Objective To investigate the effectiveness of transplanting iliac bone flap with deep iliac circumflex vessels and cancellous bone for the treatment of adult avascular necrosis of the femoral head (ANFH). Methods A retrospective analysis was made on the clinical data of 685 patients (803 hips) with ANFH, who underwent iliac bone flap transplantation with deep iliac circumflex vessels and cancellous bone between March 2002 and January 2010. There were 489 males (580 hips) and 196 females (223 hips) with a mean age of 40.4 years (range, 18-63 years), including 567 unilateral cases (303 left hips and 264 right hips) and 118 bilateral cases. The causes of ANFH included alcohol-induced in 223 cases, steroid-induced in 179 cases, alcohol + steroid-induced in 21 cases, traumatic in 136 cases, acetabular dysplasia in 8 cases, bone cyst in 5 cases, septic arthritis in 2 cases, joint tuberculosis in 3 cases, rheumatoid arthritis in 5 cases, and idiopathic in 103 cases. According to Steinberg staging, 211 hips were rated as stage II, 513 hips as stage III, and 79 hips as stage IV. The preoperative Harris hip score was 60.30 ± 7.02. Results Fat necrosis occurred in 2 cases after operation, primary healing of incision was obtained in the other cases; delayed infection, lower extremity deep vein thrombosis, and pulmonary embolism occurred in 2 cases, respectively. All patients were followed up 36-60 months (mean, 49 months). Harris hip score at last follow-up (83.50 ± 7.31) was significantly higher than that at preoperation (t= — 2 266.980, P=0.000), and the scores were significantly higher than those at preoperation in different stages (P lt; 0.05). The results were excellent in 523 hips, good in 185 hips, fair in 65 hips, and poor in 30 hips, and the excellent and good rate was 88.2%. X-ray examination showed bone fusion of transplanted bone flap and bone graft with an average of 4.2 months (range, 3-6 months); according to Steinberg staging, imaging stable rate was 78.3% (629/803) at last follow-up. Conclusion Iliac bone flap transplantion with deep iliac circumflex vessels and cancellous bone has the advantages of complete decompression of the femoral head, exact flap blood supply, improved blood supply of the femoral head, new support for the femoral head, and participation of osteoinductive effect for the treatment of adult ANFH, so it is an effective treatment for the retention of the femoral head.
Objective?To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion.?Methods?Forty-two adult Japanese rabbits, weighing 2.0-2.5 kg and male or female, were selected. Thirty-six rabbits were given a sharply left-lateral tenotomy of the supraspinatus tendon with subsequent re-attachment of the tendon. According to the depth of re-attachment, 36 rabbits were equally randomized into the cancellous-fixation group (a cancellous bed was prepared with a dental burr) and the cortical-fixation group (the same treatment was performed except the preparation of the bone bed). Six rabbits served as the controls without treatment (control group). At 4 and 8 weeks after operation, the general observation, HE staining, and the biomechanical test were performed.?Results?At 4 weeks after operation, the supraspinatus-humerus specimens morphologically showed atrophy and vague between tendon and new bone in the cancellous-fixation group and the cortical-fixation group; at 8 weeks, no obvious difference was observed between 2 groups and the control group. The histological results of the cortical-fixation group at 4 weeks revealed the interface between tendon and new bone became smooth. The interface became transitional at 8 weeks, and the shape of bone tissue was nearly normal. The interface obtained from the cancellous-fixation group at 4 weeks became sclerotic, and collagen fibers formed in disorder. With ingrowth of new bone and re-establishment of collagen-fiber continuity at 8 weeks, thickness of interface became thin, and bone tissue was remodeling. The ultimate load were significantly higher in the cortical-fixation group than in the cancellous-fixation group at both 4 and 8 weeks, and the results gained at 8 weeks is significantly higher than that at 4 weeks in each group (P lt; 0.05). Except rupture strength at 4 weeks between 2 groups and all tensile strength (P gt; 0.05), there were significant differences in the results of others (P lt; 0.05).?Conclusion?In this model, the tendon-bone healing process and the biomechanical properties of cortical-fixation is superior to those of cancellous-fixation.
Objective To investigate the long-term clinical results of treatment of adult unicameral bone cyst with cancellous allograft. Methods From 1993 to 1998, 15 patients with unicameral bone cyst were treated by allograft with lyophilized cancellous bone. Among 15 patients, there were 5 males and 10 females, aging 19-41 years with an average of 27 years. The average follow-up time was 7.5 years (6-11 years). The X-ray films were taken and the CT scanning were carried out. Results The X-ray films showed that the allograft particles became vague 2-3 months after operation, that the allograft particles fused and began to form new bone and the bone density increased 5 months after operation, and that new bone formation completed after 7 months of operation. At the end of follow-up, remodelling in new bone occurred. Reoccurrence was not found in all patients. The symptom of pain disappeared or relieved obviously. Conclusion Allograft of lyophilized cancellous bone is an effective treatment for adult unicameral bone cysts.