OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption
To observe the effect of allogenic transplantation of deep frozen nerve in repairing sensory nerve defect, 22 patients who had received this type of treatment were followed up for 0.5-5 years. There were 18 males and 4 females in this group, and the average age was 28 years old. Thirty-six nerve defects including the common volar digital nerve, proper volar digital nerve were repaired by allograft of nerves stored at deep frozen (-80 degrees C). The storation period was ranged from 9 days to 1 years. The length of the nerves were 2 cm-12 cm. After follow-up for 3 years (ranged from 7 months-5 years), 23 cases of nerve allograft obtained excellent and good results (63.9%), 10 cases were fair (27.7%) and 3 cases were poor (8.3%). It was concluded that (1) frozen nerve is one of nice materials for repairing the nerve defect (lt; 5 cm); (2) the immunity of allogenenic nerve is weak; (3) the deep frozen storation can reduce the immunity of nerve; (4) the dimethyl sulfoxide can prevent the nerve tissue from injury by deep frozen; (5) the best temperature and period for deep frozen storation should be studied further.
It is very difficult to repair large articular cartilage defect of the hip. From May 1990 to April 1994, 47 hips in 42 patients of large articuler cartilage defects were repaired by allograft of skull periosteum. Among them, 14 cases, whose femoral heads were grade. IV necrosis, were given deep iliac circumflex artery pedicled iliac bone graft simultaneously. The skull periosteum had been treated by low tempreturel (-40 degrees C) before and kept in Nitrogen (-196 degrees C) till use. During the operation, the skull periosteum was sutured tightly to the femoral head and sticked to the accetabulum by medical ZT glue. Thirty eight hips in 34 patients were followed up for 2-6 years with an average of 3.4 years. According to the hip postoperative criteria of Wu Zhi-kang, 25 cases were excellent, 5 cases very good, 3 cases good and 1 case fair. The mean score increased from 6.4 before operation to 15.8 after operation. The results showed, in compare with autograft of periosteum for biological resurface of large articular defect, this method is free of donor-site morbidity. Skull periosteum allograft was effective for the treatment of large articular cartilage defects in hip.
Objective To investigate the clinical result of treatment of bonecyst by transplantation of the autologous bone marrow combined with the allograft bone. Methods From February 2004 to March 2006, 13 patients withbone cyst were treated by transplantation of the autologous bone marrow combined the the allograft bone. Among the 13 patients, 6 were males and 7 were females, ranging in age from 5 to 16 years, averaged 11.5 years. In the patients, 5 lesions were located inthe proximal humerus, 2 in the femoral neck, 3 in the femoral shaft, 2 in the proximal tibia, and 1 in the distal tibia. Among the patients, 5 had a complication of pathologic fracture. All the patients underwent an erasion of the bone cyst, and then the transplantation of the autologous bone marrow combined with the allograft bone, and 8 of them were also given an instrument fixation. Results The follow-up for 6 months to 2 years after operation revealed that 5 of the patients had an incision healing by the first intention, 5 had an effusion in the incision site, and 3 had a delayed healing of the incision. According to the Capanne criteria, the postoperative X-ray findings indicated that 10 patients had Grade Ⅰ healing, and 3 had Grade Ⅱ healing. The complete healing took 3.5-8 months,averaged 5.2 months. There was no recurrence. When the fixation instrument was removed, no pathologic fracture occurred. The function of the upper and lower limbs recovered. Conclusion Transplantation of the autologous bone marrow combined with the allograft bone is an effective and safe procedure for treatment of bone cyst.
Objective To explore an improved reconstruction of the anterior crucial ligament (ACL) with the allograft hamstring fixed by the Rigidfix and Intrafix anchorages and to evaluate its therapeutic effectiveness in a short term. Methods The ACL reconstruction was performed under the arthroscope on 21 patients’ knees from Janaury 2006 to December 2006. There were 13 males and 8 females aged from 18 to 53 years. The injuries were caused by a traffic accident in 7 patients, a movement damage in 11, and other factors in 3. The medial collateral ligament(MCL) and the medial meniscus were injured in 10 patients, the medial meniscus andthe lateral meniscus were injured in 3, the lateral meniscus was injured in 6, and only the ACl was injured in 2. The operations were performed 7 days to 3 monhs after the injuries. The graft used was the fourstranded allograft hamstring, which was fixed by the Rigidfix and Intrafix anchorages. The therapeutic effect was evaluated according to the Lysholm rating scale. Results The follow-up of all the 21 patients for 3-9 months (average, 5.8 months) revealed that the knees of 19 patients could move beyond 120° after operation. In 1 patient who had the MCL injury, the range of genuflex was limited to 80° at 3 months after operation, and so the operation of lysis was performed under thearthroscope again. In 1 patient, the rejection against the allograft was treated by the irrigating under the arthroscope but had little effect. The anterior drawer test and the pivot shift test were negative in the 21 patients. During the Lanchman test, 1 patient had a positive result (Degree Ⅰ). The Lysholm scores were significantly increased from 56.73±6.58 to 88.14±7.02 (P＜0.01). Conclusion The surgical approach to reconstruction of ACL with the fourstranded allograft hamstring fixed by the Rigidfix and Intrafix anchorages is feasible and safe. The resulting fixation is reliable. The patients can begin their postoperative rehabilitation exercise earlier and their movement function can be restored earlier.
Objective To study the clinical effect of anterior cruciate ligament(ACL) reconstruction with different grafts under arthroscope. Methods A retrospective analysis was done on 68 cases of ACL injury.ACL reconstruction with bonepatellar tendonbone autograft and interface screw fixation were performed in 26 cases(group A) and quadruple semitendinosus tendon autograft and endobutton plate fixationin in 38 cases (group B). ACL reconstruction with bonepatellar tendonbone allograft cryopreserved and interface screw fixation were performed in 4 cases (group C). Therewere 16 males and 10 females with an average age of 26.4 years (16-45 years) in group A, 24 males and 14 females with an average age of 24.6 years (13-48 years) in group B, and 3 males and 1 female (55-65 years) in group C. The left knee involved in 14 cases, 27 cases and 3 cases, and the right knee involved in 12 cases, 11 cases and 1 case in groups A, B and C, respectively. The disease courses were 1 week to 15 months (group A), 1 week to 16 months (group B) and 2 weeksto 28 months (group C).The intermediate myodynamic recovery, IKDC score and Lysholm score were compared among 3 groups. Results All patients were followed 12-36 months (17.5 months in group A, 18.5 months in group B and 16.5 months in group C). No intra articular infection, phlebothrombosis of leg, vascular injury and nerve injury occurred. Lysholm scores was increased from preoperative 65.3±4.8 to postoperative 95.1±4.3 in group A, from 68.4±5.6 to 93.0±5.9 in group B and from 60.3±6.7 to 92.2±4.3(excellent in 3 cases and good in 1 case) in group C; the excellent and good rates were 88.5% (excellent in 18 cases, good in 5 cases and fair in 3 cases) in group A, 86.8% (excellent in 28 cases, good in 5 cases and fair in 5 cases) in group B, IKDC scores were 93.7±3.8 (group A), 95.7±4.7 (group B) and 94.8±3.6(group C); the knee joint functions were normal in 19 cases(73.1%), in 30 cases (78.9%) and in 3 cases, were fair in 5 cases (19.2%), in 5 cases (13.2%) and in 1 cases in groups A, B and C respectively. Conclusion The transplantation of bonepatellar tendonbone autograft , quadruple semitendinosustendon autograft and bonepatellar tendonbone allograft all can reconstruct and strengthen the stability of knee joint. Bonepatellar tendonbone allograft is better selection for the ACL injury in elder and quadruple semitendinosus tendon autograft is suitable to adolescent patients with disrupted ACL.
Objective To explore an effective way fortreating severe complicated distal femoral fractures. Methods Twenty-six patients with complicated distal femoral fracture who all belonged to 33C3.3type according to AO/ASIF lassification, were treated with a lateral condylar buttress plate or self-desinged aliform anatomical plate, and operated on with allogeneic bone grafting. Results All cases were followed up for an average of 14 months (ranging 5-25 months). Twenty-four wounds were primary healing postoperatively, 2 wounds were infected and healed after dressing change. Twenty-four had bone healing after 411 months, 2 needed to operate again because of earlier weight-bearing resulting in fixation failure. According to shelbourne and Brueckmann score, the excellent and good rate was 88.46%. Conclusion The internal fixation forcomplicated distal femoral fracture by self-designed aliform anatomical plate and lateral condylar buttress plate with a great deal of allograft bone is an effective surgical method. As it has long oval holes and the holes are consecutive ,the aliform anatomical plate is more suitable for severe complicated fractures. At the same time, autogenous-ilium transplantation can be substituted by the allograft bone.
fter total hip replacement ,massive bone defect occured freqently due to wearing and loosening of the prcathesis.The use of deep-freezing allograft to su pport a new implant was an attractive solution. Deep-freezing decreased the immune antigenicity of the transplanted allograft.From 1972 to 1990. the deep-freezing allografts were used in rcvision total hip replacement in 212 cases,in which 187 cases(198 hips) were followed-up for over 1 year.The general effective rate was 85%....
Objective To explore the clinical application of allogeneic tendonhandled by ultra-deep-low-temperature. Methods From March 1995 to June 2002，tendons rupture and tendons defect were repaired by ultra-deep-low-temperatureallogeneic tendon grafts in 96 cases, including 51 cases of flexor or extensor tendon defect of hand, 36 cases of coracoclariculare ligament rupture, 4 cases of cruciate ligament rupture, 2 cases of calcaneus tendon rupture and 3 cases ofextensor tendon defect of foot. The interval between injury and operation was 1day to 5 months. The length of defect was 4-12 cm with an average of 7 cm.The matching allogeneic tendons were selected during operation, and early function exercise was done after operation. Secondary release was performed in the cases of tendon adhesion.Results Follow-up time is from 6 months to 5 years (3.4 years on average). No rejection or rupture occurred after tendon allograft. The satisfactory result was achieved in 92.71% of the cases. Conclusion The allogeneic tendon is similar to auto-tendon in transplanting, healing and function is useful clinically.
Abstract In order to determine the fasibility of reestablishment of circulation with cryopreserved microvenous allografts (1.0～1.4mm in diameter), 40 rabbits were divided into 2 groups. In the control group, the fresh autografts were used. In the experimental group, 20 rabbitsfemoral vein segments were treated by a two-step freezing procedure. After stored in liquid nitrogen for 48 hours, the segments were implanted into the femoral veins as allografts. The histological as well as the pathological studies were performed with light and electron microscope, and its patency was determined by angiography. The results showed that the preservation of vein was generally good. The rejective response was weak. The patency rates of 1 week and 12 weeks were 90% and 85% respectively, and there was no significant difference with that of the allogenic fresh autografts (Pgt;0.05). It was suggested that clinical use of cryoperserved allogenic microvein grafts instead of fresh autografts was possible.