From the view of the potential risks of allogeneic bone products in clinical use. the key aspects of risk control and quality management for these products are discussed, as well as the general problems existing in the quality management system of their production enterprises in China are briefly introduced.
Bone Transplantation ; instrumentation ; methods ; Humans ; Quality Control ; Risk Assessment ; Transplantation, Homologous ; adverse effects ; instrumentation ; methods

OBJECTIVETo develop a percutaneous and transpedical interbody bone grafting apparatus for vertebral bone defect reconstruction in thoracolumbar fracture correction via minimally invasive operation.

METHODSThe percutaneous and transpedical interbody bone grafting apparatus was designed with CAD software, and the reduction effect, range of bone grafting and surgical complications of the apparatus were investigated in adult cadaveric thoracolumbar body and with computerized surgical simulation.

RESULTSThe self-designed apparatus was convenient for percutaneous and transpedical interbody bone grafting that did not give rise to complications. CT showed large bone grafting area with increased density in the vertebral body corrected with this apparatus.

CONCLUSIONThe designed apparatus allows easy manipulation and efficient bone grafting and repositioning. Minimally invasive interbody bone grafting in thoracolumbar fracture can be easily performed with proper application of the apparatus.

Bone Transplantation ; instrumentation ; Equipment Design ; Humans ; Radiography ; Reconstructive Surgical Procedures ; instrumentation ; Thoracic Vertebrae ; diagnostic imaging ; surgery

Following a post-traumatic incident, orthopaedic surgeons often struggle to look for an abundant source of alternative bone graft because the bone defect is too big or when nonunion is refractory to treatment. We present two cases where the patients' bone grafts were harvested from the healthy femur. This process involved the use of a new intramedullary reamer, which allowed the bone graft to be harvested simultaneously during the reaming process.
Adult ; Bone Transplantation ; instrumentation ; methods ; Equipment Design ; Femur ; pathology ; Humans ; Male ; Middle Aged ; Therapeutic Irrigation ; Tissue and Organ Harvesting ; instrumentation ; methods

Nanostructured materials are gaining new impetus owing to the advancements in material fabrication techniques and their unique properties (their nanosize, high surface area-to-volume ratio, and high porosity). Such nanostructured materials mimic the subtleties of extracellular matrix (ECM) proteins, creating artifi cial microenvironments which resemble the native niches in the body. On the other hand, the isolation of mesenchymal stem cells (MSCs) from various tissue sources has resulted in the interest to study the multiple differentiation lineages for various therapeutic treatments. In this review, our focus is tailored towards the potential of biomimetic nanostructured materials as osteoinductive scaffolds for bone regeneration to differentiate MSCs towards osteoblastic cell types without the presence of soluble factors. In addition to mimicking the nanostructure of native bone, the supplement of collagen and hydroxyapatite which mimic the main components of the ECM also brings signifi cant advantages to these materials.
Biomimetics ; instrumentation ; methods ; Bone Transplantation ; Collagen Type I ; Extracellular Matrix ; Humans ; Mesenchymal Stromal Cells ; Nanostructures ; Osteogenesis ; Tissue Engineering ; instrumentation ; methods

OBJECTIVETo modify a percutaneous transpedical interbody bone grafting apparatus for better surgical performance in transpedical interbody bone grafting.

METHODSThe puncture needle, guide pin and expander were removed from the original design of interbody bone grafting apparatus, with also modification of the bone grafting funnel, obturator, wick and bone harvesting device. Percutaneous puncture and transpedical interbody bone grafting were performed using the modified apparatus on two cadavers, and the operative procedures, bone grafting scope and surgical trauma were observed.

RESULTSThis modified apparatus allowed increased bone grafting scope with shortened operative time, simplified operation procedures, and reduced surgical trauma.

CONCLUSIONPercutaneous puncture and transpedical interbody bone grafting can be easily and safely performed with the modified apparatus.

Bone Transplantation ; adverse effects ; instrumentation ; methods ; Cadaver ; Female ; Humans ; Skin ; Time Factors

OBJECTIVETo evaluate the functional outcome and the complications of allograft replacement in management of bone tumors.

METHODSBetween March 1992 and September 2002 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5 - 35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts (n = 95), hemi-condylar (n = 15), massive (n = 23), allograft-prosthesis composite (n = 12), intercalary grafts (n = 15) or hemi-pelvic grafts (n = 4). Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus.

RESULTSAt a median follow-up of 47 months (range, 12 to 168 months) after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one (12.8%) patients had local recurrence and 38 (23.2%) nonunion. Late complications included 11 (6.7%) fractures of the allograft and 18 (11.0%) infections of the graft. Instability of the joint in the form of subluxation was noted in 13 (7.9%) patients. Ten extremities were amputated due to local recurrence or severe infection.

CONCLUSIONSAllografts can be used for reconstruction of bony defects after tumor resection. Allograft has nearly similar shape, strength, osteo-conduction and osteo-induction with host bone. Allograft implantation is a high complication reconstruction method, and the risk of recurrence increases when less surgical margin achieves.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; surgery ; Bone Substitutes ; Bone Transplantation ; instrumentation ; methods ; Child ; Cryopreservation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Transplantation, Homologous ; Treatment Outcome

We performed biomechanical comparison of a xenograft bone plate-screw (XBPS) system for achieving cadaveric lumbar transpedicular stabilization (TS) in dogs. Twenty dogs' cadaveric L2-4 lumbar specimens were harvested and their muscles were removed, but the discs and ligaments were left intact. These specimens were separated to four groups: the L2-4 intact group as control (group I, n = 5), the L3 laminectomy and bilateral facetectomy group (LBF) (group II, n = 5), the LBF plus TS with metal plate-screw group (group III, n = 5) and the LBF plus TS with XBPS group (group IV, n = 5). Five kinds of biomechanical tests were applied to the specimens: flexion, extension, left-right bending and rotation. The averages of the 16 stiffness values were calculated and then these were statistically analyzed. The statistical results show that the XBPS system contributes spinal stability and this system can be a good choice for achieving TS.
Animals ; Biomechanics ; Bone Plates/*veterinary ; Bone Screws/*veterinary ; Cadaver ; Dogs ; Lumbar Vertebrae/physiology/*surgery ; Range of Motion, Articular/physiology ; Spinal Fusion/instrumentation/*methods ; Transplantation, Heterologous/instrumentation/*methods

OBJECTIVETo determine the initial stability of a novel construct in cadaveric cervical spine in comparison with a conventional method.

METHODSTwelve specimens of fresh human cadaveric cervical spines (C(3)-C(7)) were randomly divided into the test group and control group. In the former group, one-level corpectomy of C(5) and three cortical iliac step-cut grafting with absorbable screw fixation was performed, and one-level corpectomy of C(5) and three cortical iliac strut grafting with anterior plate fixation in the control group. Flexibility test and graft push of strength test were carried out before and after grafting and fixation to determine the range of motion (ROM), neutral zone (NZ) and graft push out strength (POS).

RESULTSThe cervical spines of the two groups all had increased initial stability in all 6 rotational degrees of freedom with also enhanced graft POS after fixation. Compared with the control group, the test group had higher stability in extension and comparable stability in flexion and axial rotation, but lower stability in lateral bending. The graft POS after fixation in the test group, however, was lowered in comparison with the control group.

CONCLUSIONStep-cut grafting and absorbable screw fixation provides sufficient stability potential for the cervical spine in vitro and allows optimum biomechanical and biological environments to enhance graft fusion and reduce complications.

Absorbable Implants ; Biomechanical Phenomena ; Bone Screws ; Bone Transplantation ; methods ; Cadaver ; Cervical Vertebrae ; physiopathology ; surgery ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Orthopedic Procedures ; instrumentation ; methods ; Spinal Fusion ; instrumentation ; methods

Eight patients with femoral osteomyelitis were admitted in Lanzhou General Hospital of PLA between July 2012 and July 2015. During the operation the femur was fixed with non-contact locking plate after thorough debridement. Iliac morselized cancellous bones without cortical bone were filled in the bone defect after debridement. The locking plates were placed in the lateral subcutaneous interface superficial to the vastus lateralis muscle. Drainage tubes were routinely placed postoperatively. The surgery was completed successfully in all patients, and the average operation time was (130±10) min (120-150 min). Intravenous antibiotics were administrated for 2 weeks and followed by 4 week-oral antibiotics after the operation in all 8 cases. Drainage tubes remained in situ about 8 days. All patients were followed up for 12-48 months, with an average of (19±7) months. Postoperative X-ray examination showed bone union in 7 cases with an average healing time of (16±5) weeks. One patient failed with relapsed infection, and was later treated with Ilizarov apparatus after secondary debridement. No plate and screw fracture, loose and fixation failure were observed in all 8 cases.
Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Bone Plates ; classification ; Bone Transplantation ; instrumentation ; methods ; Drainage ; methods ; Femur ; transplantation ; Fracture Healing ; Fractures, Bone ; drug therapy ; surgery ; Humans ; Ilium ; transplantation ; Osteomyelitis ; drug therapy ; surgery ; Quadriceps Muscle ; surgery ; Treatment Failure ; Treatment Outcome

OBJECTIVETo explorer the effectiveness of enriched bone marrow stem cells technique for lumbar fusion.

METHODSWith the randomization and control principles, 2 graft materials [Enrichment bone marrow mesenchymal stem cells hybridized with beta-tri calcium phosphate (composite graft group), autologous iliac crest bone graft (autograft group)] were compared in posterior lumbar fusion procedures. 56 patients with degenerative disc disease, lumbar instability or spinal stenosis, were included. The volume of cells suspension in pre- and post-enrichment and the number of nucleated cells (NCs) were identified. The number of osteoprogenitor cells was estimated by counting the colony-forming units which express alkaline phosphatase (CFUs/ALP+). Then the efficiency of the enrichment was evaluated. Clinical follow-up with roentgenogram and Oswestry scale scores was performed for outcome evaluation.

RESULTS(249 +/- 31) ml bone marrow per patient from bilateral iliac crests was aspirated peri-operatively. About (43 +/- 11) ml enriched bone marrow was collected. The number of NCs was concentrated from (15.9 +/- 3.3) x 10(6)/ml to (44.1 +/- 10.8) x 10(6)/ml, CFUs/ALP+ was significantly increased from (118 +/- 86)/ml to(486 +/- 305)/ml. The follow-up was about (26.3 +/- 7.5) months. There was no significant differences in age, gender, disease and fusion segments between the two groups. The fusion rate was 93.3% and 96.2% for composite graft group and autograft group, respectively (chi2 = 0.2146, P = 0.6432). There was no difference in operation time between the two group (t = 0.5243, P = 0.6022), but blood loss in composite graft group was more than that in autograft group (t = 6.4664, P < 0.01). Cell salvage for auto-transfusion could transfuse back half of the blood loss during operation. No hematoma or chronic soreness in the bone marrow donor sites of composite graft group occurred, but a little exudation or moderate swelling in the wound happened in 4 cases which disappeared under medical treatment. Meanwhile, 15.4% patients had hematoma in the iliac bone donor site and 26.9% patients had chronic soreness, but no case had wound problem in autograft group. As for Oswestry scale scores, there was no significant difference between the two groups.

CONCLUSIONSThe enrichment technique of autologous bone marrow stem cells can greatly increase the concentration of MSCs. It is a rapid and safe method used peri-operatively. The composite material of enriched MSCs and porous beta-TCP is a good bone substitute in posterior spinal fusion.

Adult ; Aged ; Bone Substitutes ; Bone Transplantation ; methods ; Calcium Phosphates ; Female ; Follow-Up Studies ; Humans ; Ilium ; transplantation ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Fusion ; instrumentation ; methods ; Stem Cell Transplantation ; Transplantation, Autologous ; Treatment Outcome