OBJECTIVE: To investigate the short-term effectiveness of the anterior and middle columns in thoracolumbar tuberculosis reconstructed with whole autogenous spinous process-laminar bone through posterior approach. METHODS: The retrospective study included 78 patients with thoracolumbar tuberculosis who underwent posterior approach surgery and anterior and middle column bone graft reconstruction between January 2012 and May 2023. Based on the type of autogenous bone graft used, patients were divided into group A (whole autogenous spinous process-laminar bone graft, 38 cases) and group B (autogenous structural iliac bone graft, 40 cases). There was no significant difference of baseline data, such as age, gender, disease duration, involved segment of spinal tuberculosis, and preoperative erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Oswestry disability index (ODI), visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, segmental kyphotic angle, and intervertebral height between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stays, ESR, CRP, VAS score, ODI, bone fusion time, ASIA grade for neurological status valuation, postoperative complications, change of segmental kyphotic angle, change of intervertebral height were recorded and compared between the two groups. RESULTS: The operation time in group A was significantly shorter than that in group B ( P<0.05); there was no significant difference in intraoperative blood loss, postoperative drainage, and hospital stays between the two groups ( P>0.05). All patients in the two groups were followed up 14-110 months (mean, 64.1 months); there was no significant difference in the follow-up time between the two groups ( P>0.05). The ESR, CRP, ODI, and VAS score at each time point after operation in both groups significantly improved when compared with those before operation, and further improved with the extension of time, the differences were significant ( P<0.05). There was no significant difference between the two groups ( P>0.05) except that the VAS score of group A was significantly better than that of group B at 3 days after operation ( P<0.05). There was no significant difference in fusion time between the two groups ( P>0.05). The neurological function of most patients improved after operation, and there was no significant difference in ASIA grade between the two groups at last follow-up ( P>0.05). There was no significant difference in segmental kyphosis angle and intervertebral height between the two groups at each time point ( P>0.05), and no significant difference in segmental kyphosis angle, intervertebral height correction and loss were found between the two groups ( P>0.05). In group A, there was 1 case of incision fat liquefaction and 1 case of incision infection; in group B, there was 1 case of deep venous thrombosis, 2 cases of pleural effusion, and 10 cases of pain in bone harvesting area; in both groups, there were 2 cases of gout caused by hyperuricemia. There was a significant difference in the incidence of pain in bone harvesting area between the two groups ( P<0.05), and there was no significant difference in the incidence of other complications between the two groups ( P>0.05). CONCLUSION Whole autogenous spinous process-laminar bone grafting is equivalent to structural iliac bone graft in reconstruction of the anterior and middle columns in thoracolumbar tuberculosis through posterior approach, effectively supporting the stability of the anterior and middle columns of the spine, while resulting in shorter operation time and less postoperative pain in bone harvesting area.
Humans ; Tuberculosis, Spinal/surgery* ; Thoracic Vertebrae/surgery* ; Lumbar Vertebrae/surgery* ; Bone Transplantation/methods* ; Retrospective Studies ; Male ; Female ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Adult ; Middle Aged ; Transplantation, Autologous ; Operative Time ; Ilium/transplantation*

OBJECTIVE: To explore the differences in the implantation safety and stability of a S ₁ alar-iliac screw (S1AIS) or S2AIS for sacroiliac joint fixation, providing reference for selecting appropriate internal fixation in clinical practice. METHODS: Patients who underwent pelvic CT examination between January 2024 and December 2024 were selected. CT data from 80 patients with normal pelvic structure who met the selection criteria were included in a 1∶1 male to female ratio. CT digital reconstruction technology was used to measure the transverse and longitudinal diameters of the S1AIS and S2AIS insertable ranges, as well as the length, width, and sacral side length of the screw trajectory. The pelvic CT data from 30 patients were randomly selected based on a 1∶1 male to female ratio for three-dimensional (3D) printing of pelvic samples. The S1AIS/S2AIS with a diameter of 6.5 mm and 8.0 mm were implanted at the optimal entry/exit points on the left and right sides, respectively, to observe the perforation of the screw trajectory. The pelvic CT data from 1 patient was randomly selected for 3D printing of 10 pelvic samples to simulate Tile C2 fracture. They were divided into S1AIS group ( n=5) and S2AIS group ( n=5), with one S1AIS and one S2AIS fixation used for posterior sacroiliac joint separation, and the specimen stiffness and maximum load were measured by using an electric tension torsion dual axis universal mechanical tester. RESULTS: The anatomical parameter measurement showed that there was no significant difference in the length and width of the screw trajectory between S1AIS and S2AIS ( P>0.05), but the transverse and longitudinal diameters of the insertable ranges, as well as the sacral side length of the screw trajectory, were all greater than those of S2AIS, with significant differences ( P<0.05). After simulating the implantation of S1AIS and S2AIS with a diameter of 6.5 mm in pelvic specimens, no screw penetration was observed. Both S1AIS and S2AIS with a diameter of 8.0 mm showed screw penetration, with S2AIS having a higher incidence of posterior lateral sacral cortical penetration (46.7%) than S1AIS (3.3%) ( P<0.05). The biomechanical test showed that the stiffness and maximum load of S2AIS were significantly lower than those of S1AIS ( P<0.05). CONCLUSION As a method to fix the sacroiliac joint, the S1AIS has a larger insertable range, a longer sacral side length of the screw trajectory, a lower incidence of posterior lateral cortical rupture of the sacrum, and a greater fixation strength than S2AIS. Therefore, the implantation safety and fixation stability of the S1AIS are superior to S2AIS, and a diameter less than 8.0 mm screws should be selected as S2AIS for Chinese people.
Humans ; Bone Screws ; Sacroiliac Joint/diagnostic imaging* ; Male ; Female ; Sacrum/diagnostic imaging* ; Fracture Fixation, Internal/instrumentation* ; Ilium/diagnostic imaging* ; Tomography, X-Ray Computed ; Middle Aged ; Adult ; Printing, Three-Dimensional ; Aged

OBJECTIVE: To investigate the biomechanical characteristics of Schatzker type Ⅱ tibial plateau fracture fixed by different bone grafting methods and internal fixations. METHODS: Twenty-four embalmed specimens of adult knee joint were selected to make Schatzker type Ⅱ tibial plateau fracture models, which were randomly divided into 8 groups (groups A1-D1 and groups A2-D2, n=3). After all the fracture models were restored, non-structural iliac crest bone grafts were implanted in group A1-D1, and structural iliac crest bone grafts in groups A2-D2. Following bone grafting, group A was fixed with a lateral golf locking plate, group B was fixed with lateral golf locking plate combined compression bolt, group C was fixed with lateral tibial "L"-shaped locking plate, and group D was fixed with lateral tibial "L"-shaped locking plate combined compression bolt. Compression and cyclic loading tests were performed on a biomechanical testing machine. A distal femur specimen or a 4-cm-diameter homemade bone cement ball were used as a pressure application mould for each group of models. The specimens were loaded with local compression at a rate of 10 N/s and the mechanical loads were recorded when the vertical displacement of the split bone block reached 2 mm. Then, compressive and cyclic loading tests were conducted on the fixed models of each group. The specimens were compression loaded to 100, 400, 700, and 1 000 N at a speed of 10 N/s to record the vertical displacement of the split bone block. The specimens were also subjected to cyclic loading at 5 Hz and 10 N/s within the ranges 100-300, 100-500, 100-700, and 100-1 000 N to record the vertical displacement of the split bone block at the end of the entire cyclic loading test. The specimens were subjected to cyclic loading tests and the vertical displacement of the split bone block was recorded at the end of the test. RESULTS: When the vertical displacement of the collapsed bone block reached 2 mm, the mechanical load of groups A2-D2 was significantly greater than that of groups A1-D1 ( P<0.05). The mechanical load of groups B and D was significantly greater than that of group A under the two bone grafting methods ( P<0.05); the local mechanical load of group D was significantly greater than that of groups B and C under the structural iliac crest bone grafts ( P<0.05). There was no significant difference ( P>0.05) in the vertical displacement of the split bone blocks between the two bone graft methods when the compressive load was 100, 400, 700 N and the cyclic load was 100-300, 100-500, 100-700 N in groups A-D. However, the vertical displacement of bone block in groups A1-D1 was significantly greater than that in groups A2-D2 ( P<0.05) when the compressive loading was 1 000 N and the cyclic load was 100-1 000 N. The vertical displacement of bone block in group B was significantly smaller than that in group A, and that in group D was significantly smaller than that in group C under the same way of bone graft ( P<0.05). CONCLUSION Compared with non-structural iliac crest bone grafts implantation, structural iliac crest bone grafts is more effective in preventing secondary collapse of Schatzker type Ⅱ tibial plateau fracture, and locking plate combined with compression bolt fixation can provide better articular surface support and resistance to axial compression, and the lateral tibial "L"-shaped locking plate can better highlight its advantages of "raft" fixation and show better mechanical stability.
Humans ; Bone Transplantation/methods* ; Tibial Fractures/physiopathology* ; Fracture Fixation, Internal/instrumentation* ; Biomechanical Phenomena ; Bone Plates ; Ilium/transplantation* ; Adult ; Tibia/surgery* ; Bone Cements ; Knee Joint/surgery* ; Male ; Tibial Plateau Fractures

OBJECTIVE: To evaluate the effectiveness of functional perforator flaps utilizing the superficial circumflex iliac artery as a vascular pedicle, as well as chimeric iliac bone flaps, in the reconstruction of composite tissue defects in the hand and foot. METHODS: A retrospective review of the clinical data from 13 patients suffering from severe hand or foot injuries, treated between May 2019 and January 2025, was conducted. The cohort comprised 8 males and 5 females, with ages ranging from 31 to 67 years (mean, 48.5 years). The injuries caused by mechanical crush incidents (n=9) and traffic accidents (n=4). The distribution of injury sites included 8 cases involving the hand and 5 cases involving the foot. Preoperatively, all patients exhibited bone defects ranging from 2.0 to 6.5 cm and soft tissue defects ranging from 10 to 210 cm². Reconstruction was performed using functional perforator flaps based on the superficial circumflex iliac artery and chimeric iliac bone flaps. The size of iliac bone flaps ranged from 2.5 cm×1.0 cm×1.0 cm to 7.0 cm×2.0 cm×1.5 cm, while the size of the soft tissue flaps ranged from 4 cm×3 cm to 15 cm×8 cm. In 1 case with a significant hand defect, a posterior interosseous artery perforator flap measuring 10.0 cm×4.5 cm was utilized as an adjunct. Likewise, an anterolateral thigh perforator flap measuring 25 cm×7 cm was combined in 1 case involving a foot defect. All donor sites were primarily closed. Postoperative flap survival was monitored, and bone healing was evaluated through imaging examination. Functional outcomes were assessed based on the location of the defects: for hand injuries, grip strength, pinch strength, and flap two-point discrimination were measured; for foot injuries, the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, Maryland Foot Score, plantar pressure distribution and gait symmetry index (GSI) were evaluated. RESULTS: All flaps survived completely, with primary healing observed at both donor and recipient sites. All patients were followed up 6-18 months (mean, 12.2 months). No significant flap swelling or deformity was observed. Imaging examination showed a bone callus crossing rate of 92.3% (12/13) at 3 months after operation, and bone density recovered to more than 80% of the healthy side at 6 months. The time required for bone flap integration ranged from 2 to 6 months (mean, 3.2 months). One patient with a foot injury exhibited hypertrophic scarring at the donor site; however, no major complication, such as infection or bone nonunion, was noted. At 6 months after operation, grip strength in 8 patients involving the hand recovered to 75%-90% of the healthy side (mean, 83.2%), while pinch strength recovered to 70%-85% (mean, 80%). Flap two-point discrimination ranged from 8 to 12 mm, approaching the sensory capacity of the healthy side (5-8 mm). Among the 5 patients involving the foot, the AOFAS score at 8 months was 80.5±7.3, VAS score was 5.2±1.6. According to the Maryland Foot Score, 2 cases were rated as excellent and 3 as good. Gait analysis at 6 months after operation showed GSI above 90%, with plantar pressure distribution closely resembling that of the contralateral foot. CONCLUSION The use of functional perforator flaps based on the superficial circumflex iliac artery, combined with chimeric iliac bone flaps, provides a reliable vascular supply and effective functional restoration for the simultaneous repair of composite bone and soft tissue defects in the hand or foot. This technique represents a viable and effective reconstructive option for composite tissue defects in these anatomical regions.
Humans ; Male ; Middle Aged ; Female ; Perforator Flap/transplantation* ; Adult ; Plastic Surgery Procedures/methods* ; Hand Injuries/surgery* ; Aged ; Retrospective Studies ; Foot Injuries/surgery* ; Ilium/transplantation* ; Iliac Artery/surgery* ; Soft Tissue Injuries/surgery* ; Bone Transplantation/methods* ; Treatment Outcome

OBJECTIVE: To define a safe distance range from the LC-Ⅱ screw trajectory to the apex of the greater sciatic notch based on pelvic CT measurements, and to clinically assess the feasibility of using this range under iliac oblique view combined with iliac tangential view fluoroscopy to guide screw insertion. METHODS: CT scans of 104 normal pelvises collected between January 2022 and February 2025 were analyzed. There were 52 males and 52 females, with a median age of 45.8 years (range, 19-76 years). The RadiAnt DICOM Viewer software was used to reconstruct coronal, sagittal, and axial sections of the potential LC-Ⅱ screw trajectory. The maximum safety distance (Dmax) and the optimal safety distance (Dopt) from this trajectory to the greater sciatic notch were measured on the coronal and sagittal views. A retrospective analysis was conducted on 21 patients with LC-Ⅱ type pelvic fractures treated with the LC-Ⅱ screws fixation. And the screws were placed within the pre-defined safe distance under guidance from the iliac oblique view and iliac tangential view. Postoperative CT scans were obtained to evaluate the accuracy of screw placement. RESULTS: Radiographic measurements from the 104 cases showed that Dmax ranged from 1.87 to 3.87 cm (mean, 2.79 cm), and Dopt ranged from 1.01 to 2.92 cm (mean, 1.84 cm). Both Dmax and Dopt were significantly greater in the males than in the females ( P>0.05). No significant difference was found between the left and right sides within the same gender ( P>0.05). All 21 patients successfully underwent fracture reduction and fixation, with a total of 23 LC-Ⅱscrews implanted. According to the Lonstein grading system, the screw placement accuracy was rated as excellent in 16 screws, good in 3, fair in 3, and poor in 1, with an excellent and good rate of 82.6%. CONCLUSION Utilizing a CT-defined safe distance range from the screw trajectory to the greater sciatic notch, and adhering to this range under iliac oblique view combined with iliac tangential view fluoroscopy, enables the accurate and precise placement of LC-Ⅱ screws.
Humans ; Male ; Female ; Middle Aged ; Bone Screws ; Adult ; Tomography, X-Ray Computed/methods* ; Aged ; Ilium/surgery* ; Pelvic Bones/diagnostic imaging* ; Fracture Fixation, Internal/instrumentation* ; Retrospective Studies ; Fluoroscopy ; Fractures, Bone/diagnostic imaging* ; Young Adult

OBJECTIVE: To explore clinical effect of iliac bone graft fixed with high strength suture arthroscopy in treating shoulder joint forward instability with high risk of dislocation. METHODS: The clinical data of 22 patients with shoulder forward instability with high risk of dislocation treated with iliac bone graft fixed with high-strength suture arthroscopy from January 2021 to January 2023 were retrospectively analyzed, including 14 males and 8 females, aged from 17 to 46 years old with an average of (26.50±8.26) years old;the times of dislocation ranged from 4 to 22 (11.08±5.82) times;7 patients on the left side and 15 patients on the right side. American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score and Constant-Murley score were to evaluate the improvement of shoulder joint function before operation and 12 months after operation. Three-dimensional CT reconstruction was performed to evaluate the repair of glenoid bone defect, bone remodeling and bone healing before operation, immediately after and 12 months after operation. RESULTS: All patients were followed up for 12 to 24 months with an average of (18.68±3.92) months. No further dislocation or subluxation occurred in all patients. Scores of ASES, UCLA and Constant-Murley were improved from (69.50±2.26), (23.86±2.27), (75.64±3.58) before operation to (91.09±1.57), (32.27±2.03), (91.95±3.00) at 12 months after operation (P<0.05). The defect of glenoid bone was (12.41±7.55) %, (-37.23±3.75) %, (-22.41±3.58) % before opertaion, immediately and 12 months after operation, respectively, and the difference was statistically significant (P<0.05). Bone healing of iliac bone graft was achieved at 12 months after operation. CONCLUSION High strength suture arthroscopy to fix iliac bone graft for the treatment of shoulder forward instability with high dislocation risk is a safe and effective method, which could effectively restore shoulder stability and reduce surgical injury.
Humans ; Male ; Female ; Adult ; Arthroscopy/methods* ; Middle Aged ; Ilium/transplantation* ; Adolescent ; Joint Instability/physiopathology* ; Shoulder Dislocation/surgery* ; Shoulder Joint/physiopathology* ; Young Adult ; Retrospective Studies ; Bone Transplantation ; Sutures

OBJECTIVE: To explore the clinical efficacy of conventional transforaminal endoscopic technique and I See transforaminal endoscopic technique in the treatment of recurrent L₅S₁ lumbar disc herniation with high iliac crest. METHODS: A total of 36 patients with recurrent L5S1 lumbar disc herniation with high iliac crest after posterior small-incision discectomy, admitted from May 2016 to May 2023, were selected. They were divided into the conventional transforaminal endoscopy group and the I See transforaminal endoscopy group according to the different transforaminal endoscopic techniques adopted, and all patients in both groups underwent lateral transforaminal spinal canal decompression and discectomy. There were 18 patients in the conventional transforaminal endoscopy group, including 11 males and 7 females, with an age of (52.24±6.68) years;the I See transforaminal endoscopy group also had 18 patients, including 12 males and 6 females, with an age of (50.75±7.79) years. The perioperative indicators (operation time, number of intraoperative radiographs, and length of hospital stay) were compared between two groups. The clinical efficacy was evaluated using the visual analogue scale(VAS) for pain, the Japanese Orthopaedic Association(JOA) low back pain score, and the modified MacNab criteria before and after surgery. RESULTS: All patients achieved gradeⅠincision healing, with no infection cases. The operation time of the I See group was (64.25±16.67) minutes, which was significantly shorter than that of the conventional transforaminal endoscopy group (89.11±17.24) minutes, and the difference was statistically significant(P<0.05). The number of intraoperative radiographs in the I See group was (5.20±2.29) times, which was significantly less than that in the conventional transforaminal endoscopy group(19.16±3.68) times, and the difference was statistically significant(P<0.05). The VAS and total JOA scores of both groups at the 3rd day, the 3rd month after surgery, and the last follow-up were significantly lower than those before surgery, with statistically significant differences(P<0.05);however, there were no statistically significant differences in VAS and total JOA scores between two groups at the 3rd day, the 3rd month after surgery, and the last follow-up (P>0.05). According to the modified MacNab criteria for efficacy evaluation:in the conventional transforaminal endoscopy group, 14 cases were excellent and 4 cases were good;in the I See transforaminal endoscopy group, 15 cases were excellent and 3 cases were good;there was no statistically significant difference in efficacy between two groups(Z=0.177, P=0.674). CONCLUSION Both transforaminal endoscopic techniques have good clinical effects in the treatment of recurrent L₅S₁ lumbar disc herniation with high iliac crest, resulting in significant improvement of postoperative symptoms, and they are safe, reliable, and minimally invasive surgical methods. Compared with the conventional transforaminal endoscopy, the I See transforaminal endoscopic technique has shorter operation time and fewer intraoperative radiographs, so it is generally the first choice.
Humans ; Male ; Female ; Intervertebral Disc Displacement/surgery* ; Endoscopy/methods* ; Middle Aged ; Lumbar Vertebrae/surgery* ; Ilium/surgery* ; Adult ; Diskectomy/methods*

PURPOSE: The purpose of this cadaveric study was to compare the volume and weight of bone graft harvested using the curettage vs. the trephination technique from the anterior iliac crest. METHODS: Embalmed cadavers were studied in this experimental research. The right hemipelvis of each cadaver was used for the trephine bone harvesting technique, whereas the left hemipelvis was used for the conventional curettage technique. The weight and the volume of the harvested bone were measured and statistically compared between the 2 sides. The Wilcoxon Signed-Rank test was employed to compare the graft volume and weight obtained from the right and left sides of the hemipelvis. RESULTS: Ten embalmed adult cadavers were used in this study. All subjects were Caucasian males with a mean age of 59.8 years (range 44 - 73 years) at the time of death. A total of 81 cylindrical bone grafts were harvested from the right iliac crest. In 9 out of 81 (11.1%), the cortex of the ilium was penetrated by the chisel. The mean weight of the bone graft harvested with the trephine technique (26.97 ± 2.32) g was heavier than that harvested with the curettage technique (23.74 ± 2.09) g (p = 0.007). Similarly, the volume of the bone graft was higher in the trephine technique (8.40 ± 0.84) cm³ compared to the curettage technique (6.60 ± 1.26) cm³ (p = 0.011). The trephination technique lasted a mean of (12.76 ± 1.87) min (range 10.30-16.10 min), while the curettage technique lasted a mean of (14.53 ± 0.89) min (range 13.50-16.00 min) (p = 0.028). CONCLUSION: Harvesting anterior iliac crest bone graft with the trephine technique provides a higher bone volume and weight than the conventional curettage technique. The trephine technique might be advocated over the curettage technique, especially when a large amount of autologous bone graft is required. However, a meticulous harvesting technique should be followed to prevent complications. In particular, the three-dimensional anatomy should be kept in mind, and the depth of trephination should be well-controlled. CLINICAL TRIAL REGISTRATION Institutional Review Board registration: 2022/499.
Humans ; Ilium/surgery* ; Male ; Middle Aged ; Aged ; Cadaver ; Curettage/methods* ; Tissue and Organ Harvesting/methods* ; Bone Transplantation/methods* ; Adult ; Trephining/methods*

PURPOSE: Percutaneous ilio-sacral screw (ISS) insertion using conventional C-arm fluoroscopy has been a widely employed technique for pelvic posterior ring fixation, particularly in developing regions. However, this approach presents technical challenges, leading to a high malposition rate. We introduced a new method for ISS insertion without additional equipment or software and suggested whether it could reduce the malposition rate and operating time. METHODS: This is a retrospective cohort study. The study included all patients who underwent percutaneous ISS fixation between January 2020 and December 2022. Patients treated with open reduction or other types of implants were excluded. The patients were divided into 2 groups based on the screw insertion method: Group A utilized the traditional dual-plane adjustment method, while Group B received the newly introduced method. In all cases, conventional C-arm fluoroscopy was the sole guidance during the surgical procedure. Malposition rate, radiation exposure, and operating time were compared between groups. Post-operative CT scans were used to assess screw accuracy using the Smith grading method. The Student's t-test or the Mann-Whitney U test was chosen for comparing the quantitative variables based on the normality test results. The Chi-squared test was utilized for comparing qualitative variables. RESULTS: A total of 72 patients with pelvic posterior ring disruption treated with percutaneous ISS under conventional fluoroscopy guidance were included in this study. Among them, 32 patients were in Group A and 40 patients were in Group B. In Group B, the average operation duration per screw was 33 min with 29 fluoroscopy applications, which was significantly lower than that in Group A (44 min, p < 0.001, 38 times, p < 0.001, respectively). Furthermore, the post-operative CT scan revealed that only 10.7% (6/56) of screws in Group B were inappropriately positioned according to the Smith criteria. CONCLUSION The novel method introduced in this study demonstrated a reduction in both malposition rates and operating time compared to the traditional dual-plane adjustment method. Precise pre-operative CT planning in conjunction with conventional fluoroscopy could establish this method as a widely applicable technique for percutaneous ISS fixation.
Humans ; Fluoroscopy/methods* ; Retrospective Studies ; Bone Screws ; Female ; Male ; Tomography, X-Ray Computed/methods* ; Sacrum/diagnostic imaging* ; Middle Aged ; Operative Time ; Adult ; Fracture Fixation, Internal/methods* ; Ilium/diagnostic imaging* ; Aged

OBJECTIVE: To evaluate the clinical outcomes and define the indications for a one-stage mandibular reconstruction technique that combines iliac bone flaps with immediate implant-based dentures, and to assess both the accuracy of surgical planning and the long-term success of the procedure. METHODS: A total of ten patients underwent the procedure at Peking University Hospital of Stomatology between June 2020 and August 2023. The preoperative biopsy pathology of all the patients confirmed a benign tumor. In this technique, iliac bone flaps were used for mandibular reconstruction, and immediate implant-based dentures were placed during the same surgical session. Various outcome measures were evaluated, including the accuracy of the surgical reconstruction, implant placement deviations (entry point, apical point, depth, and angle), and long-term outcomes, such as cervical bone resorption, implant survival, and the cumulative survival rate. RESULTS: Thirty-eight implants were successfully inserted into the iliac flaps of the ten patients. The median follow-up duration was 23.5 months, and no significant complications occurred during the follow-up period, such as infections, titanium plate exposure, implant loosening, or damage to the implants and dentures. The accuracy of preoperative virtual surgical planning (VSP) was highly reliable. The repeatability of the VSP model compared to the postoperative reconstructed mandible was as follows: 67.82% ±10.16% within 1 mm, 82.14% ±6.58% within 2 mm, and 90.61% ±4.62% within 3 mm. The average maximum deviation from the plan was (6.10±0.89) mm, with an average overall deviation of (1.14±0.31) mm. For the implants, deviations in critical parameters were as follows: entry point deviation was (2.02±0.58) mm, apical point deviation was (2.25± 0.66) mm, depth deviation was (1.26±0.51) mm, and angular deviation was 1.84°±1.10°. The implant survival rate remained 100% during the follow-up, with a cumulative survival rate of 97.37% from 1 to 4 years. Average cervical bone resorption was 0.94 mm. CONCLUSION The combination of iliac bone flaps with immediate implant-based dentures for one-stage mandibular reconstruction demonstrated pro-mising clinical outcomes, including high implant survival and minimal complications. This technique proved to be safe and reliable for mandibular reconstruction. However, further studies with larger sample sizes and longer follow-up periods are necessary to confirm the long-term efficacy and optimal indications for this procedure.
Humans ; Mandibular Reconstruction/methods* ; Male ; Ilium/surgery* ; Female ; Middle Aged ; Surgical Flaps ; Adult ; Mandible/surgery* ; Aged ; Dental Implantation, Endosseous/methods* ; Immediate Dental Implant Loading/methods* ; Bone Transplantation/methods* ; Dental Implants