Risk factors of transport gap bending deformity in the treatment of critical-size bone defect after bone transport.

BACKGROUND: The purpose of this study was to investigate the risk factors of transport gap bending deformity (TGBD) in the treatment of critical-size bone defect (CSBD) after the removal of the external fixator. METHODS: From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using a unilateral external fixator in our medical institution. TGBD was defined as the bone callus in the distraction area with a deviation to the force line of the femur (> 10°) or tibia (> 12°) after removal of the external fixator. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson's Chi-square test was analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD. RESULTS: A total of 178 patients were enrolled in the study, with a mean follow-up time of 28.6 ± 3.82 months. The positive result of the bacteria isolated test was observed in 144 cases (80.9%). The rate of excellent and good in the bone outcomes (excellent/good/fair/poor/failure, 41/108/15/14/0) was 83.7%, and 92.3% in the functional results (excellent/good/fair/poor/failure, 50/98/16/14/0) according to the ASAMI criteria. TGBD after removal of external fixator occurred in twenty-two patients (12.3%), including 6 tibias, and 16 femurs. Age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, osteoporosis, glucocorticoid intake, duration of infection > 24 months, EFT > 9 months, EFI > 1.8 month/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis (P < 0.05). The incidence more than 50% was found in patients with femoral defect (76.1%), osteoporosis (72.7%), BMI > 25 kg/m2 (69.0%), diabetes (59.5%), glucocorticoid intake (54.7%). In the multivariate logistic regression analyses, the following factors were associated independently with TGBD, including age > 45 years, BMI > 25 kg/m2, femoral defect, diabetes, and osteoporosis. CONCLUSIONS: Bone transport using a unilateral external fixator was a safe and practical method in the treatment of CSBD caused by infection. The top five risk factors of TGBD included femoral defect, BMI > 25 kg/m2, duration of bone infection > 24 months, age > 45 years, and diabetes. Age > 45 years, BMI > 25 kg/m2, femoral defect, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.

Bone Defects in Tibia Managed by the Bifocal vs. Trifocal Bone Transport Technique: A Retrospective Comparative Study.

Background: The purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. Methods: A total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19-65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit. Results: All patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05). Conclusion: Both the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.

Tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique in the treatment of distal tibial defect-preliminary outcomes of 12 cases and a description of the surgical technique.

OBJECTIVE: To evaluate the preliminary outcomes of tetrafocal (three osteotomies) and pentafocal (four osteotomies) bone transport using Ilizarov technique for the treatment of distal tibial defect and describe the surgical technique. METHODS: A total of 12 eligible patients with distal tibial defect > 6 cm caused by direct trauma or posttraumatic osteomyelitis who were admitted to our institution from January 2017 to January 2019 were treated by tetrafocal or pentafocal bone transport using Ilizarov technique. Detailed demographic data, including age, sex, etiology, defect size, number of osteotomies (three or four), external fixation time (EFT) and external fixation index (EFI), were collected, and the bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during the surgery and the follow-up period were recorded and evaluated by the Paley classification at a minimum follow-up of two years after removal of the fixator. RESULTS: There were 9 men and 3 women with an average age of 37.4±7.8 years. The etiology included posttraumatic osteomyelitis in 8 cases and posttraumatic bone loss in 4 cases. The mean bone defect after radical debridement was 7.1±0.6 cm. Tetrafocal bone transport was applied in 9 cases, and pentafocal bone transport was applied in 3 cases. The average EFT and EFI were 5.2±0.8 months and 0.7±0.2 months/cm, respectively. The average time of follow-up after removal of the external fixator was 28.5±3.3 months without recurrence of osteomyelitis. The bone results were good in 7 cases, fair in 4 cases, and poor in 1 case, and the functional results were good in 5 cases, fair in 6 cases, and poor in 1 case. The most common complication was pin tract infection, which occurred in all cases, but there were no major complications, such as nerve or vascular injury. CONCLUSION: Tetrafocal and pentafocal bone transport using Ilizarov technique could be an alternative treatment option in selected cases with distal tibial defect > 6 cm. It could shorten the distraction period, fasten regeneration, and reduce the associated complications.

The stimulative function of long noncoding RNA CDKN2B-AS1 in osteosarcoma by targeting the microRNA-122/CCNG1 axis.

Osteosarcoma (OS), a prevalent aggressive malignancy in the bone, has limited therapeutic targets and diagnostic biomarkers. In the current investigation, RT-qPCR showed that CDKN2B-AS1 was enhanced in OS samples and cells. This research was set to examine the modulation of CDKN2B-AS1 in OS. The expression of CDKN2B-AS1 and downstream molecules was analyzed by RT-qPCR method. CCK8, EdU staining along with Transwell assays were applied to evaluate cell proliferation and invasion. Those in vitro investigations specified that silencing of CDKN2B-AS1 with shRNAs obviously impeded the proliferation and invasion of MG63 cells. To authenticate the relationships between CDKN2B-AS1 and microRNA-122-5p (miR-122-5p) or cyclin G1 (CCNG1) and miR-122-5p, we next employed luciferase reporter assay. We displayed that CDKN2B-AS1 repressed miR-122-5p to restore CCNG1 expression. All in all, our findings substantiated the indispensable function of CDKN2B-AS1 in OS progression and the possible molecular mechanism.

Risk factors of pin tract infection during bone transport using unilateral external fixator in the treatment of bone defects.

BACKGROUND: The bone transport using the unilateral external fixator, one of the Ilizarov techniques, is widely practiced in lower limb reconstructive surgery. Pin tract infection (PTI), one of most common complication, has become the important postoperative problems which plague clinicians gradually. METHODS: A group of 130 patients who received bone transport surgery for tibia or femur defects using the unilateral external fixation (Orthofix limb reconstruction system, Verona, Italy) and met the inclusion criteria were selected for the study from 2015 to 2019. Regular pin tract care was performed twice a day, and the conditions of the pin tract were evaluated by the same observer using clinical appearance criteria. The Saw's classification of PTI was used to assess the condition around screws. After the data were significant by the T-test or Pearson's Chi-square test analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of PTI. RESULTS: Ninety-one males and thirty-nine females with a mean age of 43 years (range 28-58 years) were included in this cohort. 7816 observations were documented from 12 to 36 months, and 58 cases (44.6%) of PTI (thirty-nine cases in grade 1, 17 cases in grade 2, and 2 cases in grade 3). The top five risk factors were agricultural work (OR 1.86, CI 0.94-2.39), non-urban living (OR 1.75, CI 1.24-3.26), male (OR 1.71, CI 1.02-2.31), smoking (OR 1.53, CI 0.76-1.89), and diabetes (OR 1.26, CI 1.12-2.64). No long-term sequelae were observed at the latest clinical visit. CONCLUSION: Occupation, gender, living environment (non-urban), smoking, and diabetes were the top five significant risk factors for PTI in the period of bone transport using unilateral external fixation. Awareness of predictable risk factors of PTI is beneficial to avoid or early detect the severe complications which can affect the effectiveness.

Risk factors associated with infection recurrence of posttraumatic osteomyelitis treated with Ilizarov bone transport technique-a retrospective study of 149 cases.

BACKGROUND: Post-traumatic tibial osteomyelitis is considered as complex clinical problem due to its unique characteristics such as prolonged course, multi-staged treatment and high recurrence rate. The purpose of this study is to identify and analyze the causes and risk factors associated with infection recurrence of tibial osteomyelitis treated with Ilizarov technique. METHODS: From January 2011 to January 2019, a total of 149 patients with post-traumatic tibial osteomyelitis treated with Ilizarov bone transport technique were included in this study. Demographic and clinical data were collected and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the recurrence or reinfection of post-traumatic tibial osteomyelitis after treated with Ilizarov bone transport technique. RESULTS: All included patients were successfully followed up with an average of 37.5 month (18-78 month), among them, 17 patients (11.4%) occurred with recurrence or reinfection of tibial osteomyelitis in which 2 cases were in distraction area and 15 cases in docking site. Among them, 5 patients were treated successfully with appropriate intravenous antibiotic, the remaining 12 patients were intervened by surgical debridement or bone grafting after debridement. Univariate analysis showed that Pseudomonas aeruginosa infection, bone exposure, number of previous operations (> 3 times), blood transfusion during bone transport surgery, course of osteomyelitis > 3 months, diabetes was associated with recurrence or reinfection of postoperative tibial osteomyelitis. According to the results of logistic regression analysis, Pseudomonas aeruginosa infection, bone exposure, and the number of previous operations (> 3 times) are risk factors for recurrence or reinfection of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique, with odds ratios (OR) of 6.055, 7.413, and 1.753, respectively. CONCLUSION: The number of previous operations (> 3 times), bone exposure, and Pseudomonas aeruginosa infection are risk factors for infection recurrence of posttraumatic tibial osteomyelitis treated with Ilizarov bone transport technique.

Risk factors of ankle osteoarthritis in the treatment of critical bone defects using ilizarov technique.

BACKGROUND: Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis (OA) progression and severity are often associated with the period of external fixator and the greater relative instability of the ankle joint, but few studies have quantified risk factors directly during this technique. METHODS: The study was conducted on 236 patients who underwent bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. The cumulative incidence of ankle OA diagnoses in patients after the Ilizarov technique treatment was calculated and stratified by risk factors from preoperative and postoperative management. After the data were significant through the Mann-Whitney U test analyzed, odds ratios were calculated using logistic regression to describe factors associated with the OA diagnosis including gender, age, BMI, location of bone defect, diabetes, hypertension, osteoporosis, the history of metal allergy and glucocorticoid intake, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-HF scale scores, defect size (DS), the type of bone transport, the bone union time, external fixator time (EFT), and external fixator index (EFI). RESULTS: There were 199 males and 37 females with a mean age of 47 years (range 28-59 years). Out of 236 patients, 49 had an additional treatment for ankle OA after the Ilizarov technique treatment of bone defects (average follow-up time 2.1 years, range 1.6-4.2 years). The incidence of postoperative ankle OA was 20.8 %, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The top five risk factors included double-level bone transport (OR3.79, P = 0.005), EFI > 50days/cm (OR3.17, P = 0.015), age > 45years (OR2.29, P = 0.032), osteoporosis (OR1.58, P < 0.001), BMI > 25 (OR1.34, P < 0.001). Male, BMI > 25, diabetes, osteoporosis, and AOFAS ankle-HF scale scores are the independent risk factors. CONCLUSIONS: Ilizarov external circular fixator is a safe and effective method of treatment for critical bone defects. The double level bone transport, EFI > 50days/cm, age > 45years, osteoporosis, BMI > 25 are the top five relevant risk factors of ankle OA. The probability of developing ankle OA among patients having three or more risk factors is 50-70 %.

Reconstruction of Soft Tissue Defects and Bone Loss in the Tibia by Flap Transfer and Bone Transport by Distraction Osteogenesis: A Case Series and Our Experience.

OBJECTIVE: The aim of this study is to evaluate the clinical outcome of flap transfer followed by delayed bone transport using external fixator on the soft tissue defect with segmental tibial loss. METHODS: A total of 14 patients with soft tissue defects and bone loss were treated with flap transfer combined followed by delayed bone transport using external fixator from January 2010 to January 2017 and, successfully, follow-up were included. Demographic data and data on clinical outcomes and complications were obtained from hospital record. The mean age was 35.5 years, and the average time from injury to reconstructive surgery was 4.14 months. The average soft tissue and bone defect sizes were 33.57 cm and 7.04 cm, respectively. Local or free flap was created to reconstruct the soft tissue defects. The Ilizarov external fixator or Orthofix limb reconstruction system (OLRS) was used to reconstruct bony defects by bifocal or trifocal bone transport using delayed distraction osteogenesis. The functional results were evaluated by Association for the Study and Application of the Method of Ilizarov scoring system, and all postoperative complications were recorded. RESULTS: The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24-38 months). All wounds healed after 1-stage operation, and all transferred flaps were survived. The average interval between flap coverage and bone transportation was 13.4 weeks (range, 8-24 weeks). Eight patients used bifocal, and 6 patients used trifocal approach for bone transportation. An average external fixation time was 208.5 days (range, 168-235 days) and external fixation index was 33.6 days/cm (range, 18.8-46.5 days/cm). Superficial necrosis of the flap edge was noted in 4 cases, after debridement and regular dressing, the flap healed successfully. Bone union was achieved in all patients except 4 cases that occurred with docking site nonunion which achieved satisfactory union after application of accordion maneuver and autografting of iliac bone. All patients achieved satisfactory functional recovery and were able to walk normally. CONCLUSIONS: The flap transfer followed by delayed distraction osteogenesis using external fixator which can be used for successful reconstruction of bone and soft tissue defects in lower leg.

Bifocal or Trifocal (Double-Level) Bone Transport Using Unilateral Rail System in the Treatment of Large Tibial Defects Caused by Infection: A Retrospective Study.

OBJECTIVE: The aim of this study is to assess the clinical results of bifocal or trifocal bone transport using unilateral rail system in the treatment of large tibial defects caused by infection. METHODS: There were a total of 37 eligible patients with an average age of 40.11 ± 10.32 years (range, 18-57 years; 28 males and nine females) with large tibial defects due to infection who were admitted to our hospital from June 2006 to June 2016. Among the patients, 21 underwent bifocal bone transport (BF group), and the remaining 16 were treated with trifocal bone transport (TF group). The demographic data (age, sex, interval duration before bone transport, previous operation time), intraoperative outcomes (size and location of the defect, size of soft tissue defect), postoperative variables (lengthening speed, external fixation index, duration of regenerate consolidation and docking union), postoperative bone and functional outcomes evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification (muscle contraction, axial deviation, delayed consolidation, pin problems, repeated fracture, joint stiffness and others) of the two groups were recorded and compared at a minimum follow-up of 24 months. RESULTS: The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24-38 months). There was no statistically significant difference in the demographic data, intraoperative outcomes including size and location of the defect, size of soft tissue defect, as well as postoperative complications. However, postoperative functional result in the TF group were superior to those in the BF group at a minimum follow-up of 24 months, and lengthening speed, external fixation index (EFI), duration of regenerate consolidation and docking union were significantly reduced in the TF group when compared with the BF group. CONCLUSIONS: Treatment of large tibial defects caused by infection with trifocal bone transport using unilateral rail system could significantly improve postoperative functional recovery and reduce duration of regenerate consolidation and docking union. The present study provides novel insight for the treatment of large tibial defects caused by infection.

Precise Resection of Macrodactyly Under Assistance of Three-Dimensional Reconstruction Technology: A Case Report.

Macrodactyly of the foot is an extremely rare congenital malformation characterized by an increase in the size of all the elements or structures of a digit or digits. Most sources indicate that macrodactyly affects the hand more often than the foot. This rare medical condition usually requires surgical intervention with a precise preoperative plan and postoperative rehabilitation. We present a case of macrodactyly of the right foot in which surgical reduction of the foot under assistance of 3-dimensional image technology was performed with satisfying cosmetic and functional outcomes.

Application of custom anatomy-based nerve conduits on rabbit sciatic nerve defects: in vitro and in vivo evaluations.

The intermingling of regenerated nerve fibers inside nerve grafts is the main reason for mismatched nerve fibers. This is one of the key factors affecting limb function recovery after nerve injury. Previous research has shown that the accuracy of axon regeneration can be improved by a bionic structural implant. To this aim, iodine and freeze-drying high-resolution micro-computed tomography was performed to visualize the 3D topography of the New Zealand rabbit sciatic nerve (25 mm). A series of 1-, 2-, 3-, and 4-custom anatomy-based nerve conduits (CANCs) were fabricated based on the anatomical structure of the nerve fascicle. The match index, luminal surface, and mechanical properties of CANCs were evaluated before implanting in a 10-mm gap of the sciatic nerve. Recovery was evaluated by histomorphometric analyses, electrophysiological study, gastrocnemius muscle weight recovery ratio, and behavioral assessments at 12 and 24 weeks postoperatively. The accuracy of nerve regeneration was determined by changes in fluorescence-labeled profile number during simultaneous retrograde tracing. Our results showed that the optimal preprocessing condition for high-resolution micro-computed tomography visualization was treatment of the sciatic nerve with 40% Lugol's solution for 3 days followed by lyophilization for 2 days. In vitro experiments demonstrated that the match index was highest in the 3-CANC group, followed by the 2-, 1-, and 4-CANC groups. The luminal surface was lowest in the 1-CANC group. Mechanical properties (transverse compressive and bending properties) were higher in the 3- and 4-CANC groups than in the 1-CANC group. In vivo experiments demonstrated that the recovery (morphology of regenerated fibers, compound muscle action potential, gastrocnemius muscle weight recovery ratio, pain-related autotomy behaviors, and range of motion) in the 3-CANC group was superior to the other CANC groups, and achieved the same therapeutic effect as the autograft. The simultaneous retrograde tracing results showed that the percentages of double-labeled profiles of the 2-, 3-, and 4-CANC groups were comparatively lower than that of the 1-CANC group, which indicates that regenerated nerve fascicles were less intermingled in the 2-, 3-, and 4-CANC groups. These findings demonstrate that the visualization of the rabbit sciatic nerve can be achieved by iodine and freeze-drying high-resolution micro-computed tomography, and that this method can be used to design CANCs with different channels that are based on the anatomical structure of the nerve. Compared with the 1-CANC, 3-CANC had a higher match index and luminal surface, and improved the accuracy of nerve regeneration by limiting the intermingling of the regenerated fascicles. All procedures were approved by the Animal Care and Use Committee, Xinjiang Medical University, China on April 4, 2017 (ethics approval No. IACUC20170315-02).

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation. Methods A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014.Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases.The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery. Results All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recov鄄ered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the muscu鄄locutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3.In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively. Conclusion Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Clinical outcomes of contralateral 7th cervical nerve transfer in the treatment of total brachial plexus root avulsion in Xinjiang Autonomous Region / 中华显微外科杂志

Objective@#To evaluate the long-term functional recovery after contralateral 7th cervical nerve(C7) transfer with brachial plexus root avulsion and the effect on the contralateral limbs after operation.@*Methods@#A total of 83 patients with injory of brachial plexus avulsion were underwent contralateral C7 transfer from September, 2004 to December, 2014. Among them, contralateral C7 were transferred to the median nerve in 33 cases, to radial nerve in 14 cases, to musculocutaneous nerve in 22 cases, and simultaneous transfer to median and musculocutaneous nerve in 14 cases. The followed-up contents included recovery of muscular strength and sensory innervated by the recipient nerve, bilateral limbs synergistic activity and the effect on the contralateral limbs after the surgery.@*Results@#All 83 cases were successfully followed-up for 3.2-6.2 years (average, 4.5 years), and found no significant effect on function of the contralateral limbs. In the group of C7 transferred to the median nerve group, 10 cases had muscle strength recovered≥M3, and 26 cases had sensory recovered≥S3; In the group of C7 transferred to the radial nerve, 6 cases had muscle strength recovered≥M3, and 9 cases had sensory recovered ≥S3; In the group of C7 transferred to the musculocutaneous nerve, 12 cases had muscle strength recovered≥M3, and 17 cases had sensory recovered≥S3. In the group of C7 simultaneous transferred to the median and musculocutaneous nerve, 6 cases had muscle strength of wrist and digital flexion recovered≥M3, 5 cases had elbow flexion recovered≥M3, 9 and 10 cases had sensory of innervated area and lateral forearm region recovered≥S3, respectively.@*Conclusion@#Contralateral C7 transfer is an ideal procedure for the treatment of total brachial plexus root avulsion with definitive clinical outcomes.

Application of the bionic multi-channel nerve conduit in the rabbit sciatic nerve defect by reducing mismatch of regenerated nerve fibers / 中华显微外科杂志

To investigate the role of the bionic multi-channel nerve conduit by reducing mis-match of regenerated nerve fibers in the rabbit sciatic nerve defect. Methods The experiment was conducted from July, 2017 to February, 2019. A total of 55 New Zealand white rabbits were randomly divided into two groups (First group, n=30 and Second group, n=25).There were 5 subgroups (n=6) in the first group, which were autograft and cus-tom-anatomic nerve conduits (CANC) with different channel (1-CANC, 2-CANC, 3-CANC, 4-CANC) that implanted to repair the rabbit sciatic nerve defect (10 mm). The electrophysiological, triceps muscle wet weight recovery rate, histological study and ankle index analysis were used to evaluate the treatment of each group at 12 and 24 weeks postoperatively. There were 5 subgroups (n=5) in the second group. The simultaneous retrograde tracing method was applied to compare with the number of mismatched nerve fibers at 24 weeks postoperatively. All data were recorded and analyzed by One-way ANOVA method, the Turkey’s method was used to compare the differences between each subgroup. The difference was considered to be statistically significant if P＜0.05. Results The autograft group showed the best recovery in the electrophysiology, histology study and ankle index at 12 and 24 weeks postoperatively (P＜0.05).Histology results showed that the same number of myelinated nerve fibers in all CANC group (P＞0.05), but di-ameters of nerve fiber and myelin thickness were higher in 2-CANC and 3-CANC [(10.67±0.56) μm,(10.65±0.53) μm, respectively] compared with 1-CANC and 4-CANC groups [(8.43±0.63) μm, (9.03±0.55) μm, respectively].The differ-ences were similar in electrophysiological, wet weight recovery rate of triceps muscle, histological study and ankle index analysis.Simultaneous retrograde tracing showed that the autograft group had highest total number of labeled profiles, but no significant difference of the total number of labeled profile was showed among the CANC groups. However, the 1-CANC group[(7.1±2.4) %] showed highest percentage of the FB-NY-neurons than other CANC groups[(2.7±1.9)% in 2-CANC, (2.5±2.3) % in 3-CANC, and (2.2±1.2)% in 4-CANC](P＜0.05). Conclusion The autograft group showed the best results among all groups.Compared with the 1-CANC group, the 2-CANC and 3-CANC group obtained more mature regenerated nerve fibers and with a fewer mismatch rate.Moreover, that did not affect the number of regenerated fibers.

The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect.

OBJECTIVE: To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS: The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS: The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS: Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.

Outcomes of post-traumatic tibial osteomyelitis treated with an Orthofix LRS versus an Ilizarov external fixator.

OBJECTIVE: To compare the therapeutic effects of the Orthofix limb reconstruction system (LRS) versus the Ilizarov external fixator on osteomyelitis of a tibial bone defect. MATERIALS AND METHODS: Among 153 patients hospitalized for bone lengthening therapy from January 1, 1996 to January 1, 2015, 129 patients were selected for a retrospective analysis. Forty-three of the candidate patients were treated using the Orthofix LRS and the other 86 were treated using an Ilizarov external fixator. The average follow-up was 96 months. We evaluated the patients at follow-up visits, and compared the length of time the patients wore the fixation devices. We also examined the scores of Activities of Daily Living (ADL) tests and a Self-rated Anxiety Scale (SAS), the range of motion, and the incidence of pin track infections. RESULTS: The results indicated that both approaches were effective for treating the bone defect. Compared with the patients who wore an Ilizarov fixator for the treatment of post-traumatic osteomyelitis, those who wore an Orthofix LRS tended to be more satisfied with their quality of life and the outcome after the operation. CONCLUSION: Although both approaches were effective for treating the bone defect, the overall patient outcomes were superior for the Orthofix LRS, suggesting that it should be considered as the first option in the treatment of traumatic osteomyelitis of the tibial diaphysis.

Treatment of post-traumatic tibial osteomyelitis by two-stage bone transport combined with induced membrane technique / 中华创伤骨科杂志

Objective To study the clinical efficacy of two-stage bone transport combined with induced membrane technique in the treatment of post-traumatic tibial osteomyelitis.Methods A retrospective study was conducted of the 14 patients with post-traumatic tibial osteomyelitis who had been treated by two-stage bone transport combined with induced membrane technique from February 2009 to August 2015.They were 12 males and 2 females,aged from 26 to 59 years (average,40.4 years).By the Cierny & Mader classification,they all belonged to type Ⅳ.Their disease course ranged from 6 to 30 months,averaging 15.3 months.The number of their previous operations ranged from 2 to 6 times,averaging 3.3 times.In the first stage of operation,tibial extended external fixation was installed according to preoperative design,followed by early debridement and extensive removal of osteomyelitis lesion.The length of bone defect after resection of osteomyelitis lesion was from 4 to 18 cm (average,8.5 cm).10％ vancomycin-contained polymethyl methacrylate (PMMA) bone cement was molded and placed in the bone defects.In the second stage of operation,the PMMA-induced membrane was opened to remove the PMMA bone cement,the bone marrow was drilled through and the induced membrane was then sutured up.Tibial osteotomy was conducted at an appropriate part.The average interval between the first and second stages was from 4 to 7 weeks (average,4.8 weeks).The clinical efficacy was evaluated according to the Paley criteria at final follow-ups.Complications were recorded.Results All the patients were followed up for 15 to 50 months (17.5 months).No relapse of osteomyelitis occurred.The total treatment time ranged from 11 to 19 months,with an average of 14.7 months.The total time for external fixation was from 10 to 18 months,averaging 13.2 months.The external fixator indexes ranged from 31 to 75 day/cm,with an average of 48.5 day/cm.According to Paley criteria at final follow-ups,the clinical efficacy was excellent in 11 and good in 3 cases.Pin tract infection occurred in 9 patients,mal-alignment after removal of external fixation in 6,and malunion or nonunion at the docking site in 5.Conclusions Two-stage bone transport combined with induced membrane technique can cure thoroughly post-traumatic tibial osteomyelitis.Its operation procedures are simple but effective.

[APPLICATION OF THREE-DIMENSIONAL PRINTING CUSTOMIZED BONE CEMENT MODELS ON REPAIR OF BONE DEFECT OF LIMBS].

OBJECTIVE: To determine the feasibility of fabricating molds using a three-dimensional (3D) printer for producing customized bone cement for repairing bone defect. METHODS: Between February 2015 and March 2016, 13 patients with bone defects were treated. There were 9 males and 4 females with an average age of 38.4 years (range, 20-58 years), including 7 cases of chronic osteomyelitis, 3 cases of bone tuberculosis, 2 cases of bone tumor, and 1 case of ischemic necrosis. The defect located at the humerus in 3 cases, at the femur in 4 cases, and at the tibia in 6 cases. The defect ranged from 4.5 to 8.9 cm in length (mean, 6.7 cm). Before operation, Mimics10.01 software was used to design cement prosthesis, 3-matic software to design shaping module which was printed by 3D technology. After removal of the lesion bone during operation, bone cement was filled into the shaping module to prepare bone cement prosthesis for repairing defect. RESULTS: The measurement result from Image J software showed that the match index of interface between the mirror restored digital and bone interface was 95.1%-97.4% (mean, 96.3%); the match index of interface between bone cement prosthesis and bone interface was 91.2%-94.7% (mean, 93.2%). It was one time success during separation between formed bone cement and shaping module without any shatter or fall off. All incisions healed by first intention. The cases were followed up 5-17 months (mean, 9.4 months). X-ray films and CT scans showed good position of bone cement prosthesis without any fracture; no peripheral fracture occurred. CONCLUSIONS: 3D printing customized bone cement shaping module can shorten the operation time, and customized bone cement prothesis has good match with bone interface, so it can avoid further adjustment and accord with the biomechanical rules of surgical site.

Comparison of vacuum sealing drainage and shoelace technique for leg fasciotomy wounds / 中国组织工程研究

BACKGROUND:Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports. OBJECTIVE:To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds. METHODS:A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation;in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam fol owed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups. RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

Epidemiological analysis of brachial plexus injury in the Xinjiang region trauma center / 中华显微外科杂志

Objective To investigate the brachial plexus injury patients regional and national characteristics,epidemiological characteristics.Methods Reference to foreign brachial plexus injury epidemiology survey methodology,retrospective analysis of five representative hospitalsthe trauma center in Urumqi,Xinjiang during January 2010 and May 2013 were treated 166 cases of patients with brachial plexus injury medical records.Results The incidence rate of brachial plexus injury was 1.17％ in this 5 trauma center.From 20 to 49 age group accounted for 69.87％,the ratio of male to female was 4.53:1.Workers and farmers accounted for 51.8％,Uygur,Han accounted for respectively 62.04％,24.69％.Kashi,Aksu,Urumqi accounted for respectively 22.89％,12.04％,8.43％.Motor vehicle accidents,high-altitude fall injury and injuries caused by birth trauma accounted for respectively 33.73％,31.92％ and 9.67％.Injury type:root,trunk,bundle/bundle branch injury cases accounted for respectively 28.91％,27.10％,40.36％.Conclusion Brachial plexus injury occurs mainly in young men with low income,motor vehicle accidents,and high-altitude fall injury are dangerous injury factors,different nationalities,different areas occurs constitutes obvious difference,neonatal birth trauma caused by brachial plexus injury constitute relatively high.