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1.
Artículo en Inglés | MEDLINE | ID: mdl-33819322

RESUMEN

The purpose of this study was to evaluate vertical and horizontal alveolar resorption after the extraction of eight single maxillary molars using solvent-dehydrated bone allograft (Puros) covered with a nonresorbable membrane for ridge preservation. At implant placement 4 months later, ridge dimensions were measured clinically and radiographically and compared to baseline, and a histologic analysis was performed. The mean buccal height decreased by 1.51 mm at midpoint, 0.88 mm mesially, and 1.16 mm distally. The implants were placed without additional ridge augmentation, and six of eight required an internal sinus elevation. Within the limits of this study, this technique succeeded in preserving the alveolar bone.


Asunto(s)
Aumento de la Cresta Alveolar , Tomografía Computarizada de Haz Cónico Espiral , Aloinjertos , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/cirugía , Trasplante Óseo , Humanos , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Proyectos Piloto , Politetrafluoroetileno , Solventes , Extracción Dental , Alveolo Dental/cirugía
2.
Artículo en Inglés | MEDLINE | ID: mdl-33808616

RESUMEN

In the literature, autogenous dentin is considered a possible alternative to bone substitute materials and autologous bone for certain indications. The aim of this proof-of-concept study was to use autogenous dentin for lateral ridge augmentation. In the present retrospective study, autogenous dentin slices were obtained from teeth and used for the reconstruction of lateral ridge defects (tooth-shell technique (TST): 28 patients (15 females, 13 males) with 34 regions and 38 implants). The bone-shell technique (BST) according to Khoury (31 patients (16 females, 15 males) with 32 regions and 41 implants) on autogenous bone served as the control. Implants were placed simultaneously in both cases. Follow-up was made 3 months after implantation. Target parameters during this period were clinical complications, horizontal hard tissue loss, osseointegration, and integrity of the buccal lamella. The prosthetic restoration with a fixed denture was carried out after 5 months. The total observation period was 5 months. A total of seven complications occurred. Of these, three implants were affected by wound dehiscences (TST: 1, BST: 2) and four by inflammations (TST: 0, BST: 4). There were no significant differences between the two groups in terms of the total number of complications. One implant with TST exhibited a horizontal hard tissue loss of 1 mm and one with BST of 0.5 mm. Other implants were not affected by hard tissue loss. There were no significant differences between the two groups. Integrity of the buccal lamella was preserved in all implants. All implants were completely osseointegrated in TST and BST. All implants could be prosthetically restored with a fixed denture 5 months after augmentation. TST showed results comparable to those of the BST. Dentin can therefore serve as an alternative material to avoid bone harvesting procedures and thus reduce postoperative discomfort of patients.


Asunto(s)
Aumento de la Cresta Alveolar , Sustitutos de Huesos , Trasplante Óseo , Dentina , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos
3.
Int J Oral Maxillofac Implants ; 36(2): 242-247, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909713

RESUMEN

PURPOSE: Bone graft materials and soft tissue allografts are widely used in clinical practice to counteract physiologic postextraction site tridimensional shrinkage. The aim of this study was to test if plasma of argon treatment could have a bioactivation effect on hard and soft tissue scaffolds in clinical usage. MATERIALS AND METHODS: Forty-eight bovine bone matrix and porcine collagen samples were subdivided into two groups (test and control) of 12 samples each. The test group was treated with argon plasma (10 W, 1 bar for 12 minutes), while the control group was left untreated. Immediate cell adhesion and a proliferation assay at 72 hours were performed in the perfusion chamber of a bioreactor. Additionally, micro-CT analysis was performed on the treated and untreated scaffolds, before and after soaking in cell culture medium (four samples). RESULTS: Osteoblasts seeded on plasma-treated bone matrix significantly increased the adhesion level compared with the untreated sample (43,144.3 ± 12,442.9 vs 21,736 ± 77,27.1; P = .0083). However, 3-day proliferation tests could not achieve significant differences between groups (105,715.5 ± 21,751.5 vs 107,108.6 ± 19,343.4; P = .998). No differences were measured on fibroblast adhesion on the collagen matrix in both conditions. Plasma of argon treatment and soaking in cell culture medium did not affect the bone matrix samples. The structure of collagen matrix samples was unaltered after plasma treatment, but became enlarged after soaking. CONCLUSION: Plasma of argon may be useful to biofunctionalize bone grafts, although benefits seemed to disappear after 3 days. No biologic response was detected on collagen matrix scaffolds. In vivo studies are needed to draw final clinical conclusions.


Asunto(s)
Matriz Ósea , Gases em Plasma , Animales , Argón , Trasplante Óseo , Bovinos , Colágeno , Porcinos , Andamios del Tejido
4.
Int J Oral Maxillofac Implants ; 36(2): 295-306, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33909719

RESUMEN

PURPOSE: The aim of this study was to explore the influence of different bone grafts, demineralized freeze-dried bone allograft (DFDBA, OraGraft), and deproteinized bovine bone mineral (DBBM, Bio-Oss) implanted in mouse calvaria defects on gene expression. MATERIALS AND METHODS: Male C57BL/6MLac mice were separated into three groups as follows: group 1-defect without graft as control, group 2-DFDBA, and group 3-DBBM. Affymetrix DNA microarrays were used to characterize gene expression in bone after 3 months of graft healing. Differential expression of designated genes discovered by microarray analysis was confirmed using real-time polymerase chain reaction (PCR) and immunohistochemistry. RESULTS: Compared with normal bone healing, 355 and 1,108 coding genes of bone grafted with DFDBA were upregulated and downregulated, respectively. The upregulated genes were mainly involved in chemokine signaling, macrophage activity, osteoclast activity, cytokine expression, T-cell receptor signaling, apoptosis, and MAPK signaling. The downregulated genes were predominantly involved in calcium regulation in cardiac cells, chemokine signaling, MAPK signaling, and adipogenesis. A total of 306 and 817 coding genes of bone grafted with DBBM were upregulated and downregulated, respectively. The upregulated genes were mainly involved in osteoclast activity, chemokine signaling, B cell receptor signaling, macrophage activity, and signaling of T-cell receptor, MAPK, IL-5, and IL-1. The downregulated genes were predominantly involved in calcium regulation in the cardiac cell and osteoclast activity. Real-time PCR revealed that the DFDBA and DBBM groups showed a higher mRNA level of MMP12, Bcl2A1, S100A4, and Postn compared with the control (P < .05). Histology showed that, compared with the control, the volume of new bone was higher in both types of bone grafts. Immunohistochemistry using an MMP12 antibody confirmed the microarray results because the MMP12 immunoreactivity intensified, and a positive expression of MMP12 increased significantly in the DFDBA and DBBM groups. CONCLUSION: Both DFDBA and DBBM had a gene expression network involved in new bone formation, which coincided with an increased expression of MMP-12 and osteoclast activity. Both types of graft materials appeared to connect with genes that stimulate bone remodeling at 3 months of bone grafting.


Asunto(s)
Sustitutos de Huesos , Implantes Dentales , Aloinjertos , Animales , Trasplante Óseo , Bovinos , Liofilización , Expresión Génica , Xenoinjertos , Masculino , Ratones , Ratones Endogámicos C57BL
5.
Shanghai Kou Qiang Yi Xue ; 30(1): 93-96, 2021 Feb.
Artículo en Chino | MEDLINE | ID: mdl-33907788

RESUMEN

PURPOSE: To investigate the effect of vascularized free fibular flap in repairing segmental mandibular defects. METHODS: Eighty patients with segmental mandibular defects treated in our hospital from June 2015 to May 2018 were enrolled. Both groups of patients were operated by the same group of medical staff with more than 5 years of clinical experience. Patients were divided into 2 groups using a random number table method, 40 in each group. Patients in the control group underwent non-vascularized iliac bone graft while patients in the experimental, group underwent vascularized free fibular bone flap repair. The graft survival, pain, quality of life, negative emotions and complications were compared between the two groups using SPSS 22.0 software package. RESULTS: There was no significant difference in the scores of the proximal gingival papilla, distal gingival papilla, labial margin and labial margin (P>0.05). The gingival texture, color score and total score of the root surface of the experimental group were significantly higher than the control group (P<0.05). The scores of VAS, anxiety and depression in both groups were significantly decreased after operation, but the decrease in the experimental group was greater(P<0.05). Physical function, psychological and social function, life quality of the two groups were significantly increased, but the increase of the experimental group was greater (P<0.05).Three cases (7.5%) developed complications in the control group, including 1 case of pneumonia, 1 case of infection and 1 case of wound recurrence. Two cases(5%) in the experimental group developed of complications, including 1 case of wound recurrence and 1 case of pneumonia, the difference was not statistically significant (P>0.05). CONCLUSIONS: Repair of mandibular segmental defect with vascularized free fibular bone flap can significantly improve the overall effect, relieve pain and negative emotion, improve quality of life of patients and decrease incidence of complications.


Asunto(s)
Colgajos Tisulares Libres , Procedimientos Quirúrgicos Reconstructivos , Trasplante Óseo , Peroné/cirugía , Humanos , Mandíbula/cirugía , Calidad de Vida
6.
Compend Contin Educ Dent ; 42(4): e5-e9, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33891431

RESUMEN

Retrograde peri-implantitis (RPI) is a primary microbial inflammatory condition that affects only the apical portion of an osseointegrated implant, which retains normal bone-to-implant contact in its coronal portion. Currently, no uniformly accepted definition or classification exists for RPI. This article reviews the etiopathological mechanisms, diagnostic pattern, and current treatment modalities for this type of periapical implant bone loss. The prevalence of RPI is reported to be relatively low, and along with a lack of an accepted classification system there is no widely accepted treatment algorithm. Therapeutic options include antibiotics, open-flap implant debridement, and apical resection eventually including apicoectomy of endodontically affected adjacent teeth, with or without bone grafting or removal of the affected implant. Implants with RPI usually remain osseointegrated. A diagnostic approach is proposed to establish the staging of the lesion and determine the best treatment option accordingly. When there is no loss of implant stability the most adequate treatment in the acute and chronic stage is apical resection of the implant with regeneration of the bone defect. If there is implant mobility, extraction of the implant is necessary.


Asunto(s)
Implantes Dentales , Periimplantitis , Diente , Trasplante Óseo , Implantes Dentales/efectos adversos , Humanos , Periimplantitis/diagnóstico , Periimplantitis/etiología , Periimplantitis/terapia
7.
Bone Joint J ; 103-B(4): 795-803, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789467

RESUMEN

AIMS: Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. METHODS: The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). RESULTS: The rates of major complications necessitating further surgery were 62%, 24%, 56%, and 17% for custom-made prostheses, ice-cream cone prostheses, irradiated autografts and nonskeletal reconstructions, respectively (p = 0.001). The ten-year cumulative incidence of failure of the reconstruction was 19%, 9%, 33%, and 0%, respectively. The major cause of failure was deep infection (11%), followed by local recurrence (6%). The mean functional Musculoskeletal Tumour Society (MSTS) scores were 59%, 74%, 64%, and 72%, respectively. The scores were significantly lower in patients with major complications than in those without complications (mean 52% (SD 20%) vs 74% (SD 19%); p < 0.001). For periacetabular resections involving the ilium, the mean score was the highest with custom-made prostheses (82% (SD 10%)) in patients without any major complication; however, nonskeletal reconstruction resulted in the highest mean scores (78% (SD 12%)) in patients who had major complications. For periacetabular resections not involving the ilium, significantly higher mean scores were obtained with ice-cream cone prostheses (79% (SD 17%); p = 0.031). CONCLUSION: Functional outcome following periacetabular reconstruction is closely associated with the occurrence of complications requiring further surgery. For tumours treated with periacetabular and iliac resection, skeletal reconstruction may result in the best outcomes in the absence of complications, whereas nonskeletal reconstruction is a reasonable option if the risk of complications is high. For tumours requiring periacetabular resection without the ilium, reconstruction using an ice-cream cone prosthesis supported by antibiotic-laden cement is a reliable option. Cite this article: Bone Joint J 2021;103-B(4):795-803.


Asunto(s)
Acetábulo/cirugía , Recuperación del Miembro/métodos , Osteosarcoma/cirugía , Huesos Pélvicos/cirugía , Acetábulo/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trasplante Óseo/métodos , Niño , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Osteosarcoma/diagnóstico por imagen , Huesos Pélvicos/diagnóstico por imagen
8.
Bone Joint J ; 103-B(4): 665-671, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789486

RESUMEN

AIMS: We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH). METHODS: This retrospective comparative study included 81 patients with ONFH; 37 patients (40 hips) underwent CVO with BIG (BIG group) and 44 patients (47 hips) underwent CVO alone (CVO group). Patients in the BIG group were followed-up for a mean of 12.2 years (10.0 to 16.5). Patients in the CVO group were followed-up for a mean of 14.5 years (10.0 to 21.0). Assessment parameters included the Harris Hip Score (HHS), Oxford Hip Score (OHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), complication rates, and survival rates, with conversion to total hip arthroplasty (THA) and radiological failure as the endpoints. RESULTS: There were no significant differences in preoperative and postoperative HHS or postoperative OHS and JHEQ between the BIG group and the CVO group. Complication rates were comparable between groups. Ten-year survival rates with conversion to THA and radiological failure as the endpoints were not significantly different between groups. Successful CVO (postoperative coverage ratio of more than one-third) exhibited better ten-year survival rates with radiological failure as the endpoint in the BIG group (91.4%) than in the CVO group (77.7%), but this difference was not significant (p = 0.079). CONCLUSION: Long-term outcomes of CVO with BIG were favourable when proper patient selection and accurate surgery are performed. However, this study did not show improvements in treatment results with the concomitant use of BIG. Cite this article: Bone Joint J 2021;103-B(4):665-671.


Asunto(s)
Trasplante Óseo/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteotomía/métodos , Adolescente , Adulto , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos
9.
Mymensingh Med J ; 30(2): 323-328, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33830109

RESUMEN

Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. This quasi experimental study was done at Mymensingh Medical College Hospital, Dhaka Medical College Hospital and some other private hospitals of Bangladesh. The study includes patients who underwent core decompression and non-vascularized fibular grafting in avascular necrosis of femoral head from January 2017 to December 2018. In this study we evaluated total 20 patients and majority of the patients belongs to the group of 20-30 years. Out of 20 patients, 8 of them were unilaterally involved rest 12 had bilateral involvement. Out of 24 hips of bilateral involvement 4 were grade III and IV (Ficat and Arlet classification) therefore not included in the study. So, we study 28 hips only. The average success rate was 90% after core decompression and non-vascularized fibular bone grafting. Harris hip score of 60 on presentation had poorer outcome. Patients with less than 80 degrees of flexion had poorer outcome.


Asunto(s)
Necrosis de la Cabeza Femoral , Bangladesh , Trasplante Óseo , Descompresión Quirúrgica , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/cirugía , Peroné/cirugía , Estudios de Seguimiento , Humanos , Resultado del Tratamiento
10.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(4): 390-395, 2021 Apr 09.
Artículo en Chino | MEDLINE | ID: mdl-33832044

RESUMEN

Guided bone regeneration technique is a conventional method to repair various bone defects among series of techniques for bone augmentation around implant. Due to the excellent mechanical properties and biological compatibility, titanium mesh has unique advantages in the application of guided bone regeneration technology, such as broad clinical indications, high stability in osteogenesis. Though there are still some complications during the application of titanium mesh, a number of studies have tried to prevent the complications, so as to increase the success rate of bone augmentation surgery. This review elaborates the characteristics of titanium mesh, conventional clinical applications, common complications in application, and the research progress of its application and improvement, in order to provide reference for the improvement of titanium mesh in clinical and research applications.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Regeneración Ósea , Trasplante Óseo , Implantación Dental Endoósea , Mallas Quirúrgicas , Titanio
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 381-386, 2021 Mar 15.
Artículo en Chino | MEDLINE | ID: mdl-33719249

RESUMEN

Objective: To summarize the current progress of vascularized bone grafting in the treatment of osteonecrosis of the femoral head (ONFH), and to provide reference for treatment of ONFH. Methods: The literature at home and abroad on the treatment of ONFH with vascularized bone grafting was reviewed, and the mechanism, operating methods and effectiveness, indications, and complications were summarized. Results: Vascularized bone grafting is a commonly used clinical hip-preserving operation. By replacing necrotic bone tissue with vascularized bone, it can rebuild the blood circulation system, promote the healing of the necrotic area, and provide biomechanical support for the necrotic area of the femoral head, prevent the joint surface collapse. The main operations include the vascularized iliac bone flap grafting, the vascularized greater trochanter bone flap grafting, and the vascularized fibular grafting. The clinical application has achieved certain effectiveness, and the different procedures are suitable for different types of patients. The procedures need to be selected based on the patient's overall condition, the cause of ONFH, the necrosis stage, and the degree of the evaluation. Conclusion: Vascularized bone grafting has a definite effectiveness in the treatment of ONFH in the young and middle-aged. It can significantly improve hip joint function, control the further development of the disease to a great extent, effectively delay or even avoid hip arthroplasty. It is a reliable hip-preserving operation worthy of promotion.


Asunto(s)
Necrosis de la Cabeza Femoral , Cabeza Femoral , Trasplante Óseo , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/cirugía , Peroné , Humanos , Ilion , Persona de Mediana Edad , Resultado del Tratamiento
12.
Bone Joint J ; 103-B(3): 492-499, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641418

RESUMEN

AIMS: Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. METHODS: In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. RESULTS: Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). CONCLUSION: Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492-499.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera , Trasplante Óseo/métodos , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Anciano , Anciano de 80 o más Años , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Falla de Prótesis , España
13.
Bone Joint J ; 103-B(3): 456-461, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641428

RESUMEN

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.


Asunto(s)
Trasplante Óseo/métodos , Fosfatos de Calcio/farmacología , Fémur/cirugía , Ilion/trasplante , Procedimientos Quirúrgicos Reconstructivos/métodos , Tibia/cirugía , Adulto , Artrodesis , Desbridamiento , Femenino , Fémur/lesiones , Fémur/patología , Humanos , Japón , Masculino , Persona de Mediana Edad , Polimetil Metacrilato , Estudios Retrospectivos , Tibia/lesiones , Tibia/patología , Cicatrización de Heridas/efectos de los fármacos
14.
Zhongguo Gu Shang ; 34(1): 73-80, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33666024

RESUMEN

OBJECTIVE: To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process. METHODS: A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups. RESULTS: All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (P>0.05). Intraoperative blood loss was (541.6±35.3) ml in group A, (546.8±27.8) ml in group B, and (540.1±34.5) ml in group C, withno statistically significant difference among three groups(P>0.05). Preoperative anterior vertebral height loss rate was (46.0± 3.1)% in group A, (46.4±3.3)% in group B, and (45.3±3.6)% in group B;at the final follow up, the loss rate of anterior vertebral height among three groups was (8.6±5.0)%, (8.1±4.2)%, (9.4±4.3)%, respectively. There were no statistically significant differences before operation and final follow-up among three groups (P>0.05). Preoperative Cobb angle was (35.1±4.8)° in group A, (35.2±4.5)° in group B and (35.2±4.5)° in group C, with no statistically significant difference among three groups (P>0.05);postoperative at 3 days, Cobb angle in three groups was (15.1±3.6)°, (15.3±3.1)° and (15.2±3.4)°, respectively, there was no statistically significant difference among three groups (P>0.05);at the final follow-up, the Cobb angle among three groups was (17.7±3.3)°, (17.9±3.9)°, (18.6±3.6)°, respectively, with no statistically significant difference among three groups (P>0.05). The time of bone graft fusion was (5.6±0.5) months in group A, (5.6±0.6) months in group B and (5.8±0.6)months in group C, with no statistically significant difference among three groups (P>0.05). Frankel classification at the final follow up, 4 cases were grade B, 7 cases were grade C, 10 cases were grade D, and 86 cases were grade E. Spinal nerve function in all three groups recovered to a certain extent after treatment, with no statistically significant difference among three groups (P> 0.05). Oswestry Disability Index at the final follow-up showed no statistically significant difference among three groups (P> 0.05). CONCLUSION: The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.


Asunto(s)
Fusión Vertebral , Tuberculosis de la Columna Vertebral , Trasplante Óseo , Humanos , Vértebras Lumbares , Estudios Retrospectivos , Costillas/cirugía , Mallas Quirúrgicas , Vértebras Torácicas/cirugía , Titanio , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/cirugía
15.
Zhongguo Gu Shang ; 34(3): 228-34, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-33787166

RESUMEN

OBJECTIVE: To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis. METHODS: From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed. RESULTS: The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (P<0.05). The follow up time was (24.2±5.1) months in group A and (24.0±5.0) months in group B, there was no significant difference between two groups (P>0.05). At the follow-up of 4 months after operation, one patient in group A was found to have enlarged psoas major abscess on the contralateral side, and was cured after secondary operation. No sinus formation, cerebrospinal fluid leakage, internal fixation loosening, fracture or distal junction kyphosis were found during follow-up. The fusion time was (5.1±1.6) months in group A and (5.1± 1.7) months in group B, there was no significant difference between two groups (P>0.05). The VAS, ODI score, sagittal Cobb angle, ESR and CRP value of the lesion segment at the last follow-up of the two groups were significantly improved (P<0.05), but there was no significant difference between two groups (P>0.05). CONCLUSION: The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.


Asunto(s)
Tornillos Pediculares , Fusión Vertebral , Tuberculosis de la Columna Vertebral , Anciano , Trasplante Óseo , Desbridamiento , Femenino , Humanos , Vértebras Lumbares/cirugía , Masculino , Estudios Retrospectivos , Vértebras Torácicas , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/cirugía
16.
Zhongguo Gu Shang ; 34(3): 288-92, 2021 Mar 25.
Artículo en Chino | MEDLINE | ID: mdl-33787177

RESUMEN

OBJECTIVE: To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing. METHODS: From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation. RESULTS: All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening). CONCLUSION: It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Asunto(s)
Fracturas del Fémur , Fijación Intramedular de Fracturas , Fracturas no Consolidadas , Adulto , Clavos Ortopédicos , Placas Óseas , Trasplante Óseo , Femenino , Fracturas del Fémur/cirugía , Fémur , Curación de Fractura , Fracturas no Consolidadas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del Tratamiento
17.
Oral Maxillofac Surg Clin North Am ; 33(2): 231-238, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33663951

RESUMEN

The goals of alveolar cleft repair include (1) stabilization of the maxilla, (2) permitting tooth eruption, (3) eliminating the oronasal fistula, (4) improving aesthetics, and (5) improving speech. Alveolar cleft repair should be considered one of the steps of a larger comprehensive orthodontic management plan. In conjunction with closure of the oronasal fistula, a variety of grafting materials can be used in the alveolar cleft. Autogenous grafts have been found to have greater efficacy compared with allogenic or xenogeneic bone, substitute bone, and alloplasts but with more donor site morbidity.


Asunto(s)
Labio Leporino , Fisura del Paladar , Proceso Alveolar/cirugía , Trasplante Óseo , Fisura del Paladar/cirugía , Estética Dental , Humanos , Maxilar
18.
Oral Maxillofac Surg Clin North Am ; 33(2): 211-229, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33750652

RESUMEN

Osseous grafting serves to restore form and function to craniofacial defects. These grafts have been used with the aim of enhancing osteoinductive, osteoconductive, and osteogenic properties to address vertical and horizontal defects so as to render the edentulous ridge more amenable to implant placement. As the biology of bone grafts continues to be unearthed, the use of adjuvants to augment grafts has proved effective. Three-dimensional printing, tissue engineering with the use of stem cells, immunotyping and hormonal therapy all hold promise for the future in the thrust to discover the ideal graft.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Regeneración Ósea , Trasplante Óseo , Implantación Dental Endoósea , Humanos
19.
Unfallchirurg ; 124(4): 319-332, 2021 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-33666680

RESUMEN

Osteochondral lesions (OCL) of the talus are defined as chondral damage with subchondral involvement. The traumatic etiology is important; in particular, sprains and fractures can lead to lesions of the articular surface and the subchondral plate. As a result, unstable lesions and subchondral cysts can trigger substantial persistent pain and functional impairments. A primary conservative treatment can be considered and is especially recommended in children and adolescents; however, return to previous sports activity and level is often not achieved. The principles of reconstructive surgical management include internal fixation of osteochondral fragments, bone marrow stimulation, autologous membrane-augmented chondrogenesis ± bone grafting, osteochondral transfer, retrograde techniques ± bone grafting, (matrix-associated) autologous chondrocyte implantation and autologous osteoperiosteal graft from the iliac crest. Additional surgical procedures for ankle stabilization and deformity correction should be considered if necessary.


Asunto(s)
Cartílago Articular , Fracturas Intraarticulares , Astrágalo , Adolescente , Artroscopía , Trasplante Óseo , Niño , Humanos , Ilion , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Trasplante Autólogo
20.
Clin Oral Implants Res ; 32(4): 498-510, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33548069

RESUMEN

OBJECTIVES: To present the results of guided bone regeneration (GBR) of atrophic edentulous ridges with customized CAD/CAM titanium meshes. MATERIAL AND METHODS: Forty-one patients, presenting with 53 atrophic sites, were enrolled between 2018 and 2019. GBR was obtained with titanium meshes filled with autogenous bone chips and bovine bone mineral (BBM). After a mean of 7 months (range: 5-12 months), meshes were removed and 106 implants placed. After a mean of 3.5 months (range: 2-5 months), implants were uncovered and prosthetic restorations started. The outcomes were vertical and horizontal bone augmentation changes, biological complications and implant survival. RESULTS: Out of 53 sites, 11 underwent mesh exposure: eight of them were followed by uneventful integration of the graft, while three by partial bone loss. The mean vertical and horizontal bone gain after reconstruction was 4.78 ± 1.88 mm (range 1.00-8.90 mm) and 6.35 ± 2.10 mm (range 2.14-11.48 mm), respectively. At the time of implant placement, mean changes of initial bone gain were -0.39 ± 0.64 mm (range -3.1 to + 0.80 mm) and -0.49 ± 0.83 mm (range -3.7 to +0.4 mm), in the vertical and horizontal dimensions, respectively. Reduction of bone volume was significantly higher (p < .001 for both dimensions) in the exposed sites. The mean follow-up of implants after loading was 10.6 ± 6.5 months (range: 2-26 months). The survival rate of implants was 100%. CONCLUSION: Customized titanium meshes can represent a reliable tool for GBR of severely atrophic sites, with simplification of the surgical phases.


Asunto(s)
Aumento de la Cresta Alveolar , Implantes Dentales , Proceso Alveolar , Animales , Regeneración Ósea , Trasplante Óseo , Bovinos , Implantación Dental Endoósea , Humanos , Estudios Retrospectivos , Mallas Quirúrgicas , Titanio
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