1
|
Zhang H, Fu J, Jie S, Wang X, Wang S, Wu H, Hu Y, Huang C. Induced membrane technique versus one-stage autografting in management of atrophic nonunion of long bone in the lower limb: clinical and health burden outcomes. J Orthop Surg Res 2023; 18:853. [PMID: 37946277 PMCID: PMC10636875 DOI: 10.1186/s13018-023-04296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE In this study, we aimed to compare the outcomes of the two-stage induced membrane technique (IMT) and one-stage autografting in the treatment of aseptic atrophic nonunion in lower limb long bones. METHODS From January 2014 to January 2022, we reviewed all surgically treated long bone nonunion patients, including patients aged 18 years or older with atrophic nonunion, who were either treated with the two-stage induced membrane technique (IMT) or one-stage autografting. Outcome parameters interns of clinical, quality of life and healthcare burden were recorded and retrospectively analysed between the two treatment populations. The follow-up time was at least 1 year. RESULTS In total, 103 patients who met the criteria for aseptic atrophic nonunion were enrolled. Among them, 41 (39.8%) patients were treated with two-stage IMT, and 62 (60.2%) patients were treated with one-stage autologous bone grafting. The follow-up time was 12 to 68 months, with an average of 28.4 months. The bone healing rate was comparable in both groups (IMT: 92.7% vs. one-stage grafting: 91.9%, P = 0.089) at 12 months post-operation, and the bone healing Lane-Sandhu score was superior in the IMT group (mean: 8.68 vs. 7.81, P = 0.002). Meanwhile, the SF-12 scores of subjective physical component score (PCS) (mean: 21.36 vs. 49.64, P < 0.01) and mental health component score (MCS) (mean: 24.85 vs. 46.14, P < 0.01) significantly increased in the IMT group, as well as in the one-stage grafting group, and no statistically significant difference was found within groups. However, the total hospital stays (median: 8 days vs. 14 days, P < 0.01) and direct medical healthcare costs (median: ¥30,432 vs. ¥56,327, P < 0.05) were greater in the IMT group, while the complications (nonunion 8, infection 3, material failure 2, and donor site pain 6) were not significantly different between the two groups (17.1% vs. 19.4, P = 0.770). CONCLUSION The data indicate that two-stage method of IMT serves as an alternative method in treating atrophic nonunion; however, it may not be a preferred option, in comprehensive considering patient clinical outcomes and healthcare burden. More evidence-based research is needed to further guide clinical decision-making.
Collapse
Affiliation(s)
- Hu Zhang
- Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Jingshu Fu
- Banan Hospital of Chongqing Medical University, Banan District, Longzhouwan Street No. 659, Chongqing City, 400038, People's Republic of China
| | - Shen Jie
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Xiaohua Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Shulin Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China
| | - Hongri Wu
- Department of Orthopaedics, Southwest Hospital, Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China.
- Department of Orthopedics, Navy 905th Hospital, Naval Medical University, Shanghai, People's Republic of China.
| | - Yongjun Hu
- Banan Hospital of Chongqing Medical University, Banan District, Longzhouwan Street No. 659, Chongqing City, 400038, People's Republic of China.
| | - Chunji Huang
- Army Medical University (Third Military Medical University), Gaotanyan Street No.30, Shangpingba District, Chongqing, 400038, People's Republic of China.
| |
Collapse
|
2
|
Xu D, Xie J, Wu B, Zou Y, He Y, Li Z. Comparison of mini-open reduction and autologous bone grafting with closed reduction and intramedullary device insertion for tibial shaft fractures: a retrospective study. J Orthop Surg Res 2023; 18:519. [PMID: 37480093 PMCID: PMC10362687 DOI: 10.1186/s13018-023-04024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND We compared the clinical efficacy of mini-open reduction and autologous bone grafting (GM) and closed reduction (GC) using intramedullary nailing for the treatment of tibial shaft fractures. METHODS This retrospective study included 70 tibial shaft fractures treated with GM or GC between January 2018 and December 2021. The demographic characteristics and clinical outcomes were compared between the two treatment methods. RESULTS This study included 70 patients who were followed-up for 12.4 months. In total, 31 and 39 patients were treated with GM and GC, respectively. The operative duration was significantly shorter for GM (95.2 ± 19.3 min) than for GC (105.5 ± 22.2 min, p = 0.0454). The number of radiation times was significantly lower for GM (14.7 ± 6.3) than for GC (22.2 ± 9.2, p < 0.005). There were no statistically significant differences between the groups in terms of the wound complication or infection rates. The malunion and nonunion rates were high after GC than after GM, but there are no significant differences between the groups. CONCLUSIONS Closed reduction and intramedullary nailing remains the first choice for tibial shaft fractures. GM is a safe and effective treatment worth considering. Future prospective randomized controlled trials are warranted.
Collapse
Affiliation(s)
- Danfeng Xu
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China
- Central Laboratory, The Central Hospital Affiliated to Shaoxing University, Shaoxing, 312030, People's Republic of China
| | - Jianxin Xie
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China
| | - Bing Wu
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China
| | - Yubin Zou
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China
| | - Yong He
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China
| | - Zhaosheng Li
- Department of Spine Surgery, The Central Hospital Affiliated to Shaoxing University, Hua-yu Road 1, Keqiao, Shaoxing, 312030, People's Republic of China.
| |
Collapse
|
3
|
Zhang C, Ma T, Duan N, Huang Q, Lu Y, Lin H, Zhang K, Xu Y, Wang Q, Xue H, Wang C, Li Z. Clinical and radiographic outcomes of revision with autogenous "structured" bone grafting combined with superior plate for recalcitrant atrophic nonunion of clavicular midshaft: a retrospective study. Int Orthop 2022; 46:2585-2592. [PMID: 36048235 DOI: 10.1007/s00264-022-05564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To assess the efficacy of autogenous "structured" bone grafting (ASBG), it was combined with superior plate (SP) revision operations for recalcitrant clavicular midshaft aseptic nonunion (CMAN). METHODS This retrospective study included 12 patients who suffered from failure of autologous cancellous bone grafting (ACBG) and SP fixation because of CMAN. Visual analogue scale (VAS) data for pain and disabilities of arm, shoulder, and hand (DASH) scores of patients who underwent these procedures from January 2019 to December 2020, obtained before surgery and at the final follow-up time, were analysed. RESULTS The average time between primitive fracture and this operative treatment was 29 months (15-38 months). The average duration of surgery was 153 minutes (range, 115-230 min), and the average blood loss was 560 ml (range, 350-860 ml). Complications occurred in two cases (16.67%): one was persistent pain at the donor site, and the other was a calf muscle vein thrombosis. No tissue infection was observed during follow-up. The mean follow-up time was 18 months (range, 12-30 months). All fractures progressed to osseous healing at a mean time of 14 weeks (range, 12-16 weeks). The mean pain VAS score significantly improved, from 4.8 ± 1.7 pre-operatively to 1.9 ± 1.1 at the final follow-up (P = 0.01). The mean DASH score improved significantly from 30.1 ± 11.2 pre-operatively to 7.8 ± 4. 2 at the final follow-up (P < 0.01). CONCLUSIONS ASBG combined with SP revision surgery achieved excellent clinical outcomes in patients with recalcitrant CMAN.
Collapse
Affiliation(s)
- Congming Zhang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Teng Ma
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Ning Duan
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Qiang Huang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Yao Lu
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Hua Lin
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Kun Zhang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Yibo Xu
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Qian Wang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Hanzhong Xue
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China
| | - Chaofeng Wang
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China.
| | - Zhong Li
- Department of Orthopaedics and Traumatology, Xi'an, Jiaotong University College of Medicine, Honghui Hospital, 555 Youyi Road, Xi'an City, 710054, China.
| |
Collapse
|
4
|
Mukhopadhaya J, Ranjan R, Sinha AK, Bhadani JS. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022; 17:137-143. [PMID: 36756289 PMCID: PMC9886028 DOI: 10.5005/jp-journals-10080-1564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/17/2022] [Indexed: 01/02/2023] Open
Abstract
Background Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. Materials and methods A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer's scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Results Stable union was accomplished in all. There was a significant improvement in the average Neer's score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Conclusion Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Clinical significance Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union. How to cite this article Mukhopadhaya J, Ranjan R, Sinha AK, et al. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. Strategies Trauma Limb Reconstr 2022;17(3):137-143.
Collapse
Affiliation(s)
- John Mukhopadhaya
- Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
| | - Rajeev Ranjan
- Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
| | - Amit Kumar Sinha
- Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
| | | |
Collapse
|
5
|
Cooper GM, Kennedy MJ, Jamal B, Shields DW. Autologous versus synthetic bone grafts for the surgical management of tibial plateau fractures: a systematic review and meta-analysis of randomized controlled trials. Bone Jt Open 2022; 3:218-228. [PMID: 35285251 PMCID: PMC8965781 DOI: 10.1302/2633-1462.33.bjo-2021-0195.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aims Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures. Methods A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout. Results Six studies involving 353 fractures were identified from 3,078 records. Following ROB2 assessment, five studies (representing 338 fractures) were appropriate for meta-analysis. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference -0.45 mm, p = 0.25, 95%confidence interval (CI) -1.21 to 0.31, I2 = 0%) and long-term (> six months, standard mean difference -0.56, p = 0.09, 95% CI -1.20 to 0.08, I2 = 73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, and defect site pain at long-term follow-up, perioperative blood loss, duration of surgery, occurrence of surgical site infections, and secondary surgery. Mean blood loss was lower (90.08 ml, p < 0.001, 95% CI 41.49 to 138.67) and surgery was shorter (16.17 minutes, p = 0.04, 95% CI 0.39 to 31.94) in synthetic treatment groups. All other secondary measures were statistically comparable. Conclusion All studies reported similar methodologies and patient populations; however, imprecision may have arisen through performance variation. These findings supersede previous literature and indicate that, despite perceived biological advantages, autologous bone grafting does not demonstrate superiority to synthetic grafts. When selecting a void filler, surgeons should consider patient comorbidity, environmental and societal factors in provision, and perioperative and postoperative care provision. Cite this article: Bone Jt Open 2022;3(3):218–228.
Collapse
Affiliation(s)
- George M Cooper
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Matthew J Kennedy
- Department of Orthopaedics, Forth Valley Royal Hospital, Larbert, UK
| | - Bilal Jamal
- Division of Limb Reconstruction, Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - David W Shields
- Division of Limb Reconstruction, Department of Trauma and Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
6
|
Bhandary M, Hegde AM, Shetty R, Shetty P. Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2021; 14:311-314. [PMID: 34413612 PMCID: PMC8343676 DOI: 10.5005/jp-journals-10005-1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Tooth loss due to trauma often triggers residual alveolar resorption to a greater degree in the sagittal direction leading to atrophy. However, in a pediatric patient, if this defect is left untreated, it can cause further atrophy leading to collapse of the arch. In the maxillary anterior area, this is also of esthetic concern. Hence, it is viable to reconstruct the alveolar defects and restore the alveolar anatomy with superior quality of bone while the patient is still in growing phase to avoid any structural and dental malformation, as well as to provide a more novel treatment like dental implant at a later stage when growth ceases. Modes for successfully augmenting the bone are diverse. Among these, barrier membrane with guided bone regeneration, distraction osteogenesis, and bone block graft is ubiquitous. The current case report deals with the management of horizontal atrophic anterior maxillary region using autologous block bone graft harvested from mandibular symphysis, to augment the alveolar ridge and aid in esthetic and functional restoration of alveolar anatomy by restoring the defect with the bone of superior quality as well as preparing the site for receiving implant prosthesis in future when growth ceases. How to cite this article: Bhandary M, Hegde AM, Shetty R, et al. Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2021;14(2):311–314.
Collapse
Affiliation(s)
- Meghna Bhandary
- Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangaluru, Karnataka, India
| | - Amitha M Hegde
- Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangaluru, Karnataka, India
| | - Rajmohan Shetty
- Department of Pediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangaluru, Karnataka, India
| | - Preethesh Shetty
- Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangaluru, Karnataka, India
| |
Collapse
|
7
|
Körner D, Gonser CE, Döbele S, Konrads C, Springer F, Keller G. Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years. J Orthop Surg Res 2021; 16:243. [PMID: 33832525 PMCID: PMC8028759 DOI: 10.1186/s13018-021-02384-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. METHODS A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22-107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. RESULTS The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9-3.2 cm2) and 5 mm (range 5-9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases CONCLUSIONS: Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.
Collapse
Affiliation(s)
- Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
| | - Christoph E Gonser
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Stefan Döbele
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Christian Konrads
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| |
Collapse
|
8
|
Jung WH, Takeuchi R, Kim DH, Nag R. Faster union rate and better clinical outcomes using autologous bone graft after medial opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1380-7. [PMID: 30903222 DOI: 10.1007/s00167-019-05463-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the radiological bone union rate after medial opening wedge high tibial osteotomy (MOW-HTO) and stabilization using a TomoFix™ plate (Synthes, Oberdorf, Switzerland) in three patient groups. METHODS Retrospective analysis of 137 knees that underwent MOW-HTO between January 2014 and January 2017 was using a TomoFix™ plate. Osteotomy gaps were filled with β-tricalcium phosphate (β-TCP) (group A), left unfilled (group B), and subject to autologous bone graft and β-TCP (group C). Radiological bone union using simple radiography was determined by a modified version of the Brosset et al. osteotomy filling index. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Lysholm score. Statistical analyses using the Chi-square and ANOVA tests were performed between the groups. RESULTS The mean time for radiological bone union was 8.3 ± 3.1 months in group A, 7.2 ± 3.2 in group B and 3.4 ± 1.5 in group C (p = 0.001). There was statistically significant faster bone union in Group C. If the opening distance was more than 10 mm, group A united in 8.6 ± 3.6 months, group B in 8.8 ± 3.4, and group C in 3.5 ± 1.7 (p = 0.001). IKDC and Lysholm knee scores improved significantly (p = 0.004 for IKDC and 0.001 for Lysholm knee scores) in group C when compared to groups A and B at sixth month follow-up. At final follow-up, there was no difference in IKDC and Lysholm knee scores. Less delayed union occurred in group C. CONCLUSIONS MOW-HTO with autologous bone graft and β-TCP had the fastest radiological bone union and best clinical scores at 6 month follow-up. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
Collapse
|
9
|
Torres Y, Raoul G, Lauwers L, Ferri J. The use of onlay bone grafting for implant restoration in the extremely atrophic anterior maxilla. A case series. Swiss Dent J 2019; 129:274-285. [PMID: 30857386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Functional and aesthetic treatments are challenging when ensuring maintain long-term successful prosthetic rehabilitation after alveolar ridge resorption of the anterior maxilla. The goal of this case series was to evaluate implant success rate, prosthetic stability and patient satisfaction in patients treated by onlay bone grafting in atrophic premaxilla. Nineteen patients treated for severe atrophic anterior maxilla by reconstruction using onlay bone grafting and implant restoration between 2002 and 2012 were examined. The surgical procedure was designed to allow the insertion of 49 endosseous implants in the grafted anterior maxillae. Bone resorption and implant success rate were retrospectively evaluated after a follow-up period of 5 years (from 5 to 15 years) subsequent to reconstruction. A questionnaire was the medium used to evaluate patient satisfaction and highlight functional and aesthetic outcomes. The bone grafting success rate was 74%. None of the grafted bones were reported to be infected. Four implants were removed. Implant survival rate was 91.8% after 8.9 years. The permanent reconstruction was fixed in 74% of the cases and removable in 26%. The level of patient satisfaction reported was 6.5/7. In conclusion, his study suggests that onlay bone grafting can be considered a predictable technique for rehabilitation in atrophic premaxilla. The procedure has a high implant survival rate, acceptable bone resorption over time, and promotes graft stability for longterm prosthetic fixation, thereby increasing patient satisfaction.
Collapse
Affiliation(s)
- Yolande Torres
- Department of Oral and Maxillofacial Surgery, Roger Salengro Hospital, Lille Teaching Hospital, Avenue Émile-Laine, Lille Cedex, France
| | - Gwenaël Raoul
- Department of Oral and Maxillofacial Surgery, Roger Salengro Hospital, Lille Teaching Hospital, Avenue Émile-Laine, Lille Cedex, France
| | - Ludovic Lauwers
- Department of Oral and Maxillofacial Surgery, Roger Salengro Hospital, Lille Teaching Hospital, Avenue Émile-Laine, Lille Cedex, France
| | - Joël Ferri
- Department of Oral and Maxillofacial Surgery, Roger Salengro Hospital, Lille Teaching Hospital, Avenue Émile-Laine, Lille Cedex, France
| |
Collapse
|
10
|
Abstract
BACKGROUND Treatment of tibial diaphyseal nonunions are rather difficult. Plate-screw, intramedullary nailing and external fixation are the methods used for treatment. The aim of this study is to evaluate the treatment results of aseptic diaphyseal nonunions following tibia fractures by intramedullary compressive tibia nailing (IMCN) with or without bone graft. MATERIALS AND METHODS Twenty eight patients who had aseptic tibial nonunion without bone defects operated between 2005 and 2015 were included in the study. The mean age of our patients was 36.4 years (range 20-56 years). There were 22 males and 6 females. Fifteen of the patients exhibited hypertrophic nonunion and thirteen exhibited atrophic nonunion. The average time between fracture occurrence and presentation to our department was 1.6 years (range 1-20 years). All patients underwent fibular osteotomy by removal of a 2 cm bone block from the middle one-third of the fibulas. In all cases, IMCN was applied following the reaming procedure, then maximum bone contacts were achieved manually between proximal and distal bone fragments afterward, and dynamic compressive fixation with 1 mm of compression was performed by a single rotation of the compression screw at the top of the nail. Direct X-ray images were assessed according to the Rust criteria, and functional outcomes were assessed according to the Johner-Wrush criteria. Finite-element analysis was performed for 1 mm of compression. For statistical analysis, Fisher's exact test, Pearson's Chi-square test, and Mann-Whitney U-test were used. RESULTS Union was achieved in all patients. Radiological union was obtained at an average of 15.5 ± 1.86 weeks. Functional results were found to be good or excellent in 25 (89.2%) patients and average or poor in 3 (10.8%) patients. One patient developed skin necrosis at the wound site, which was treated with rotational flap and skin graft. None of the patients developed implant failure, thromboembolism, deep-vein thrombosis, or infection. CONCLUSIONS The use of compressive intramedullary nailing with or without bone graft is an effective method for the treatment of tibial nonunion.
Collapse
Affiliation(s)
- Cengiz Aldemir
- Department of Orthopaedics and Traumatology, SaglikBilimleri University, Antalya Education and Research Hospital, Antalya, Turkey,Address for correspondence: Dr. Cengiz Aldemir, Department of Orthopaedics and Traumatology, SaglikBilimleri University, Antalya Education and Research Hospital, Varlik Avenue, KazimKarabekir Street, 07100 Antalya, Turkey. E-mail:
| | - Fatih Duygun
- Department of Orthopaedics and Traumatology, SaglikBilimleri University, Antalya Education and Research Hospital, Antalya, Turkey
| |
Collapse
|
11
|
Diermeier T, Herbst E, Braun S, Saracuz E, Voss A, Imhoff AB, Achtnich A. Outcomes after bone grafting in patients with and without ACL revision surgery: a retrospective study. BMC Musculoskelet Disord 2018; 19:246. [PMID: 30031398 PMCID: PMC6054851 DOI: 10.1186/s12891-018-2174-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current literature is lacking of data regarding functional outcomes in patients following bone tunnel grafting with or without revision anterior cruciate ligament (ACL) reconstruction. Therefore, the aim of the present study was to evaluate the clinical outcome in patients with (RACL) or without revision ACL reconstruction (OBG) following bone grafting. METHODS Fifty-nine patients (18 female, 41 male) who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACL reconstruction between 2011 and 2014 were retrospectively analyzed. In 44 patients (mean age: 30,5 ± 8,5 years) a staged revision ACL reconstruction (RACL) was performed after bone grafting. 10 patients (mean age: 33.2 ± 10.3 years) refused to have ACL revision surgery after bone grafting (OBG). Outcome measures included instrumented laxity testing, the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score and Tegner activity scale. RESULTS After mean period of 33,9 ± 17.0 months, 54 patients were available for follow up examination. In the RACL group, the Lysholm score was 77,2 ± 15,5 (range 35-100), the mean IKDC subjective knee score was 69,0 ± 13,4 (range 39,1-97,7) and the mean Tegner activity score was 4,1 ± 1,5 (range, 1-9). Similarly, in the OBG group the mean Lysholm score was 72,90 ± 18,7 (range 50-100), the mean IKDC subjective score was 69,3 ± 20,0 (range 44,1-100) and the mean Tegner activity score was 4,6 ± 1,2 (range, 3-6). No significant difference was observed between the two groups. Knee laxity measurements were elevated without revision ACL surgery, however the difference was not significant. CONCLUSION Bone tunnel grafting with or without second stage ACL revision surgery showed no significant difference in functional outcome score. Thus, in case of revision ACL instability careful patient selection is necessary and expectations should be discussed openly with the patients.
Collapse
Affiliation(s)
- Theresa Diermeier
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sepp Braun
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Emine Saracuz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas Voss
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Andrea Achtnich
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
12
|
Sawa M, Nakasa T, Ikuta Y, Yoshikawa M, Tsuyuguchi Y, Kanemitsu M, Ota Y, Adachi N. Outcome of autologous bone grafting with preservation of articular cartilage to treat osteochondral lesions of the talus with large associated subchondral cysts. Bone Joint J 2018; 100-B:590-595. [PMID: 29701088 DOI: 10.1302/0301-620x.100b5.bjj-2017-1119.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims The aim of this study was to evaluate antegrade autologous bone grafting with the preservation of articular cartilage in the treatment of symptomatic osteochondral lesions of the talus with subchondral cysts. Patients and Methods The study involved seven men and five women; their mean age was 35.9 years (14 to 70). All lesions included full-thickness articular cartilage extending through subchondral bone and were associated with subchondral cysts. Medial lesions were exposed through an oblique medial malleolar osteotomy, and one lateral lesion was exposed by expanding an anterolateral arthroscopic portal. After refreshing the subchondral cyst, it was grafted with autologous cancellous bone from the distal tibial metaphysis. The fragments of cartilage were fixed with 5-0 nylon sutures to the surrounding cartilage. Function was assessed at a mean follow-up of 25.3 months (15 to 50), using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot outcome score. The radiological outcome was assessed using MRI and CT scans. Results The mean AOFAS score improved from 65.7 (47 to 81) preoperatively to 92 (90 to 100) at final follow-up, with 100% patient satisfaction. The radiolucent area of the cysts almost disappeared on plain radiographs in all patients immediately after surgery, and there were no recurrences at the most recent follow-up. The medial malleolar screws were removed in seven patients, although none had symptoms. At this time, further arthroscopy was undertaken, when it was found that the mean International Cartilage Repair Society (ICRS) arthroscopic score represented near-normal cartilage. Conclusion Autologous bone grafting with fixation of chondral fragments preserves the original cartilage in the short term, and could be considered in the treatment for adult patients with symptomatic osteochondral defect and subchondral cysts. Cite this article: Bone Joint J 2018;100-B:590-5.
Collapse
Affiliation(s)
- M Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - T Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - M Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Tsuyuguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - M Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - N Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
13
|
Schneppendahl J, Jungbluth P, Sager M, Benga L, Herten M, Scholz A, Wild M, Hakimi M, Windolf J, Grassmann JP. Synergistic effects of HBO and PRP improve bone regeneration with autologous bone grafting. Injury 2016; 47:2718-2725. [PMID: 27817884 DOI: 10.1016/j.injury.2016.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/29/2016] [Indexed: 02/02/2023]
Abstract
Bone defects remain a challenge for patients and orthopaedic surgeons. Autologous transfer of cancellous bone grafts remains the standard of care. However, in recent years various osteoinductive substitute materials, such as platelet rich plasma (PRP) and hyperbaric oxygen therapy (HBO) have been shown to improve bone healing. This study evaluates the effects of a combined application of PRP and HBO with autologous bone grafting in an animal model. In 48 New Zealand White rabbits bone defects at the radius were filled with autologous bone harvested at the iliac crest. This was combined with application of autologous PRP and/or HBO treatment for the duration of this study. After 3 and 6 weeks histomorphometric, immunohistochemical and radiologic evaluations were performed. All animals tolerated the treatment well. Improved bone regeneration was shown in all groups at 6 weeks compared to 3 weeks. Additional application of PRP and HBO resulted in an increase in new bone formation and increased neovascularization at 3 and 6 weeks. There was no statistical significant difference between PRP and HBO application in these regards. A combinatory use of PRP and HBO resulted in an increased bone regeneration and neovascularization compared to all other groups. This study provides evidence for an improvement of bone regeneration with the combinatory application of PRP and HBO to autologous cancellous bone grafts in a model of weight bearing bone defects in rabbits. Also synergistic effects of these two measures on angiogenesis were evident.
Collapse
Affiliation(s)
- Johannes Schneppendahl
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Pascal Jungbluth
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| | - Martin Sager
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Laurentiu Benga
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Monika Herten
- University Hospital Muenster, Department for Vascular and Endovascular Surgery, Waldeyerstraße 30, 48149 Münster, Germany
| | - Armin Scholz
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Michael Wild
- Department of Orthopaedic, Trauma, and Hand Surgery, Klinikum Darmstadt, Grafenstraße 9, 64283 Darmstadt, Germany
| | - Mohssen Hakimi
- Department of Trauma, Orthopaedic, and Hand Surgery, Vivantes Klinikum am Urban, Dieffenbachstraße 1, 10967 Berlin, Germany
| | - Joachim Windolf
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Jan-Peter Grassmann
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| |
Collapse
|
14
|
Ru JY, Cong Y, Shi D, Lu YH, Niu YF, Xu HD. Augmentative locking plate with autologous bone grafting for distal femoral nonunion subsequent to failed retrograde intramedullary nailing. Acta Orthop Traumatol Turc 2016; 50:393-9. [PMID: 27449592 PMCID: PMC6197441 DOI: 10.1016/j.aott.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective To explore the indications and efficacy of augmentative locking compression plate (LCP) or less invasive stabilization system (LISS)with autogenous bone grafting (BG) in treating distal femoral nonunion subsequent to failed retrograde intramedullary nailing (RIN). Methods A retrospective study was performed for 21 patients with distal femoral nonunion subsequent to failed RIN, who received therapy with either augmentative LCP (n = 11) or LISS with autogenous BG (n = 13). Operation time, time to union, union rate, time to renonunion, complication rate and SF-36 scores a year after hardware removal were compared between the two groups. Results The bone union occurred in 13/13 (100%) cases in augmentative LISS group versus 9/11 (81.8%) cases in augmentative LCP group [odds ratio (OR) = 3.21, 95% confidence interval (CI) 0.7–13]. Time to union, time to renonunion, complication rate of the augmentative LCP group were significantly more than that of the augmentative LISS with autogenous BG group (p = 0.023, p = 0.021 and p = 0.033). No significant difference was found in the average operation time of two groups (p = 0.121). At the follow-up a year after hardware removal, statistically significant HRQOL improvement in the augmentive LISS group was measured at the level of pain (p = 0.003) and general health perception (p = 0.011), as compared to the augmentive LCP group. Conclusions We suggest augmentative LCP, for distal femoral nonunios after RIN, may be optimal for that of typeAO33A fractures, whereas augmentative LISS for that of typeAO33C fractures more.
Collapse
|
15
|
Zhou L, Wang P, Han H, Li B, Wang H, Wang G, Zhao J, Liu Y, Wu W. Prototyped grafting plate for reconstruction of mandibular defects. J Craniomaxillofac Surg 2014; 42:1723-9. [PMID: 25008032 DOI: 10.1016/j.jcms.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 04/02/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022] Open
Abstract
To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting plate in combination with autologous iliac bone grafts. Individualized titanium bone-grafting plates were manufactured using a series of techniques, including reverse engineering, computer aided design, rapid prototyping and titanium casting. A 40-mm discontinuous defect in the right mandibular body was created in 9 hybrid dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging was performed to evaluate the bone metabolism and reconstitution of the grafts. The specimens were evaluated by biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histological examination. The results revealed that the symmetry of the mandibles was reconstructed using the customized grafting plate, and the bony continuity of the mandibles was restored. By 12 weeks after the operation, the cancellous iliac grafts became a hard bone block, which was of comparable strength to native mandibles. A fibrous tissue intermediate was found between the remodelled bone graft and the titanium plate. The results indicate that the prototyped grafting plate can be used to restore mandibular discontinuous defects, and satisfactory aesthetical and functional reconstruction can be achieved.
Collapse
Affiliation(s)
- Libin Zhou
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Peilin Wang
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Haolun Han
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Baowei Li
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Hongnan Wang
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Gang Wang
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China
| | - Jinlong Zhao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, 145 Western Changle Road, Xi'an 710032, Shaanxi, PR China
| | - Yanpu Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, 145 Western Changle Road, Xi'an 710032, Shaanxi, PR China.
| | - Wei Wu
- Department of Otolaryngology Head and Neck Surgery, The 306th Hospital of PLA, 9 Anxiangbeili Street, Chaoyang District, Beijing 100101, PR China.
| |
Collapse
|