bone graft

Osteo-bone grafting (ie, maxillary bone grafting or external bone grafting) is a procedure in which cortical bone plates are fixed on two bones to promote bone healing. The cortical bone plate is hard and clinically used to treat the non-union of the long bone bone fracture, the bone defect and the extra-articular bone graft during the joint fusion operation. In addition to stimulating osteogenesis, this implant osteotomy mainly uses its internal fixation. In practical applications, cancellous bone grafting is often used to fill voids and enhance stimulating osteogenesis. The disadvantage of bone grafting is that the diameter of the bone after bone grafting is increased, and the wound is difficult to suture. At the same time, the ability of the cortical bone to resist infection is weak, and patients with potential infections are better off. Treatment of diseases: fractures Indication 1. Bone defects caused by or after bone tumor resection. 2. Congenital sacral pseudoarthrosis, or pseudoarthrosis caused by nonunion of the fracture. 3. Various benign bone tumors or inflammatory lesions can be filled with cavities after scraping, and bone filling can be performed to restore the firmness of the bones. 4. Various internal and external fusion techniques, limb lengthening, osteotomy, and poor blood flow in the fracture for open reduction, bone graft can fill the defect, promote healing and strengthen fusion. 5. Congenital dislocation of the hip with acetabular capping or hip bone rotation. 6. Blood supply failure fractures, such as femoral neck intracapsular fractures, or ischemic osteonecrosis, such as adult femoral head necrosis, bone grafts that can be anastomosed to replace the sclerotic bone, increase local blood supply, and promote bone healing. Preoperative preparation 1. Prevention of wound infection is an important guarantee for the success of bone grafting. The anti-infective power of the graft bone is very weak. Once infected, the bone graft is soaked in the pus, necrosis will occur, and failure will occur. The precautionary measures are: the skin should be strictly prepared for the affected area and the donor area; the storage process of the stored bone must have strict sterility requirements; those with bone and soft tissue infection must be cured after 3 to 6 months of infection. Bone graft surgery, otherwise the surgery is easy to stimulate local latent bacteria, so that the infection recurs. Such patients should use antibiotics before surgery, and should use the anti-infective cancellous bone graft or the anastomotic bone graft. 2. The soft tissue around the bone area and the blood supply to the bone should be rich, and the growth force should be strong, so as to ensure the healing process of the bone graft. If the local skin and soft tissues have extensive scars, the blood supply will not be good, and the content after bone transplantation will increase, the skin will be difficult to suture, and infection will occur easily, forming a sinus. Therefore, the scar should be removed before surgery, and the flap should be transplanted to create conditions for the healing of the bone graft. 3. Many patients who need bone grafting have undergone multiple operations or long-term external fixation, resulting in muscle atrophy of the injured limb, decalcification of the bones, varying degrees of joint activity, poor blood circulation and low anti-infectiveness. The tissue growth ability is also poor. External fixation after an indispensable period of bone grafting will result in muscle atrophy and increased joint stiffness. Therefore, a period of functional exercise and physical therapy should be performed before surgery. For patients with non-displaced lower extremity fracture non-union or bone defect, functional exercise can be performed under the protection of stent or external fixation. 4. Preoperative x-ray film to understand the condition of the diseased bone, design the operation according to the condition (including the bone grafting part, the size of the bone graft and the bone grafting method). If the bone graft is to be anastomosed, the full length of the graft bone and the lateral x-ray film should be taken before surgery to select the site and length of the bone graft. 5. Before the bone graft of the anastomotic blood vessel, the ultrasonic artery should be used to detect the presence and blood flow of the main artery in the donor and recipient limbs in order to design the operation. Generally, the branches of the main arteries of the limbs are used for anastomosis, such as the deep femoral artery of the femoral artery, the inner and outer arteries of the circumflex femoral artery. If there are 2 main arteries in the receiving area, such as the ulnar artery, radial artery, anterior and posterior iliac artery, one of the main arteries may be used for anastomosis. The prerequisite must be that another major artery is confirmed by ultrasonic flowmeter or clinical examination. The blood supply is good. The veins in the recipient area are usually treated with superficial veins, such as the cephalic vein, the venous vein, the great crypt, the small saphenous vein and its branches. Therefore, the superficial vein of the recipient area should be examined for damage or inflammation before surgery. Recently used as a puncture, the superficial vein of the infusion cannot be used as a receiving vein. Surgical procedure 1. Surgery in the donor area According to the needs of the diseased bone, choose the appropriate long bone of the appropriate size from the bone bank, or cut the cortical bone plate of a certain length, width and thickness from the autologous tendon and tibia. Generally, the length of the bone plate is 5 times of the diameter of the bone, and the two ends thereof are at least 2 to 3 cm overlapping with the bone, and the width should be 1/6 to 1/4 of the bone circumference. 2. In the operation of the affected area, select the appropriate exposure route to expose the two ends of the diseased bone, remove the hardened bone and scar tissue at the end of the bone, cut through or drill through the marrow cavity, and form a new wound on both ends. The transplanted cortical bone plate is then placed on the surface of the bone, and the bone graft surface should be selected to bear the side of the bone without bending or bending, and the cortical bone of the surface is cut into a thin layer, the area of which should be slightly larger than the transplanted surface. Cortical bone plate, which allows the graft bone to be in close contact with the bone, which is conducive to fixation and accelerated healing. After the bone end was reset and the transplanted cortical bone was placed, it was fixed with screws. Then, all the gaps and defects are filled with cancellous bone fragments around the bone defect area and the graft bone.