone tuberculosis, which involved femur, iliac, tibia, humerus, phalanx, fibula, calcaneus, talus and acetabulum. All of the cases were followed up for 1 to 23 months, 15.3 months on average, before radiographic examination. Results All operations were successful and no general response was observed in all of the cases. X-ray examination showed an integrity interface between CPC and bone. And CT showed no gap existed. There was no increase of serum calcium and phosphate levels. Conclusion CPC is applicable in the low- or non-weight-bearing site of the extremities.
Since October 1984, we have designed a method of conversed transplant of radial styloid bone flap with fascial pedicle in the treatment of 22 patients with non-united waist fractures of carpal scaphoid. The results from follow-up of 2-7 years were satisfactory.This article introduced the design of the bone flap, the operative procedure and the advantages of the bone flap.
In order to evaluate coral as a bone graft substitute in repair of bone defect, particulates of coral were implanted into skull bone defect of rabbit, 1.5 cm in diameter. Hydroxyapatite and blank were taken as controls. The rabbits were sacrificed at the second, fourth, eighth and twelveth weeks after the operation. The specimens were taken and performed histological examination and histomorphometry observation. Results were as follows: at the second week many multinucleus giant cells infiltrated. As time elapsed, the coral were progressively degenerated and new bone was formed to fill the defect. Up to the twelveth week, the coral degenerated completely and new bone formed in the center of the defect. Percentage of new bone was in defect was 36.9%. Compared with the controls, there were significant differences (P lt; 0.01). It was suggested that coral had good osteoconductility. Howevel, coral underwent rapid degeneration, it might result in inconplete repair of bone defect.
Abstract To restore the bone defect after curettage of bone cyst, hydroxyapatite bioactive microcrystal glass (HBG) was used. From 1990 to 1995, HBG was applied in 17 cases. The bone involved were humerus, femur, tibia and fibula. Among them, 6 were complicated with pathological fracture. After eradication of the focus, the cyst was filled in ZnCl2 powder and irrigated with saline, then particles or segments of HBG were implanted into the cavity. The fracture were fixed with Enders rod. All the extremities were immobilized with plaster splint for about 6 to 8 weeks. Three months later, the lower limbs began to have functional exercises. By X-ray examination, the border between HBG and bone was clear in 2 weeks, after 1 month the clear border become blurred, and 2 months after operation, HBG was intermingled with bone. After 1 year there was neither absorption of bone nor HBG. No recurrence of the aptic lesion occurred in 1 year. HBG was a kind of artificial bone composed of hydroxyapatite and bioactive microcrystal glass, the latter contained silicon.It was characterized by its bioactivity, osteoinductivity and good tissue compatibility. The microcrystal would facilitate the growth of osseous tissues, which caused HBG intermingled with the surrounding bone. The source of HBG was abundant. It might be an ideal artificial bone.
To investigate the therapeutic effect of open reduction, bone grafting, and internal fixation with plastic ti-alloy plate on intra-articular calcaneal fracture. Methods From January 2005 to December 2007, 32 patients (37 feet) with intra-articular calcaneal fracture underwent open reduction, bone grafting of autogeneic il ium (30-80 g) and internal fixation of plastic ti-alloy plate. There were 21 males and 11 females aged 18-56 years old (average 42.1 years old). There were 5 cases of bilateral calcaneal fracture and 27 cases of unilateral calcaneal fracture, including 2 cases of open fracture and 30 cases of close fracture. According to Sanders classification system, there were 11 cases of type II, 18 cases of type III and 8 cases of type IV. Preoperatively, Bouml;hler angle was (— 9.6 ± 4.2)° and Gissane angle was (101.4 ± 10.6)°. Nine feet underwent emergency operation and 28 feet received operation 5-7 days after injury. Results The wounds of 34 feet healed by first intention. The wound margin of 3 feet was gray with a small amount of colorless exudates, and healed after dressing change. All patients were followed for 12-24 months (average 16 months). X-ray films displayed that the fracture all healed within 3-4 months after operation. At 6 months after operation, the Bouml;hler angle and the Gissane angle was (28.5 ± 6.1)° and (128.9 ± 4.8)°, respectively, indicating there were significant differences when compared with before operation (P lt; 0.05). According to Maryland foot score system, 15 cases were graded as excellent, 18 cases were good, 4 cases were poor, and the excellent and good rate was 89.19%. Conclusion Open reduction, bone grafting, and internal fixation with plastic ti-alloy plate is an effective method to treat intra-articular calcaneal fracture. Choosing right operational timing, performing subarticular surface grafting when necessary and using appropriate plastic ti-alloy plate internal fixation can minimize the incidence of postoperative compl ications
Objective To compare the bone resorption between the proximal fixation of the anatomique benoist giraud（ABG） hip and the distal fixation of the anatomic medullary locking（AML） hip by the medium-term X-ray films, and to evaluate the clinical results of the two prostheses. Methods From January 1992 to December 1996, 298 patients (396 hips) underwent the total hip arthroplasty at Wilson Hospital in Korea. In 125 patients, 176 hips were ABG hips, including 103 avascularnecrosis hips, 57 dysplasia hips, and 16 other diseased hips; In the other 173 patient the remaining 220 hips were AML hips, including 147 avascular necrosis hips, 65 dysplasia hips, and 8 other diseased hips. The A-P X-ray imagings were followed up for 5-12 years averaged 8 years, and were compared with the immediate postoperative X-ray imagings. The bone resorption area was measured and the bone resorption cases were recorded according to the Gruen zone obsesvation. Results During operation, 2 ABG hips and 5 AML hips were cracked at the femoral diaphysis; 3 ABG hips and 1 AML hip were cracked at the metaphysis; 6 ABGhips and 3 AML hips were fractured because of trauma after operation; among them, 2 ABG hips needed the stem revision and the remaining hips underwent the openreduction and the internal fixation. During the follow-up, 9 ABG hips were revised, 7 hips of which developed the aseptic loosening. No AML hip was revised, but 3 AML hips developed the aseptic loosening. The bone resorption pattern in theABG and AML hips was similar. The bone resorption occurred most commonly in theGruen zones 1 and 7, and it extended from the metaphysis to the diaphysis. In the Guren zones 2, 5, 6 and 7, there were more AML hips than ABG hips that developed the bone resorption. The bone resorption area around the AML hip was larger than that around the ABG hip. Conclusion The stress shielding bone resorption usually occurs proximally to the union area of the bone and the prosthesis. The ABG prosthesis is a proximal fixation prosthesis, therefore, the stress shielding bone resorption can be reduced. The bone resorption around the AML prosthesis develops slowly within 10 years after operation. The stress shielding bone resoption may reach the summit within 10 years and it will not develop endlessly, so the prosthesis will be stable for a long time. The probabilityof the bone resorption in the ABG prosthesis is smaller than that in the AMLprosthesis. The bone resorption around the AML prosthesis may develop slowly after 10 years and will not affect the stability of the prosthesis for a long time.
Objective To study the effect of autogenous bone marrow on guided bone regeneration (GBR),and evaluate the repairing ability of GBR in bone defect with autogenous bone marrow. Methods Ten mm segmental defects were produced in both radii of 18 rabbits. The defect was bridged with a silicon tube. Autogenous bone marrow was injected into the tube on the experimental group at 0, 2,4 weeks after operation, and peripheralblood into the control group at thesame time. The X-ray, gross, histological and biochemical examinations were observed invarious times. Results The new bone formation of experimental group was prior to that of control group; calcium and alkaline phosphatase of experimental groupwere higher than those of control group. The experimental group had all been healed at the tenth week, but no one healed in control group. Conclusion It can be conclude that autogenous bone marrow can stimulate bone formation and facilitate GBR in bone defect.
In order to restore the function of shoulder joint in patient with tumor of upper end of humerus, artificial humeral head replacement was performed. The materials included resinene, nylon-6 and large molecular polyethylene from 1978 to 1993, 14 patients were treated. The tumors involved in this group were giant cell tumor, synviosarcoma, bone cyst, osteochondroma, osteoblastoma, osteofibrosarcoma, osteosarcoma, chondrosarcoma, parosteosarcoma and malignant giant cell tumor. After resection of the tumor, the artificial prosthesis was implanted with bone cement. After 1 to 16 years follow-up, functions of the shoulder joint were reserved in 86% of the patients.