cortical bone grafting

Prior to the advent of metal internal fixation plates, cortical bone plate transplantation was a common method for the treatment of nonunion, often supplemented with cancellous bone graft to enhance its osteogenesis. Cortical bone is mainly derived from long bones such as the femur, tibia, tibia and tibia. The humerus is the most commonly used source of cortical bone donors, and the bones taken from the tibia are better. The tibia has a certain strength, usually taking the middle 1/3 or upper 1/2 of the tibia as the bone graft material. The humerus is not the main weight-bearing bone. It has no obvious effect on the function of the lower limbs after cutting. However, the following points should be paid attention to when taking the bone: 1Properly protect the common peroneal nerve; 2The distal 1/3 segment of the humerus must be preserved to ensure the ankle joint. Stability; 3 can not cut the long and short tibia. The removed humerus is treated with an intramedullary needle fixation method. It is suitable for repairing children's long bones such as ulna and humeral bone defects; some bone diseases such as the distal humeral neoplasms can be removed, and nearly 1/3 of the humerus can be removed to replace the distal radius. Treatment of diseases: nonunion 1. Cut the humeral bone (1) Incision: Make an arc-shaped incision on the anterolateral side of the calf. Because of the muscle tissue under it, it can avoid postoperative scar and bone adhesion. (2) Bone: Cut the skin and subcutaneous tissue, pull the flap to both sides, design the required size of the bone block, cut the periosteum in the I shape, push it open to the sides with the periosteal stripper to reveal the inner side of the tibia. Make a mark with the bone chisel according to the size of the required bone block, drill a small hole on the line with a hand drill, connect the small hole into a line with a knife, and slash the bone along the outline with a chainsaw or an electric saw. Piece. It is advisable to retain the anterior and posterior margins of the humerus to avoid reducing the firmness of the tibia itself after the bone is taken, thereby causing fractures. After removing the bone block, scrape the appropriate amount of cancellous bone with a spatula at the upper end of the humerus, and do not hurt the callus and joint surface. The removed bone pieces are covered with wet gauze for use. (3) Closing the wound: After the hemostasis is completed, the deep fascia is sutured, the defect on the bone is closed, and the subcutaneous tissue and the skin incision are sutured. 2. Cut the humeral bone segment (1) Incision: Make a straight incision on the outside of the humerus, the length depends on the need to take the bone. Separation between the stapedius muscle and the soleus muscle reveals the periosteum, longitudinally incision, subperiosteal dissection from the distal end to the proximal end, and the periosteal stripper is placed close to the bone surface to avoid damage to the radial artery and other blood vessels. (2) Bone extraction: After the humerus is exposed, the length of the required bone block is determined, and a plurality of small holes are drilled with the bone drill at both ends, and sawed with a wire saw or an air saw. If bone osteotomy is used, care should be taken to avoid cleft palate or fracture. If the humerus is used to replace the distal end of the humerus, the proximal 1/3 of the humerus should be taken. The common peroneal nerve is exposed behind the biceps tendon and gradually dissipates distally to the common peroneal nerve to bypass the head and neck of the humerus. Here, the common peroneal nerve is covered by the beginning of the longissimus dorsi. The blade cuts the thin layer of muscle fibers outward, dislodges the nerve and pulls it forward, and then cuts the tibia as described above. Care should be taken not to injure the anterior tibial artery between the humerus neck and the tibia while continuing subperiosteal dissection. After careful hemostasis, the deep fascia is sutured, and the subcutaneous tissue and skin are sutured.