| ObjectiveClinical study----Clinical application of bone transport technique: to explore the clinical therapeutic value of bone transport technique in the treatments of infected bone nonunion and deficit bone nonunion, to analyze the therapeutic effects and to summarize the prevention of the common complications.Animal modeling experiments----Establishment of large segmental bone defect in femurs of rabbits:to explore and establish the large segmental bone defect in femurs of rabbits and to provide the basis for the future experiment studies.Animal experiments----Experimental study of epimedium promotion of osteogenesis with femur distraction in rabbits:to observe the impacts of epimedium on the restoration of femur bone deficits.MethodsClinical study----Clinical application of bone transport technique:with retrospective research methods,33cases of bone nonunion patients which were accordance with the inclusive criteria, from November,2010to March,2014were collected. All the cases were applied with bone transport technique to restore the bone deficits. With the imaging data qualitative analysis, the osteogenesis speed and the bone deficit reunion time with following the femur distraction were observed and the occurrence of common complications was summarized. By analyzing the typical cases, the complications were recorded with Paley category, and the clinical therapeutic values of bone transport technique were explored.Animal modeling experiments----Establishment of large segmental bone defect in femurs of rabbits:in total42New Zealand SPF rabbits, male and female, were bilaterally osteotomized to femoral shaft and the bone deficit was formed with the length as about12mm. The modified unilateral external fixation was set. Following5days rest, the distraction was applied with the speed as1mm/d, bid, for successive12days. The spirit, appetite and weights were recorded every day and the stability of the external fixation was checked. By observing the X-ray examination of the bilateral femurs before and after distraction, the feasibility and repeatability of the modeling were assured.Animal experiments----Experimental study of epimedium promotion of osteogenesis with femur distraction in rabbits:the32rabbits with successful modeling were randomized into experimental group and control group. On the day1after the end of distraction, the local regions of distraction were injected with epimedium in the experiment group, and with rhBMP-2in the control group, with100μ/g/kg in each until sacrificing. By comparing the indexes such as general situation, X-ray imaging, micro-CT bone scanning, biomechanical detection, HE staining, scanning electron microscope, etc, the impacts of epimedium and rhBMP-2on promoting osteogenesis speed following distraction were explored.ResultsClinical study----Clinical application of bone transport technique:among the33cases of bone nonunion and deficits following Ilizarov technique application,31cases were basically cured and the bone deficits were restored. Among them, one was osteotomized with small incision due to axis deviation and consequently the reduction was excellent and was followed-up regularly; and one was osteosarcoma following pulmonary metastasis before surgery and died7months after surgery. Among the complications in all the cases,3were severe osteoporosis,10were slight or moderate osteoporosis and the ankle knee activity was decreased to some extent compared with before surgeries, and6were needle infections, and the infections were cured after strengthening the drug dressing and nursing.Animal modeling experiments----Establishment of large segmental bone defect in femurs of rabbits:all the42rabbits were applied with the modeling. Among them, one died before surgery due to diarrhea, one was paralyzed with lower extremities due to sciatic nerve injury, one become obvious thin and died due to appetite lost following surgery, three were failed due to bone fracture while osteotomizing, two were failed due to Kirschner wire slipping, one was dropped out due to axial angle of femoral shaft, one failed to fix due to the compression of the external fixation to the cages. All the others met the requirements and32rabbits in total were included.Animal experiments----Experimental study of epimedium promotion of osteogenesis with femur distraction in rabbits:for the detections of specimen general situation, X-ray imaging, HE staining and scanning electron microscope, the osteogenesis rates and quality14days and28days after the mineral stage in the experimental group were better than those in the control group. The bone volume (BV), bone mass density (BMD), tissue mineralized density (TMD), Tb. Th, Tb. Sp, the total volume of bone callus (TV), BV/TV and structure model index (SMI)28days after the mineral stage, etc, were analyzed with the micro-CT bone scanning, and the results showed that except the BV, TV and BV/TV, all the other indexes were significantly different (P<0.05), with the experimental group better than the control group. The micro-CT bone scanning was rebuilt via the MIMICS software and showed that the osteogenesis speed and quality in the former were better than those in the latter, and the biomechanical indexes such as N. m, maximum deflection, maximum load, torsional rigidity, elasticity stress, maximum stress, failure angle, Failure energy, etc, were compared. With the statistical analyses, the results showed that except the torsional rigidity and failure angle, all the other indexes were significantly different (P<0.05), with the experimental group better than the control group. ConclusionClinical study----Clinical application of bone transport technique:the clinical therapeutic effects of bone transport technique in the treatment of infective bone deficit and nonunion were definite, but with a long treatment period, especially the longer consolidation, the more complications.Animal modeling experiments----Establishment of large segmental bone defect in femurs of rabbits:by setting the modified unilateral external fixation and improving the modeling methods, the models of large segmental bone defect in femurs of rabbits were excellent, with high stability, repeatability and success rates, which were worthy of being further popularized in the animal experiments.Animal experiments----Experimental study of epimedium promotion of osteogenesis with femur distraction in rabbits:the epimedium could promote the osteogenesis speed following distraction in mineral stage and enhance the quality of the osteogenesis. |
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