scholarly journals Reconstruction of massive tibial defect caused by osteomyelitis using induced membrane followed by trifocal bone transport technique: a retrospective study and our experience

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yimurang Hamiti ◽  
Maimaiaili Yushan ◽  
Cheng Lu ◽  
Aihemaitijiang Yusufu
Keyword(s):  
Clinical Outcomes ◽  
Operation Time ◽  
Bone Transport ◽  
Fixation Index ◽  
Induced Membrane ◽  
Tibial Defect ◽  
Previous Operation ◽  
Masquelet Technique ◽  
Transport Technique

Abstract Objective To evaluate clinical outcomes of the application of induced membrane followed by trifocal bone transport technique in the treatment of massive tibial defect caused by osteomyelitis. Method A total of 18 eligible patients with tibial defect > 6 cm caused by osteomyelitis who were admitted to our institution from January 2010 to January 2016 and treated by induced membrane followed by trifocal bone transport technique. There were 12 male and 6 females with an average age of 40.4 years old. A detailed demographic data (age, sex, etiology, previous operation time, defect size and location, interval from Masquelet technique to trifocal bone transport technique, external fixation index (EFI), duration of regenerate consolidation and docking union) were collected, bone and functional outcomes were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during and in the period of follow up were recorded and evaluated by Paley classification at a minimum follow-up of 2 years. Results The etiology include posttraumatic osteomyelitis in 13 cases and primary osteomyelitis in 5 cases. An average of previous operation time was 3.4 times. Mean tibial defect after radical debridement was 6.8 cm. An average interval duration from formation of induced membrane to trifocal bone transport was 4.8 weeks. An average of EFI was 37.1 days/cm, the duration of regenerate consolidation and docking union were 124.7 days and 186.4 days, respectively. An average time of follow-up after removal of external fixator was 28.5 month without recurrence of osteomyelitis. The bony outcome was excellent in 6 cases, good in 8 cases, fair in 3 cases and poor in 1 case, and functional outcome was excellent in 4 cases, good in 10 cases, fair in 2 cases and poor in 2 cases. The most common complication was pin tract infection which occurred in 15 cases and there were no major complications such as nerve or vascular injury. Conclusion Massive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes.

scholarly journals Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

scholarly journals Treatment of Diaphyseal Forearm Defects Caused by Infection Using Ilizarov Segmental Bone Transport Technique

2020 ◽  
Author(s):  
Yanshi Liu ◽  
Maimaiaili Yushan ◽  
Zhenhui Liu ◽  
Jialin Liu ◽  
Chuang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Bone Defects ◽  
Bone Transport ◽  
Segmental Bone Transport ◽  
The Mean ◽  
Forearm Bone ◽  
Segmental Bone ◽  
Transport Technique

Abstract Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection.Methods: This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23-57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up.Results: There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p<0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusion: Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

2020 ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background Surgical management of lumbar disc herniation in the hidden zone is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce a safe and effective technique named microscopic extra-laminar sequestrectomy (MELS) for treatment of hidden zone lumbar disc herniation and present clinical outcomes within a two year follow-up period. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with hidden zone lumbar disc herniation were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and herniated fragment were visually exposed using this extra-laminar approach. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 months, ranging from 18 to 24 months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is a safe and effective method in the management of hidden zone lumbar disc herniation. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

scholarly journals Combined use of the Ilizarov non-free bone plasty and Masquelet technique in patients with acquired bone defects and pseudarthrosis

2020 ◽  
Vol 26 (4) ◽  
pp. 532-538
Author(s):  
D.Yu. Borzunov ◽  
◽  
D.S. Mokhovikov ◽  
S.N. Kolchin ◽  
E.N. Gorbach ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Soft Tissues ◽  
Bone Defects ◽  
Bone Transport ◽  
Long Bone ◽  
Cement Spacer ◽  
Technical Problems ◽  
Induced Membrane ◽  
Masquelet Technique ◽  
Membrane Technique

Introduction The Masquelet induced membrane technique is effective in the management of acquired heterogeneous long bone defects and pseudarthrosis. The combination of the Masquelet technology and Ilizarov non-free bone grafting seems promising and reduces the risks of recurrence at long-term in patients with congenital pseudarthrosis. Purpose Presentation of new technological solutions that allow combining the advantages of the Ilizarov bone transport and Masquelet bone grafting in patients with acquired bone defects. Materials and methods Retrospective assessment of the results of bone reconstruction in 10 patients who were treated by a combination of Ilizarov and Masquelet bone grafting technologies to repair long bone defects after failures of previous treatment. Fragments of the biomembrane formed around the cement spacer temporarily replacing the tibial gap after resection bone defect or pseudarthrosis were examined in all patients. The studies were carried out using a Reichard sledge microtome, an AxioScope stereomicroscope and an AxioCam ICc 5 digital camera, a JSM- 840 scanning electron microscope and an INCA-200 Energy X-ray electron probe microanalyzer. Results and discussion The combined Masquelet technique and Ilizarov non-free bone plasty provide the conditions that are favorable for reparative processes of the transported fragments. After removal of the spacer, there is a tunnel formed in the interfragmental gap, the walls of which are made of the induced membrane. Bone transport is carried out without technical problems through the compromised tissues which are debrided at the time of distraction initiation, outside the scars. At the same time, there are low risks of inflammation around the transosseous elements; there is no danger of cutting and perforation of soft tissues by transported fragments. Conclusions Complete organotypic rearrangement of the distraction regenerate with the use of Ilizarov non-free bone plasty and the Masquelet technique excludes the possibility of deformities or fractures at the level of newly formed bone areas. Active distraction histogenesis ensures the closure of soft tissue defects without additional reconstructive plastic interventions. The revealed dependence of the induced membrane blood supply on the method of treatment previously used might be a criterion for predicting the treatment outcome in patients with acquired bone defects and pseudarthrosis.

scholarly journals Radiographic and Clinical Outcomes following Combined Oblique Lumbar Interbody Fusion and Lateral Instrumentation for the Treatment of Degenerative Spine Deformity: A Preliminary Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Kai Wang ◽  
Can Zhang ◽  
Cheng Cheng ◽  
Fengzeng Jian ◽  
Hao Wu
Keyword(s):  
Back Pain ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Operation Time ◽  
Spine Deformity ◽  
Lumbar Interbody Fusion ◽  
Degenerative Spine ◽  
Oblique Lumbar Interbody Fusion

Objective. The authors recently used a combination of minimally invasive oblique lumbar interbody fusion (OLIF) and lateral fixation for the treatment of degenerative spine deformity. The early results were promising. Radiographic and clinical results as well as complications were retrospectively assessed in the current study. Methods. Eleven patients with degenerative spine deformity underwent combined OLIF and lateral instrumentation without real-time electromyography (EMG) monitoring. Radiographic measurements including coronal Cobb angle, central sacral vertebral line (CSVL), lumbar lordosis (LL), sagittal vertebral axis (SVA), pelvic tilt (PT), and LL-PI (pelvic incidence) mismatch were taken preoperatively and at last follow-up postoperatively in all patients. Concurrently, the visual analog score (VAS) for back pain and the Oswestry Disability Index (ODI) score were used to assess clinical outcomes. The fusion rate of OLIF cage, total blood loss, operation time, hospital stay, and complications were also evaluated. Results. At last follow-up, all patients who underwent combined OLIF and lateral instrumentation achieved statistically significant improvement in coronal Cobb angle (from 15.3±4.7° to 5.9±3.1°, p < 0.01), LL (from 34.3±9.0° to 48.2±8.5°, p < 0.01), PT (from 24.2±9.6° to 16.2±6.0°, p < 0.01), LL-PI mismatch (from 15.4±8.7° to 7.0±3.7°, p < 0.01), CSVL (from 2.1±2.2cm to 0.7±0.9cm, p = 0.01), and SVA (from 7.0±3.9cm to 2.9±1.8cm, p < 0.01). VAS for back pain (from 6.9±1.4 to 2.0±0.9, p < 0.05) and ODI (from 39.5±3.1 to 21.9±3.6, p < 0.01) improved significantly after surgery. Conclusions. A combination of OLIF and lateral instrumentation is an effective and safety means of achieving correction of both coronal and sagittal deformity, resulting in improvement of quality of life in patients with degenerative spine deformity. It is a promising way to treat patients with moderate degenerative spine deformity.

scholarly journals Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia

2020 ◽  
Vol 9 (2) ◽  
pp. 279
Author(s):  
Irene K. Sigmund ◽  
Jamie Ferguson ◽  
Geertje A.M. Govaert ◽  
David Stubbs ◽  
Martin A. McNally
Keyword(s):  
External Fixation ◽  
Bone Defect ◽  
Bone Transport ◽  
Defect Size ◽  
Fixation Index ◽  
Segmental Defect ◽  
Docking Site ◽  
The Mean ◽  
Acute Shortening

This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber–Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16–128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) (p = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment (p = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% (p < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.

scholarly journals Three‐dimensional‐printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow‐up of 24 months

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuqi Zhang ◽  
Li Min ◽  
Minxun Lu ◽  
Jie Wang ◽  
Yitian Wang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Clinical Outcomes ◽  
Weight Bearing ◽  
Three Dimensional ◽  
Operation Time ◽  
Pubic Bone ◽  
Type Iii ◽  
3D Printed ◽  
The Mean

Abstract Background Pubic defects resulting from type III hemipelvectomy are commonly not reconstructed due to the need to preserve the weight-bearing axis. However, the opening of the anterior pelvic ring will inevitably lead to increased pelvic instability. To improve long-term pelvic stability, three-dimensional (3D)-printed customized prostheses were designed to reconstruct pubic defects. This study presents and evaluates the short-term clinical outcomes and complications from the use of this construct. Methods Five patients who underwent type III hemipelvectomy and 3D-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analysed. Operation time and blood loss during the operation were recorded. Local and functional recovery was assessed. Prosthetic position and osseointegration were evaluated. Oncology results and complications were recorded. Results The prostheses consisted of three with stems and two without. The mean follow-up time was 23.6 months. At the last follow-up, all five patients were alive with no evidence of disease. No deep infections or local recurrence had occurred. The mean blood loss and mean intraoperative time were 1680 ml and 294 min, respectively. The mean functional MSTS score at the final follow-up was 29.8. Fretting wear around the prosthetic stem was found in 3 patients, while bone wear on the normal-side pubis was found in 2 patients. Osseointegration was observed in all patients. Conclusions 3D-printed customized prostheses for reconstructing pubic bone defects after type III hemipelvectomy showed acceptable early outcomes. The good outcomes were inseparable from the precision prosthesis design, strict surgical procedures, and sensible postoperative management.

scholarly journals Comparison of Clinical Outcomes Between Stand-Alone Oblique Lumber Interbody Fusion and Posterior Lumbar Interbody Fusion for Treatment of Degenerative Lumbar Diseases

2020 ◽  
Author(s):  
Run Peng Guo ◽  
Xian Da Gao ◽  
Pei Yu Du ◽  
Wen Yuan Ding ◽  
Lei Ma
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Operation Time ◽  
Lumbar Interbody Fusion ◽  
Incision Length ◽  
Degenerative Lumbar Diseases

Abstract Background: This study evaluated the clinical and imaging results of oblique lumber interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of degenerative lumbar diseases.Methods: The clinical data of 99 patients with degenerative lumbar diseases in the Third Hospital of Hebei Medical University from January 2016 to January 2018 were analyzed retrospectively. 49 cases were dealt with by OLIF (stand-alone) (OLIF group) and 50 cases with PLIF (PLIF group). Clinical and imaging data were collected before surgery and at each follow-up visit. Clinical data included operation time, blood loss, incision length, length of hospital stay, visual analogue score (VAS), Oswestry dysfunction index (ODI), Japanese orthopaedic association (JOA) scores and complications. imaging measurment included the height of segmental intervertebral space, lumbar lordotic angle, operative segmental lordotic angle and fusion rate. The relationship between clinical results and radiology was assessed by comparing the radiological results before and after operation.Results: 99 cases of interbody fusion were performed successfully, and all patients had clinical improvement. The follow-up time was 24-38 months. The operation time, intraoperative blood loss, incision length and hospital stay in OLIF group were significantly less than those in the PLIF group (p<0.05). The intervertebral disc height, lumbar lordotic angle and operative segmental lordotic angle in the two groups were significantly enhanced compared with those before operation, and the difference was statistically significant (p<0.05). All of them achieved satisfactory fusion effect. Complications were found in 5 cases in OLIF group and 13 cases in PLIF group.Conclusion: Both OLIF and PLIF are effective in the treatment of degenerative lumbar diseases. Compared with PLIF, OLIF has a lot advantages in early stage after operation, However, similar clinical outcomes were achieved in the two approaches at mid-term follow-up visit.

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