BACKGROUND: Bone tissue engineering materials/call complex has been able to live in the muscle, subcutanecus tissue, ano other heterotopic bones, or in small mammals to repair bone defect. However, there is still much practical and clinical gap, such as bone tissue engineering and technical ability to repair large bone defects in big mammals, as well as how to promote the in vivo tissue-angineerad bone revascularization process.OBJECTIVE: To observe the bone formation using beagle deep fascia pedicled flap and tissue-engineered bone.METHODS: Beagle bone marrow mesenchymal stem calls were isolated, cultured, and inoculated on poly-lactone (PCL).Bone/bone membrane defect was induced in middle tibia on the left side of beagle. Then, the defect was implanted with fascia-encapsulated bone marrow mesenchymal stem cells (BMSCs), considering as experimental group. The second defect was induced in the middle tibia on the right side of beagle and implanted with BMSCs/PCL, considering as control group. The third defect was induced in 2 additional beagles without any implantation, considering as blank control group. Gross observation, X-ray test, histology, and magnetic resonance perfusion imaging were performed on the models to observe growth and ostecblasts andvasculadzation. RESULTS AND CONCLUSION: There was no new bone formation and blood vessels growth in the blank control group, and the defect was filled by fiber scar tissues finally. After 8-16 weeks, the bone defect was gradually filled by bony tissue, and more calluses which grew in implants were observed. The broken ends of fractured bone were not intact, and pulp cavity was sclerotic.Bone formation in the experimental group was rapid than in the control group. After 6 weeks, a great quantity of calluses was observed; after 8 weeks, stant materials were completely degraded; after 12 weeks, bone defect was succassfully repaired. A greet quantity of cancallated bones was observed, the newborn cavitas medullaris was smooth, and cortical bone was successive and stable. The amount, pore diameter, and distribution of formed blood vessels in the experimental group were superior to those in the control group, suggesting that tissue-engineered bone was able to effectively and rapidly repair bone defect in some animal.Fascia flap could promote the revascularization in vivo of tissue-engineered bone.

ObjectiveTo evaluate the radial rotation osteotomy and ulnadouble rotation osteotomy obstetric brachial plexus injury (obstetric brachial plexus palsy) forearm pronation deformity sequelae value.MethodsFrom August 2007 to August 2011, twenty cases of obstetric brachial plexus palsy sequelae in children with forearm pronation deformity, the implementation of a simple radial rotating radial osteotomy (5cases),double-rotation radius and ulna osteotomy (15 cases) and two surgical type,and by 6 to 54 months after surgery (mean 25 months) follow-up.The groupfunctions to forearm pronation angle and conscious function improvement as the evaluation criteria. ResultsThe 15 cases of radius and ulna osteotomy in children with dual function and appearance in 14 cases significandy improved,one case of supination deformity;five underwent simple radial pronation osteotomy,three patients had improved function and appearance,followed up for 6 months, eight months after the merger which radial head dislocation in 2 cases due to poor efficacy of dual-line radius and ulna osteotomy, twenty patients in this group did not appear nonunion.ConclusionSimple radial rotation osteotomy surgery in obstetric brachial plexus palsy forearm pronation deformity complications without radial head dislocation has some value, radius and ulna double osteotomy in forearm pronation deformity with radial head dislocation aftermath of the effect is more excellent.

Objective To compare the curative effects of Orthofix extended external fixator versus Ilizarov external fixator in the treatment of bone defects following post-traumatic tibial osteomyelitis.Methods During the period from January,1996 through January,2015,129 patients were selected for a retrospective analysis.They were 106 males and 23 females,aged from 14 to 60 years (average,36.5 years).Orthofix extended external fixator was used in 43 of them and Ilizarov external fixator in 86.Bone transportation started 7 to 10 dlays after surgery at a speed of 1 mm/d and was completed in 4 turns.The 2 groups were compared in terms of mineralization time for the extended bone,hone lengthening length,fixation time,union indexes,Activity of Daily Living Scale (ADL),Self-Rating Anxiety Scale (SAS),knee range of motion (ROM) and complications.Results The patients were followed up for 13 to 216 months (average,96 months).Orthofix group and llizarov group were not significantly different in mineralization time for the extended bone,bone lengthening length,fixation time or union indexes (P ＞ 0.05).In Orthofix group and Ilizarov group respectively,there were 6 versus 73 patients with mildly limited self-living abilities and 37 versus 13 patients with little limited self-living abilities by ADL scores;there were 33 versus 16 cases of mild anxiety,8 versus 63 cases of moderate anxiety and 2 versus 7 cases of grave anxiety by SAS scores;there were 39 versus 10 cases of limited knee ROM of 15° to 30° and 4 versus 76 cases of limited knee ROM of 30° to 60°.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The rate of complications in Orthofix treatment group(79.1％,34/43) was significantly lower than in Ilizarov group (88.4％,76/86) (P ＜ 0.05).Conclusions In the treatment of bone defects following post-traumatic tibial osteomyelitis,the curative effects of Orthofix extended external fixator are similar to those of Ilizarov external fixator.However,they may have different effects on the life and psychology of the patients in the long run.Therefore,specific therapeutic scheme should be decided in consideration of the advantages of the 2 treatments as well as the conditions of specific patients.

Bone lengthening technique is one of the core surgical technique for skeletal lengthening and reconstruction. It is widely used in the treatment of nonunion, segmental bone defect, bone infection, congenital or post-traumatic limb length differences, and hand-foot deformity correction. Until today, the surgical techniques and devices of bone lengthening are improving over time, and it is to improve the quality of treatment and reduce complications. However, the bone lengthening technique is different from the treatment for other orthopedic diseases, and it has the following feature, including requiring multiple steps, longer treatment course, and application of external fixator. This article will summarize the hot research in the field of bone lengthening treatment in recent years and provide reference for future clinical treatment.

OBJECTIVETo explore the therapeutic effect of osteogenically induced adipose-derived stem cells (ADSCs) on vascular deprivation-induced osteonecrosis of the femoral head (ONFH) in rabbit model.

METHODSVascular deprivation-induced ONFH was established by intramuscular injection of methylpre- dnisolone, and vascular occlusion of the capital femoral epiphysis by electrocoagulation in adult New Zealand white rabbits. Eight weeks after the establishment of vascular deprivation-induced ONFH, animals were randomly divided into three equal groups. In Group A (control), no therapy was given. In Group B, core decompression was performed by drilling a hole (1.2 mm in diameter) from the outer cortex 2.5 cm distal to the proximal end of the greater trochanter. In Group C, 1 multiply 10(7) osteogenically induced ADSCs were resuspended in 0.5 ml PBS, and then injected directly into the femoral head. Femoral head specimens were obtained at postoperative 8 weeks. The bone formation and three-dimensional microstructure of the femoral head was evaluated by micro-computed tomography scans. Immunohistochemical analysis was performed to detect the expression of osteocalcin. Angiogenesis and repair of the femoral head were observed histologically.

RESULTSIn trabecular bone at the proximal femur region, the trabecular volume was higher in Group C (130.70 mm(3)+/-4.33 mm(3)) than that in Groups A (101.07 mm(3)+/-7.76 mm(3)) and B (107.89 mm(3)+/-8.68 mm(3), P less than 0.01). Bone volume was significantly increased in Group C (40.09 mm(3)+/-6.35 mm(3)) than in Groups A (29.65 mm(3)+/-4.61 mm(3)) and B (31.80 mm(3)+/-4.01 mm(3), P less than 0.01). The trabecular number was higher in Groups C (1.58+/-0.25) than other two groups (1.15+/-0.18, 1.16+/-0.21, P less than 0.01). Bone mineral density showed statistically significant difference between Groups C and A or B (375.38+/-23.06) mg HA/ccm, vs (313.73+/-19.30) mg HA/ccm and (316.09+/-16.45) mg HA/ccm, P less than 0.01). Histological examination indicated that there was more new bone formation in Group C than in other groups.

CONCLUSIONTreatment with autologous osteogeni-cally induced ADSCs transplantation results in an enhanced osteogenesis and microstructure of the vascular deprivation-induced osteonecrosis in rabbits.

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.

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.

Objective To explore the possibility of reduce the treatment cycle of post-traumatic osteomyelitis patients treat with bone transportations. Methods In February, 2017, a patient was diagnosis as left tibial os-teomyelitis with soft tissue defects and treated. Before start trifocal bone transportation with Orthofix external fixator, we did preoperative practice with computer and model. Except this case we also had some article review in this report. Results This case not only finished 12.5 cm bone transportation in 45 days but also treated soft tissue defect before bone transportations. In this method we save almost 2/3 time to compare with monofocal bone transportations, and frame time were also faster than previous method. But because of some mishaps when we follow-up, the gap was occurred in docking side after 140 days follow-up that may need bone transplants. After 140 days of operation, the gap was disap-peared. Conclusion A new type bone transportations in this study and it may reduce treatment time of osteomyelitis.

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.

Objective:To study the preoperative CTA and 3D medical reconstruction software, aiming to provide an imaging basis for the preoperative design of peroneal artery perforator flap.Methods:From January 2016 to January 2018, 13 patients with soft tissue defect on foot were studied. Of the patients, 7 injuries were caused by traffic accident, 2 by machine crush and 4 by heavy object crush. The size of defect ranged from 5.0 cm×3.0 cm to 17.0 cm×10.0 cm. CTA technology was used to obtain the images of the affected lower limb, and the 3D visual reconstruction of peroneal artery perforators was generated by using Mimics software. The distribution of peroneal artery perforator was observed. The preoperative design of the flap was completed with the tools come with the software package. The peroneal artery perforator flap was harvested according to the design by computer simulation. Data taken before the surgery were compared with the data taken in the operation. Then the flap was rotated 180° to repair the defect. Regular follow-ups were made in outpatient clinic or via internet after operation. The appearance, texture, colour and blood supply of the flap were observed. The function of foot and ankle was scored according to the American Orthopaedic Foot Ankle Association(AOFAS). Results:A visible 3D flap model of the peroneal artery perforator flap was successfully reconstructed by Mimics software. The anatomical characteristics and region of blood supply of the 13 cases were basically comparable to what were found in the operation. The size of the flap was 6.0 cm×4.0 cm-18.0 cm×11.0 cm. All the flaps survived completely. All the patients completed 6-17(mean, 8.1) months follow-up. The colour and texture of the flaps were good. At the last follow-up, according to the AOFAS score, 7 cases were in excellent, 4 in good and 2 in fair, with an excellent and good rate at 84.61%.Conclusion:Aided by digital technology, it provides a visual 3D morphological support for the design of peroneal artery perforator flap and overcomes the blind spot in the preoperative design, hence it leads to an accurate harvest of the flap in operation.