Since 1979, vascularized iliac bone graft based on the deep circumflex iliac vessels (DCIV) or the deep superior branches of superior gluteal vassels (SGV) was used to the treatment of bone defect, non-union of fracture, and aseptic necrosis of the femoral head in Ⅱ4 cases. Of these Ⅱ4 graftings, 68 were pedicled, 46 were microvascular free transfer. Early callus formation developed 6 weeks after surgery. Solid bony union was obtained in 3 months. Among 32 patients with aseptic necrosis of femoral head followed more tha 1 years, dior relief of pain and omprovement of X-ray findings were obtained in 31. The advantages of using vascularized iliac bone graft, especially based on the DCIV and SGV, are discussed. The author has a good opinion of vascularized iliac bone graft based on the SGV.
ObjectiveTo compare the effectiveness of short segmental pedicle screw fixation with and without fusion in the treatment of thoracolumbar burst fracture. MethodsA retrospective analysis was made on the clinical data of 57 patients with single segment thoracolumbar burst fractures, who accorded with the inclusion criteria between February 2012 and February 2014. The patients underwent posterior short segmental pedicle screw fixation with fusion in 27 cases (fusion group) and without fusion in 30 cases (non-fusion group). There was no significant difference in gender, age, cause of injury, time between injury and admission, fracture segment and classification, and neurologic function America Spinal Injury Association (ASIA) classification between 2 groups, which had the comparability (P > 0.05). The operative time, blood loss, and hospitalization days were compared between 2 groups. The height of the injured vertebra, the kyphotic angle, and the range of motion (ROM) were measured on the X-ray film. The functional outcomes were evaluated by using the Greenough low-back outcome score and the visual analogue scale (VAS) for back pain. The neurologic functional recovery was assessed by ASIA grade. ResultsThe operative time was significantly shortened and the blood loss was significantly reduced in the non-fusion group when compared with the fusion group (P < 0.05), but no significant difference was found in hospitalization days between 2 groups (P > 0.05). The patients were followed up for 2.0-3.5 years (mean, 3.17 years) in the fusion group and for 2-4 years (mean, 3.23 years) in the non-fusion group. X-ray films showed that 2 cases failed bone graft fusion, the fusion time was 12-17 weeks (mean, 15.6 weeks) in the other 25 cases. Complication occurred in 2 cases of the fusion group (1 case of incision deep infection and 1 case of hematoma at iliac bone donor site) and in 1 case of the non-fusion group (fat liquefaction); primary healing of incision was obtained in the others. The Cobb angle, the height of injured vertebrae showed no significant difference between 2 groups at pre-operation, immediate after operation, and last follow-up (P > 0.05). The ROM of injured vertebrae showed no significant difference between 2 groups at 1 year after operation (before implants were removed) (P > 0.05). The implants were removed at 1 year after operation in all cases of the non-fusion group, and in 11 cases of the fusion group. At last follow-up, the ROM of injured vertebrae in the non-fusion group was significantly higher than that in the fusion group (P < 0.05), but no significant difference was found in Greenough low-back outcome score, VAS score, and ASIA grade between 2 groups (P > 0.05). ConclusionFusion is not necessary when thoracolumbar burst fracture is treated by posterior short segmental pedicle screw fixation, which can preserve regional segmental motion, shorten the operative time, decrease blood loss, and eliminate bone graft donor site complications.
To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.
【Abstract】 Objective To evaluate the cl inical outcome of free vascularized fibular associated with il iac graft intreatment of old femoral neck fracture. Methods From January 1994 to January 1997, 76 cases of old femoral neck fracture were treated with free vascularized fibular associated with il iac graft, including 54 males and 22 females, aging from 24 to 48 years with an average of 31.5 years. All of these fractures resulted from injury. There were 20 cases of Garden II, 41 of Garden III and 15 of Garden IV. Based on the location of fracture, there was 26 cases of subcapital, 42 cases of transcervical and 8 cases of basal. Sixty-five cases were treated with internal fixation, 7 cases with skin traction and 4 just with staying in bed. Their Harris score were from 52 to 72 with an average of 65.6. The time from injury to operation was 2-24 months. The size of free vascularized fibular was 6-8 cm and il iac graft was 3.0 cm×2.0 cm×1.5 cm. Results In 76 cases, 68 were followed up and all fractures healed within 4 to 6 months with an average of 5.2 months. The increased density in femoral head was observed 1 year after operation. After 10 years of operation, normal hip function was achieved in 63 cases（followed up 10.1 -12.4 years with theaverage as 10.5 years); the Harris score was 87.5 (84 to 94). The structure of femoral head was normal and the grafted fibular and il iac bone healed with the femoral, no elapse or cyst occurred. Five cases had been compl ied with total hip replacement for femoral head necrosis or other. Conclusion Free vascularized fibular associated with il iac graft is a good method to treat old femoral neck fracture.
Eight cases(10 hips) of avascular necrosis of femoral head in adults were treated with transplantation of sartorius musculo-skeletal graft through the greater trochanter since August 1990. The patients were followed up for 12 to 20 months,with disappearance of pain in 7 cases. The degree of hip motion was markedly increased. The good results rated 87.5 percent.
Objective To estimate clinical effect ofspin iliac deep vascular pedicled periosteum flap in repairing traumatic femoral neck of theca inside fracture in young and middleaged. Methods From April 1993 to September 2001, 12 cases of traumatic femoral neck fracture were given diaplastic operation with fixation of 3 centre hollow pressed bolt and were conducted under os traction bed and "C" arm X-ray machine. Spin iliac deep vascular pedicled periosteum flap wasstripped off, and transferred to the front of femoral neck fundus，then transplanted to the narrow inside of fracture through outer open door of articular capsule.Results All patients were followed up for 17 years. All fracture healedwithout femoral head necrosis, but mild arthritis appeared in 7 cases.Conclusion Vascular pedicled periosteum flap transfer of young and middle-aged femoral neck fracture, by decompression of femoral neck and reconstruction of blood circulation, can promote the fracture healing and decrease the wound and blood circulation destroy.
Objective To investigate the effect of transplantation of the cutaneous iliac flap on repairing bone and soft tissue defect of metatarsal. Methods From October 1999 to December 2003, the cutaneous iliac flap was designed for the repair of bone and soft tissue defect of metatarsal in 4 male patients, whose ages ranged from 26 to 47, with skin graft for the coverage of the iliac flap. The duration of injury ranged from 1 to 5 months. The length of the defect ranged from 4 to 7 cm and the defect area ranged from 5 cm×3 cm to 9 cm×5 cm. Results One week after transplantation, complete survival of iliac flap was observed in 3 cases and partial survival in 1 case (but later proved survived). Callus was seen 1 month after transplantation and Kwires were removed 4months after transplantation. Patients were followed up for 5 to 24 months. There were no ulcers. The ability of walking and bearing was satisfying as well asthe function and shape. Conclusion With satisfying restoration of function and shape, transplantation of the cutaneous iliac flap with skin graft is an alternative to treat bone and soft tissue defect of metatarsal with one stage surgery.