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Objective: To explore the feasibility of using the entry point and screw path parameters of sacroiliac (S 2 AI) screws inserted under O-arm 3D computer navigation as a reference for freehand screw insertion in patients with degenerative spinal deformities. Methods: A retrospective analysis was conducted on the clinical data of 66 patients with degenerative spinal deformities who received S 2 AI screw fixation assisted by the O-arm 3D computer navigation system at Nanjing Drum Tower Hospital Affiliated with Nanjing University Medical School from January 2017 to April 2022. The patients included 6 males and 60 females, with a mean age of (64.3±5.9) years. Preoperatively, the entry point was set as the intersection of 1 mm from the outer and lower edges of the S 1 foramen, adjusted intraoperatively by navigation, and verified postoperatively by full spinal CT scans and 3D reconstructions. Using the S 1 screw entry point as the origin, the position of the bilateral S 2 AI screw entry points, tailward angulation (SA), outward angulation (TA), and vertical distance from the entry point to the skin (SD) were measured on postoperative CT 3D images. The accuracy of S 2 AI screw placement and any intraoperative and postoperative complications were recorded. Differences in entry point coordinates and screw path parameters between the left and right sides were compared. The intraclass correlation coefficient (ICC) was used to assess intra-observer and inter-observer agreement. Results: The coordinates and screw path parameters for the S 2 AI screws placed using the O-arm navigation demonstrated good intra-observer and inter-observer consistency (ICC>0.75). The left entry point was located (8.08±1.39) mm laterally and (24.47±2.20) mm caudally from the S 1 entry point, while the right entry point was (8.09±1.41) mm laterally and (24.40±2.54) mm caudally, with no significant difference between the left and right sides (both P >0.05). The left TA was 46.33°±3.44°, SA was 39.14°±6.12°, and SD was (60.38±13.37) mm; the right TA was 46.37°±3.41°, SA was 39.59°±5.89°, and SD was (60.30±12.24) mm, with no significant differences between the left and right parameters (all P >0.05). There was no significant neurovascular complications intraoperatively or two weeks postoperatively, with a screw insertion accuracy of 97.7% (129/132). Conclusions: In the fixation of the pelvis in degenerative spinal deformities, the use of O-arm navigation-assisted S 2 AI screw insertion has a high accuracy rate. It is recommended that for freehand screw insertion, the entry point should be located 24 mm caudally and 8 mm laterally from the outer and lower edges of the superior articular process of S 1 , with an TA of approximately 46° and a SA of approximately 39°.

BACKGROUND: In recent years, new progress has been made in the treatment of Paprosky III acetabular defects at home and abroad. Commonly used reconstruction methods include tantalum metal pads, acetabular strengthening cups-reinforcing rings, cemented acetabular prostheses, reconstruction steel plates, and titanium metal mesh. OBJECTIVE: To investigate the clinical efficacy of using autogenous iliac bone blocks in combination with titanium plate to reconstruct Paprosky III type of acetabular defects in revision total hip arthroplasty. METHODS: Totally 15 patients with severe acetabular defects reconstruction utilizing autogenous iliac bone blocks combined with titanium plates, including 9 men and 6 women, with age of 47-78 years, were selected from June 2012 to August 2020 from First Affiliated Hospital of Bengbu Medical College. Clinical manifestations and postoperative X-ray characteristics of the patients were observed. The Harris hip score and visual analogue scale score prior to operation and at the last follow-up visit were evaluated. The anteverted angle and abduction angle of the postoperative acetabular cup were recorded. The changes of center-edge angle of hip joint and acetabular angle were measured 1 week after surgery and at the last follow-up. The incidence of postoperative complications was observed. This study was approved by the Ethics Committee of First Affiliated Hospital of Bengbu Medical College. RESULTS AND CONCLUSION: (1) All of the 15 patients were successfully operated and followed up for 12 to 60 months. Among them, one case had symptoms of lateral femoral cutaneous nerve injury, but no plate fracture, osteolysis, infection, or periprosthetic fracture occurred. (2) Harris hip score and visual analogue scale score were significantly improved during the last follow-up in 15 patients (P < 0.05). (3) The anteversion angle and abduction angle of the acetabular cup were (16.96±0.76)° and (41.64±0.81)°, respectively, both of which were within the safety range in 15 patients. One week post surgery and at the last followup, the center-edge angle and acetabular angle were not significantly different in 15 patients (P > 0.05). (4) It is concluded that for patients with Paprosky III acetabular bone defects, acetabular ring reconstructed by autogenous iliac bone and allogeneic grain bone combined with titanium plate can restore anatomic structure of the hip joint, which provides a strong initial fixation for the prosthesis, finally obtaining satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Elderly patients with Neer 3- and 4-part fractures of the proximal humerus have poor proximal bone, so the bone defect after fracture reduction is very serious, which will lead to poor effect of simple locking plate fixation. OBJECTIVE: To evaluate the efficacy and mechanism of allogeneic ilium and fibula in the treatment of Neer 3- and 4-part fractures of the proximal humerus in the elderly. METHODS: Data of 64 elderly patients with Neer 3- and 4-part fractures of the proximal humerus and undergoing different surgery techniques in Department of Orthopedics, The First Affiliated Hospital of Shanxi Medical University from November 2014 to March 2019 were retrospectively analyzed. They were divided into three groups: single locking plate (group A, 24 cases), locking plate combined with allogeneic ilium (group B, 19 cases) and locking plate combined with allogeneic fibula (group C, 21 cases). The following observation indexes were compared in three groups: (1) General indicators: operation time, intraoperative blood loss, hospital stay; (2) imaging indicators: the neck-shaft angle, humerus head height, and healing time; (3) efficacy indicators: Constant-Murley score, visual analog scale, the incidence of complications. RESULTS AND CONCLUSION: (1) All patients were healed and followed up from 12 to 24 months. (2) The operation time and hospital stay in group A were significantly better than those in groups B and C (P < 0.05). However, there was no significant difference in intraoperative blood loss compared with groups B and C (P > 0.05). There was no significant difference in three indicators between groups B and C (P > 0.05). (3) Group A had higher neck-shaft angle and humerus head height than groups B and C (P < 0.05), and there was no significant difference between group B and group C (P > 0.05). There were significant differences in the healing time between groups A, B and C (P < 0.05), in which group A > group C > group B. (4) The total Constant-Murley score and the score of active items in group A were lower than those in groups B and C (P < 0.05), and there was no significant difference between group B and group C (P > 0.05). There was no statistically significant difference in visual analog scale score among groups A, B and C (P > 0.05). (5) Complications in group A included screw resection in 1 case, humeral head necrosis in 1 case, and joint stiffness in 2 cases. There was 1 case of acromial impingement syndrome in group B. In group C, screw resection occurred in 1 case and head necrosis of humerus in 1 case. There was no significant difference in the incidence of complications in the three groups (P > 0.05). (6) It is indicated that locking plate is the first choice for the treatment of Neer 3- and 4-part fractures of the proximal humerus in the elderly. For those with significant bone defects, mechanical stability can be achieved by combining fibula allografts. For partial bone defects, ilium allograft can be used to accelerate osteogenic healing. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the surgical treatment of spinal deformities and tumors, the firm and stable fixation of the lumbosacral junction is a task that must be completed in the operation, and it is a relatively great challenge. The incidence rate of postoperative complications (such as pseudarthrosis, failure of internal fixation and loosening) is high. The mechanical strength of the bone tissue in the sacrum is low, and the high load in the lumbar vertebrae and pelvis increases the risk of internal fixation pullout, which further leads to the loosening of the instrument. Although there are some of the most effective surgical techniques, the complexity of surgical techniques often leads to unsatisfactory clinical results OBJECTIVE: To summarize the latest research progress on the sacropelvic fixation and clinical applications of the S2 alar iliac (S2AI) screws, and provide a reference for clinical treatment. METHODS: The computer was used to search articles published from 2005 to 2020 in CNKI, Wanfang, and PubMed. The search terms were “S2 alar iliac screw, S2AI, iliac screw, sacropelvic fixation, alar iliac screw” in English and Chinese. Relevant articles were consulted, and finally 43 articles were included for analysis. RESULTS AND CONCLUSION: (1) Sacral pelvic fixation, such as ilium and S2AI screw, was added to the lower end of long segmental fixation of the spine to solve the above-mentioned related complications. (2) S2AI screw placement technique plays an important role in stabilizing sacroiliac joint. Because of its unique screw placement method, it avoids screw dislocation, reduces postoperative sacroiliac joint pain and reduces the risk of reoperation. (3) As a new technology of spinal and pelvic fixation, S2AI screw has many advantages and clinical significance, but due to the complex and diverse structure of sacroiliac joint and individual differences of patients, there are still related problems in clinical application of S2AI screw. [ABSTRACT FROM AUTHOR]

To improve the accuracy and operation efficiency of patient registration for the surgical navigation system， the registration strategy which combined three-point method and iterative closest point (ICP) algorithm was proposed. Firstly， the patient registration problem was defined and the acquisition methods of preoperative and intraoperative data were introduced. Then， the spherical center of the optical positioning markers were taken as the common features between patient space and image space， and the initial registration was completed by using the three-point method. Finally， the spherical regions with radius r were established by taking each point of patient point cloud after initial mapping as the spherical center， and the points of image point cloud located in these regions were retained to realize sampling， and the improved ICP algorithm was used to perform accurate registration of the two point clouds. The experimental results showed that the mean registration errors for pig femur and pig ilium when using the proposed method are (0.83±0.10)mm and (0.86±0.09)mm， respectively， which is superior to the traditional ICP algorithm in terms of accuracy and stability， and is efficient and easy to operate with certain potential values in clinical applications. [ABSTRACT FROM AUTHOR]

Objective To explore the imaging manifestations of secondary bursa formation in osteochondroma, so as to improve the diagnosis of this disease. Methods The clinical, CT and MRI data of 12 cases of osteochondroma with secondary bursa formation confirmed by surgery and pathology were retrospectively analyzed. Of the 12 patients, 2 received plain CT scan, 3 received MRI, and 7 received both CT and MRI. Results Of the 12 cases, 4 cases occurred in the scapula (2 cases on the left side, 2 cases on the right side), 5 cases occurred in the lesser trochanter of the femur (3 cases on the left side, 2 cases on the right side), and 1 case occurred in the distal part of the left femur. One case occurred in the distal part of the right fibula, and one case occurred in the left ilium. The image showed an irregular mass next to the osteochondroma, 8 cases showed low density on CT scan, 1 case showed low density on CT scan, 7 cases showed low signal on T_1WI, 2 cases showed high signal on T_1WI, and 1 case showed high density. Signal; high signal on T_2WI. Mural nodules and septal shadows were seen in 12 cases of bursa, and 3 cases also had secondary synovial osteochondromatosis. CT and MRI enhanced scan showed that the bursal wall was markedly enhanced. Conclusion The formation of secondary bursae of osteochondroma is more likely to occur in the long-term abrasion site, and the clinical manifestations are mainly pain and discomfort and mass enlargement; the imaging manifestations are irregular water-like density or signal masses next to the osteochondroma, in the bursa Visible wall nodules, separated, can be secondary to synovial osteochondromatosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Saving the humeral head is a challenge when the proximal humerus is fracture in orthopedic trauma, and how to obtain medial column support is a hot topic in recent years. OBJECTIVE: To summarize the general concept, clinical significance and function, the common injury mechanism of humeral calcar, and the progress using locking plate so as to improve the clinicians' understanding for the humeral calcar and to reduce the occurrence of surgical complications. METHODS: From 2004 to 2019, Wanfang, CNKI, VIP, PubMed, Web of Science, and Springer Link about the treatment and research progress of proximal medial wall of the humerus were searched by the first author. The key words were "proximal humeral fracture, Philos, infermedial screw, calcar screw, fibular allograft, middle support" in English, and "proximal humeral fracture, humeral spur, medial column, plate, fibular allograft" in Chinese. The references were retrieved by hand. Finally, 51 studies were used for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The range of the humeral calcar region is still unclear. There is no uniform classification standard for fractures involving the humeral calcar region. X-ray films show that calcar fracture patterns are often inconsistent with the actual fracture situation, which is often a complex fracture. Lack of understanding and paying litter attention to the humeral calcar region is the main reason of iatrogenic injury and the failure to get a good repair. (2) Treatment using the locking plate is still the preferred method for proximal humerus fracture. Meanwhile, it is a feasible method that using the screw, the allogeneic iliac bone graft, the bone cement or the medial plate to reconstruct the medial column if there is a "repairable medial wall". Getting anatomical reduction of the internal wall and effective support of the medial column during operation can help to reduce postoperative complications. However, the use of the medial buttress plate requires further research to verify. It is critical important to repair the rotator cuff for the medial column support. (3) The range of the humeral calcar region needs to be unified. Understanding the humerus calcar is essential for the treatment of proximal humeral fracture. Only by mastering the fracture mode of the humerus calcar and choosing the most appropriate surgical procedure before surgery, meanwhile, achieving anatomical reduction of the medial wall and the effective support of the medial column during operation can reduce the postoperative complications of the fracture. Repairing of the rotator cuff carefully during operation is indispensable for patients to obtain better shoulder function. [ABSTRACT FROM AUTHOR]

It is very difficult to fix the comminuted radial head fracture of Mason type Ⅲ. Surgical methods include radial head resection, screw and plate fixation, and artificial radial head replacement. However, the surgical methods are controversial. In this article, a case of reconstruction of the radial head and obtaining a good function of the elbow joint with the self-made bone harvester was reported. This paper introduces the method of reconstructing the radial head with selfmade bone remover, and provides new ideas for the treatment of unstable comminuted radial small head fracture in the future. [ABSTRACT FROM AUTHOR]

BACKGROUND: Proximal junctional kyphosis is a common complication after spinal deformity surgery, which can lead to a variety of adverse clinical outcomes. Therefore, it is necessary to analyze the risk factors that may lead to proximal junctional kyphosis after surgery, in order to expand our understanding of proximal junctional kyphosis and provide guidance for its prevention. OBJECTIVE: To evaluate the risk factors of proximal junctional kyphosis after spinal deformity surgery using meta-analysis. METHODS: A systematic literature search was performed using PubMed, EMbase, Cochrane, CNKI and Wanfang Medical Database (up to May 2019). The quality of literatures was assessed and selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted. RevMan 5.3 software was used for data analysis and the data were dealt by meta-analysis. The meta-analysis results were evaluated. RESULTS AND CONCLUSION: (1) This study included 26 studies involving 4 498 patients of whom 921 with proximal junctional kyphosis. The incidence of proximal junctional kyphosis after spinal orthopedic surgery was 25%. (2) There were significant differences between the proximal junctional kyphosis and non-proximal junctional kyphosis groups in age, body mass index, osteoporosis, number of surgical vertebral bodies, the upper instrumented vertebra to the thoracolumbar segment (T10-L1), the lower instrumented vertebra to the sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis (P < 0.05). (3) There were no significant differences in gender, osteotomy, combined surgery, preoperative proximal kyphosis angle or preoperative lumbar lordosis (P > 0.05). (4) Our meta-analysis showed that age, body mass index, osteoporosis, the number of operative vertebrae> 5 at fixation segment, the upper instrumented vertebra internal fixation to thoracolumbar segment (T10-L1), the lower instrumented vertebra fixation to sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis were the main risk factors for proximal junctional kyphosis. The incidence of proximal junctional kyphosis can be reduced by intervening the high-risk population and making the suitable surgical procedures. Proximal junctional kyphosis was due to a variety of non-surgical and surgical factors. More rigorous epidemiological studies are needed to provide reliable evidence for reducing the incidence of proximal junctional kyphosis. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the feasibility and safety of the deep circumflex iliac artery (DCIA) derived chimeric flap through the anatomical study of the blood vessels and perforating branches in the ilioinguinal region, and to provide the basis for selecting different DCIA chimeric flap schemes according to the difficulty of surgery, defect conditions and repair needs., Methods: Six Chinese adult specimens were dissected by retrograde perfusion of red latex into bilateral femoral arteries. At the same time, the length, diameter and main branch position of DCIA vascular pedicle were measured in 12 lower limb CTAs, and compared with the anatomical data. Six patients with oral tumors accompanied by mandibular defects who were treated in the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University from July 2020 to November 2021 were repaired and reconstructed with the chimeric iliac myofascial flap. The postoperative appearance and occlusal function of the recipient area were observed. SPSS 19.0 software package was used for data analysis., Results: A total of 19 DCIA perforators with an external diameter of ≥ 0.5 mm were found in 12 specimens of ilioinguinal region. These perforators were distributed in the 5 cm×3 cm area, inside the ilium and 5cm behind the anterior superior iliac spine. The length of DCIA vascular pedicle was (6.73±1.06) cm. The measured value of the external diameter of the starting position of the vascular pedicle was (2.55±0.29) mm. The outer diameter of DCIA skin perforator penetrating deep fascia was (1.12±0.14) mm. In the CTA analysis of 12 lower limbs, it was found that the length of DCIA vascular pedicle was (6.98±0.62) cm. The measured diameter at the original position of vascular pedicle was (2.35±0.20) mm. Six cases of mandibular defects were repaired with iliac internal oblique fascia mosaic flap. Six cases of lliac flap survived successfully after operation. Follow up for 6 to 24 months (average 12 months) showed that the mandibular shape and function recovered well, the intraoral myofascial flap became mucosal, and the implanted iliac bone showed no significant volume change on CT after operation. Walking and weight bearing in donor area were basically normal, and no abdominal hernia occurred., Conclusions: DCIA and its main branches have a relatively constant course and distribution in the ilioinguinal region. According to the conditions of different defect areas, different tissue types of chimeric flaps based on DCIA can be prepared to meet the repair requirements. The donor site complications can be controlled, and it is an ideal choice to repair mandibular defects.

Objective: To compare the outcomes between iliac crest and accessory navicular as different bone grafts in the Cotton osteotomy in the treatment of pediatric flexible flatfoot deformity. Methods: A retrospective cohort study. The clinical data of pediatric flexible flatfoot patients with symptomatic accessory navicular received operations from July 2018 to March 2022 in Beijing Tongren Hospital were retrospectively analyzed. All the patients were treated with Cotton osteotomy. According to the different sources of bone grafting in Cotton osteotomy, the patients were divided into iliac crest group and accessory navicular group. There were 12 patients (19 feet) in iliac crest group, including 9 males and 3 females with a median age M ( Q 1 , Q 3 ) of 11(11, 12) years and were followed-up for 36(6, 48) months. There were 9 patients (16 feet) in accessory navicular group, including 6 males and 3 females, with a median age M ( Q 1 , Q 3 ) of 11(11, 11) years and were followed-up for 12(6, 17) months. Radiographic evaluations were reviewed and compared between the two groups before surgical treatment and at final follow-up, included talo-1st metatarsal angle (T1MT), talonavicular coverage angle (TNCA), talocalcaneal angle (TCA) in weight bearing anteroposterior view, and Meary angle, calcaneal Pitch angle, Kite angle, cuneiform articular angle (CAA) in weight bearing lateral view, and hindfoot alignment angle (HAA) in calcaneal long axial view. Functional scores included American Orthopedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and Maryland scores were recorded and compared before and after the operation. The complications were also recorded. Results: Total of 21 patients were successfully followed in this study. The radiographic measurements in the two groups, such as T1MT, TNCA, Meary angle, Pitch angle, Kite angle, CAA, HAA, were all significantly improved at the last follow-up when compared with those before the surgery (all P <0.05); and the AOFAS, VAS, Maryland scores in both groups were all improved after the surgery (all P <0.05). There was a significant difference in CAA alteration (∆CAA) after the operation between the two groups, the ∆CAA in iliac crest group and the accessory navicular group was 6.0°±2.6° and 4.3°±1.3°, respectively ( P =0.017). There was no significant differences in the improvement of other radiographic measurements between the two groups (all P >0.05). All the patients had a successful bone union. Two patients had donor site pain in the iliac crest group and were treated conservatively. Conclusion: Compared with iliac crest bone graft, accessory navicular bone graft could achieve comparable outcomes in radiographic measurements and functional scores in the treatment of pediatric flexible flatfoot with accessory navicular pain.

BACKGROUND: Iliac bones are common habitant parts in metastatic tumor of bone, and the affiliate cortex is easy to be penetrated into soft tissue blots. The irregular iliac shape and its complex surrounding tissues create the difficulties in puncture operations and cement perfusion. OBJECTIVE: To investigate the clinical outcomes of CT-guided versus DSA-guided puncture combined with bone cement perfusion for metastatic tumor to the ilium. METHODS: Sixty-four patients with metastatic tumor to the ilium udergoing bone cement perfusion were enrolled, and then divided into control and experimental groups (n=32 per group), followed by treated with DSA-guided percutaneous injection of bone cement, and CT-guided puncture, respectively. Subsequently, the diffuse distribution of bone cement was observed using CT. The success rate, leakage rate, Visual Analogue Scale scores and Oswestry Disability Index were compared between two groups. RESULTS AND CONCLUSION: (1) All patients received the surgery successfully, and bone cement leakage happened in two cases of control group and one case of experimental group. (1) The Visual Analog Scale and Oswestry Disability Index scores in the two groups were significantly better than those before treatment (P < 0.05), and the scores showed no significant differences between two groups (P > 0.05). (3) No difference was found in the pain relief and functional recovery between two groups. (4) To conclude, CT-guided treatment can achieve satisfactory outcomes for metastatic tumor to the ilium by bone cement infusion in appropriate time. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical characteristics, classification, surgical approach, complication and prognosis of cervical dumbbell-shaped tumors. Methods Twenty-six consecutive cases with cervical dumbbell-shaped tumors were retrospectively studied. According to tumor location by imaging examination, all tumors were divided into 3 types. Type Ⅰ (17 cases) was mostly intravertebral and foraminal. Surgery through posterior approach was performed and internal fixation was operated in 8 cases. Type Ⅱ (4 cases) was mostly paravertebral and foraminal. Surgery through the anterolateral approach was performed without internal fixation. Type Ⅲ (5 cases) was equalization of intravertebral and paravertebral, and underwent surgery through combined posterior-anterolateral approach and internal fixation was performed in all of those cases. If the unilateral facet joint was destroyed, internal fixation was necessary. Lateral mass screw internal fixation and transpedicular screw fixation supplemented by fusion with autologous iliac bone graft were used to maintain cervical spinal stability. Results Among 26 patients there were 19 schwannomas, 4 neurofibromas, 2 gangliocytoma and 1 spinal meningioma. Total and subtotal tumor resection was achieved in 23 and 3 patients respectively. Among them 50% (13/26) of the cases were used internal fixation including 8 TypeⅠand 5 Type Ⅲ patients. The follow-up period was from 7 to 62 months, and mean time was 30 months. Four cases (15.38%) were found local tumor recurrence. Two cases suffered with surgical infection and cerebrospinal fluid leakage. There was no spinal cord injury and spinal deformity. Conclusion In order to increase the total resection rate and decrease recurrence rate, surgical approach should be selected according to the imaging classification of tumors. Stability reconstruction is absolutely necessary for the patients with facet joint destroyed. doi: 10.3969/j.issn.1672-6731.2013.11.006Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n11a6

Objective: To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures., Methods: Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days)., Results: The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d'Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred., Conclusion: For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.

Objective To compare and analyze the treatments of anterior-superior iliac spine avulsion fractures in chil­dren and adolescents. Methods Clinical datas of 44 cases diagnosed as the anterior-superior iliac spine avulsion fractures from January 1,2009 to December 31,2014 in our hospital were retrospective analyzed. According to the treatment method,the pa­tients were divided into the surgical group (n=24) and the conservative group (n=20) . The surgical group was treated by open re­duction and absorbable screw fixation, the conservative group was received a conservative treatment of resting with hip and knee flexion. Results Children in the two groups were followed up for 1-7 years, average 4.0 years. In the surgical group, all the cases were osseous healing,hip joint activities were normal and back to normal movement,no absorbable screws prolapse,nonunion incision infection and lateral thigh skin hypesthesia were observed. In the conservative group, all cases were osseous healing too, while one case appeared delayed healing, the healing time was 6.5 months, one case showed hip and thigh lateral discomfort, but self-relieved. Conclusion Comparison of conservative against surgical treatment of open reduction and absorbable screw fixation of anterior-superior iliac spine avulsion fractures, patients with surgical treatment heal faster, function recovery earlier, can carried out early activity and prevent the stiff joints, furthermore, the absorbable screws do not need to be removed, which avoiding secondary operation. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical characteristics, classification, surgical approach, complication and prognosis of cervical dumbbell?shaped tumors. Methods Twenty-six consecutive cases with cervical dumbbell-shaped tumors were retrospectively studied. According to tumor location by imaging examination, all tumors were divided into 3 types. Type ? (17 cases) was mostly intravertebral and foraminal. Surgery through posterior approach was performed and internal fixation was operated in 8 cases. Type ? (4 cases) was mostly paravertebral and foraminal. Surgery through the anterolateral approach was performed without internal fixation. Type ? (5 cases) was equalization of intravertebral and paravertebral, and underwent surgery through combined posterior - anterolateral approach and internal fixation was performed in all of those cases. If the unilateral facet joint was destroyed, internal fixation was necessary. Lateral mass screw internal fixation and transpedicular screw fixation supplemented by fusion with autologous iliac bone graft were used to maintain cervical spinal stability. Results Among 26 patients there were 19 schwannomas, 4 neurofibromas, 2 gangliocytoma and 1 spinal meningioma. Total and subtotal tumor resection was achieved in 23 and 3 patients respectively. Among them 50% (13/26) of the cases were used internal fixation including 8 Type?and 5 Type ? patients. The follow-up period was from 7 to 62 months, and mean time was 30 months. Four cases (15.38%) were found local tumor recurrence. Two cases suffered with surgical infection and cerebrospinal fluid leakage. There was no spinal cord injury and spinal deformity. Conclusion In order to increase the total resection rate and decrease recurrence rate, surgical approach should be selected according to the imaging classification of tumors. Stability reconstruction is absolutely necessary for the patients with facet joint destroyed. [ABSTRACT FROM AUTHOR]

Objective: To compare and study the traditional iliac bone extraction and iliac crest preserving bone extraction, and to observe their curative effects., Methods: From January 2016 to December 2018, 50 patients were treated with traditional iliac bone extraction and iliac crest preserving iliac bone extraction, with 25 cases in each group. In the traditional iliac bone extraction group, there were 18 males and 7 females, aged (42.0±7.9) years, hospitalized for (20.0±5.5) days and followed up for (13.68±1.60) months. There were 16 males and 9 females in the iliac crest preserving osteotomy group, aged (44.0±8.2) years, hospitalized for (21.0±6.5) days and followed up for (14.04±1.54) months. The operation time, intraoperative bleeding, postoperative pain visual analgue scale(VAS), fracture healing and complications were recorded and compared between the two groups., Results: In the traditional iliac bone extraction group, the operation time was (16.20±2.51) min, the amount of bleeding was (63.20±17.73) ml, the VAS score on the first day after operation was 4.72±1.21, and the fracture healing time was (4.84±0.90) months. In the iliac crest preserving osteotomy group, the operation time was (16.24±3.00) min, the amount of bleeding was (62.80±18.14) ml, the VAS score was 4.80±1.29 on the first day after operation, and the fracture healing time was (4.68±0.80) months. There was no significant difference in operation time, bleeding volume, pain VAS on the first day after operation and fracture healing time between the two groups( P >0.05)., Conclusion: Compared with the traditional iliac bone removal surgery, this bone removal method of preserving the appearance of iliac bone is simple and convenient. While ensuring the amount of bone removal, it retains the appearance of iliac crest as much as possible and reduces local discomfort symptoms after operation. It is worth popularizing.

Bertolotti's syndrome which causes low back pain with lumbosacral transitional vertebrae, was first reported in 1917. In the transitional vertebra, at least one transverse process fuses or articulates with the sacrum and ilium. Sometimes the articulate portion causes low back pain or related pain. We reported five cases with Bertolotti's syndrome among sports players. All cases were treated conservatively. Local injection of steroid was required in the articulated portion in two cases. We must be aware of Bertolotti's syndrome on the differential diagnosis among young sports players with low back pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate the anatomy of the perforator vessels of the deep circumflex iliac artery (DCIA) and the techniques for repairing mandibular complex defect using chimeric deep circumflex iliac artery perforator flap (DCIAPF)., Objective: We analyzed the origin, distribution, number and courses of the perforator vessels of the DCIA, and measured the outside diameters of the vessels at the origin in 6 adult cadaveric specimens (12 sides) with latex perfusion. From July, 2018 to September, 2019, based on the results of anatomical study and imaging findings and using the digital surgical guide plate, we harvested DCIAPF from 4 patients for repairing mandibular body or angle defects and oral soft tissue defects., Objective: The perforating vessels of the DCIA included abdominal muscular branches, osteomusculocutaneous branches and terminal musculocutaneous branches. The abdominal muscle branches originated from the DCIA inguinal segment in 4 and from both the inguinal and iliac segments in 2 of the specimens. The osteomusculocutaneous branches all originated from the internal iliac crest in 75% and from both the inguinal and internal iliac crest segments in 25% of cases; the inguinal segment gave rise to only one perforating branch. The number of the musculocutaneous perforating branches was 1 (58.3%) or 2 (41.7%). In the 4 patients undergoing mandibular reconstruction, the DCIAPF survived in all cases with good recovery of the donor site wound. Satisfactory facial appearance with good oral morphology and occlusal relationship was achieved at 1 month postoperatively in all the patients. None of the patients experienced obvious functional abnormalities at the donor site, and imaging examination confirmed successful reconstruction of the oromandibular defects in all the cases., Objective: A good understanding of the anatomic characteristics of the perforator vessels of the DCIA combined with imaging examinations and digital surgery technology facilitates the harvest of DCIAPF for repairing mandibular body or angle defects complicated by oral soft tissue defects.

Objective: To summarize the current progress of vascularized bone grafting in the treatment of osteonecrosis of the femoral head (ONFH), and to provide reference for treatment of ONFH., Methods: The literature at home and abroad on the treatment of ONFH with vascularized bone grafting was reviewed, and the mechanism, operating methods and effectiveness, indications, and complications were summarized., Results: Vascularized bone grafting is a commonly used clinical hip-preserving operation. By replacing necrotic bone tissue with vascularized bone, it can rebuild the blood circulation system, promote the healing of the necrotic area, and provide biomechanical support for the necrotic area of the femoral head, prevent the joint surface collapse. The main operations include the vascularized iliac bone flap grafting, the vascularized greater trochanter bone flap grafting, and the vascularized fibular grafting. The clinical application has achieved certain effectiveness, and the different procedures are suitable for different types of patients. The procedures need to be selected based on the patient's overall condition, the cause of ONFH, the necrosis stage, and the degree of the evaluation., Conclusion: Vascularized bone grafting has a definite effectiveness in the treatment of ONFH in the young and middle-aged. It can significantly improve hip joint function, control the further development of the disease to a great extent, effectively delay or even avoid hip arthroplasty. It is a reliable hip-preserving operation worthy of promotion.

Objectives: To explore the clinical efficacy of endoscopic L 5 /S 1 discectomy through interlaminar approach for the patient with the high iliac crest and migrated disc herniation., Methods: A retrospective study of 31 patients with the high iliac crest and migrated disc herniation at the L 5 /S 1 level was conducted in our hospital. All of the consented patients accepted endoscopic L 5 /S 1 discectomy through interlaminar approach from January 2016 to January 2019. Preoperative, postoperative, and follow-up Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess the pain and waist function of patients. The clinical efficacy was evaluated according to Macnab criteria., Results: All the patients were followed up for 12-48 (29.68±9.64) months. The operation time was (79.16±22.43) min. The times of fluoroscopy were 2.71±0.78. The VAS of low back and leg pain was 7.09±0.94 before the surgery, 1.45±1.23 at 3 months after the surgery, and 1.27±0.92 at the last follow-up. The VAS after the surgery and at the last follow-up was significantly lower than that before the operation ( P <0.05). The ODI was 56.03±6.64 before the surgery, 16.45±6.83 at 3 months after the surgery, and 13.03±4.96 at the last follow-up. The ODI was significantly lower after the surgery and at the last follow-up compared with that before the surgery ( P <0.05). The Macnab score at the last follow-up was graded as excellent in 26 cases, good in 3 cases, fair in 2 cases, and the percentage of excellent and good were 93.5%. Part of the nucleus pulposus remained in 2 cases after the operation, one case underwent endoscopic revision and one case received conservative treatment; postoperative pain due to nerve root irritation was in one case and relieved by conservative treatment., Conclusions: The endoscopic L 5 /S 1 discectomy through interlaminar approach is a relatively safe and effective treatment for the patient with the high iliac crest and migrated disc herniation, which can reduce X-ray examinations and complications, and achieve satisfactory clinical outcomes.

Objective: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis., Methods: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L 4 to S 2 . The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed., Results: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively., Conclusion: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.

Objective: To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy (PELD) treatment in patients with L 5 , S 1 lumbar disc herniation., Methods: A retrospective study between May 2014 and March 2016 was conducted, including 100 patients with disc herniation at L 5 , S 1 , who were initially enrolled for the PELD treatment. Among them, 66 patients were successfully treated with PELD (group A), and the other 34 patients failed to perform puncture, catheterization, or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans. By analyzing the X-ray films of lumbar vertebrae (including bilateral ilium) of the two groups before operation, the concept of ilium height rate and ilium angle rate was put forward innovatively. The ilium height rate and ilium angle rate of the two groups were measured and compared, and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis., Results: The ilium height rate was 0.61±0.09, 0.74±0.05 and the ilium angle rate was 0.66±0.08, 0.80±0.08 in groups A and B, respectively, showing significant differences between the two groups ( F =69.729, P =0.000; F =65.165, P =0.000). ROC curve analysis showed that the critical point of ilium height rate was 0.71 (area under ROC curve was 0.927, P =0.000), and the critical point of ilium angle rate was 0.75 (area under ROC curve was 0.965, P =0.000)., Conclusion: PELD is not recommended for patients with L 5 , S 1 intervertebral disc herniation, when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75. Other surgical plans such as transpedicular approach, transpedicular approach, or open surgery, should be recommended to reduce the risk of surgery and the pain of patients.

Objective: To investigate the clinical results of locking compression plate combined with autologous iliac bone graft in the treatment of aseptic ulnar nonunion., Methods: From March 2009 to July 2017, 22 patients with aseptic ulnar diaphyseal nonunion with complete follow-up data were treated with surgery, including 12 males and 10 females, aged from 16 to 58 (39.7±9.9) years old and ranging in course of disease from 10 to 192 (39.4±55.7) months. There were 15 atrophic nonunions, 5 hypertrophic nonunions and 2 synovial pseudo-articular nonunions. After debridement of the nonunion, locking compression plate was used to fix the nonunion and autogenous iliac bone graft was given. Bone healing rate, surgical complications and clinical results were evaluated., Results: All the patients were followed up, and the duration ranged from 13 to 42 months, with a mean of (22.5±8.2) months, and 1 patient did not heal. Visual analogue pain scores ranged from 0 to 3 (0.9±0.9). Pronation of forearm was 47 to 86 (69.0±14.7) degrees, supination was 35 to 85 (63.0±9.4) degrees, wrist flexion was 20 to 80 (51.0±10.2) degrees, wrist flexion was 32 to 88 (71.0±11.7) degrees, elbow flexion contracture was 0 to 25 (9.0±5.6) degrees, further flexion was 105 to 150 (134.0±13.9) degrees, and grip strength was 87% on the opposite side. According to the Anderson scoring system, 8 cases were excellent, 11 were satisfied, 2 were not satisfied, and 1 was failed., Conclusions: LCP combined with autologous iliac bone graft can effectively treat aseptic ulna diaphyseal nonunion., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To investigate the methods and clinical effects of autologous iliac bone transplantation, platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) in the treatment of nonunion., Methods: From January 2015 to December 2016, 60 patients with nonunion were treated, including 41 males and 19 females, aged 18 to 42 years old with an average age of 29 years old. Patients with nonunion were divided into autologous bone transplantation treatment group(control group), autologous bone transplantation and platelet-rich plasma(PRP) combined with extracorporeal shock wave(ESW) treatment group(experimental group). The callus formation, local complications, final growth of fracture and Johner-Wruhs functional classification of operative limbs of the two groups were compared 3 months after operation., Results: Fifty-five patients were followed up, 27 in the control group and 28 in the experimental group, 5 patients were lost. The follow-up period ranged from 8 to 24 months. The callus score in the control group was significantly lower than that in the experimental group at 3 months after operation( P <0.05). There was no swelling and infection in the skin of the iliac bone acquisition site and non-union operation site in both groups. The clinical and bone healing time of the control group was significantly longer than that of the experimental group( P <0.05). In the experimental group, 28 patients achieved bone union; in the control group, 24 patients achieved bone union, and 3 patients had bone nonunion again. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the control group was significantly lower than that in the experimental group( P <0.05)., Conclusions: Autologous iliac bone transplantation combined with platelet-enriched plasma(PRP) and extracorporeal shock wave(ESW) has a certain effect in the treatment of bone nonunion after fracture surgery. It can significantly improve the formation of new bone. It is a comprehensive and useful way to treat bone nonunion after fracture surgery in clinical work., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To evaluate clinical effect of autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst., Methods: Twenty-two osteochondral lesion of talus patients with subchondral cyst were collected from January 2011 to December 2014, including 18 males and 4 females aged from 34 to 58 years old with an average of (46.4± 6.9) years old. All patients manifested pain and swelling of ankle joint, 7 patients manifested partially limited activity of ankle joint, 2 patients manifested unstable of ankle joint, and 2 patients manifested poor force line of foot. All lesions located on the medial side of talus dome. The area of cartilage injury ranged from 64 to 132(101.6±27.1) mm2, and diameter of subchondral cyst ranged from 9 to 15(10.5±1.8) mm. VAS score and AOFAS score were used to evaluate pain releases and recovery of ankle joint function before operation, 12 and 24 months after operation. Healing condition of autograft was assessed under arthroscopy after removal of internal fixation at 1 year after operation., Results: All patients were followed up from 24 to 60 months with an average of(42.5±9.9) months. Postoperative MRI at 12 months showed autograft healed well but little cyst still seen. Bone grafting and talus healed well, and formation of fibrocartilage well under arthroscopy. Postoperative MRI at 24 months showed combination of bone grafting and surrounding bone well, and small cyst could seen but less than before. VAS score at 12 months after operation 2.8±0.8 was less than that of before operation 6.2±1.5, but had no differences compared with 24 months after operation 2.6 ±0.8 ( P >0.05). AOFAS score at 12 months after operation 83.0±5.6 was less than that of before operation 55.3±13.7, but had no differences compared with 24 months after operation 83.7±6.6( P >0.05)., Conclusions: Autogenous iliac bone graft in treating osteochondral lesion of the talus with subchondral cyst could have a good synosteosis and fibrous cartilage on surface, and relieve clinical symptoms., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2019 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To investigate the clinical effect of drilling columnar autogenous iliac bone graft and analyze the effect of bone grafting on postoperative complications in donor site., Methods: From March 2014 to October 2016, 68 patients with autogenous iliac bone graft were retrospectively analyzed, and divided into drilling group and osteotomy group, 34 patients in each group. In drilling group, there were 24 males and 10 females with an average age of (40.06±5.60) years old ranging from 23 to 53 years old;in osteotomy group, there were 26 males and 18 females with an average age of (39.32±6.44) ranging from 22 to 56 years old. The operative time of bone extraction, blood loss in donor area, healing time of donor site and postoperative donor site complications were observed and compared between the two groups. VAS score was used to evaluate the pain of donor site in different periods after operation., Results: All patients were followed up for 12 to 24 months, with an average of 16.9 months in drilling group and 17.1 months in osteotomy groups. The bone healing structure was displayed in the recipient area in two groups, the effect of autogenous iliac bone grafting was good. There was no significant difference in operative time between two groups ( P >0.05). There was significant difference between two groups in the amount of donor site bleeding and the time of donor site wound healing( P <0.05). Postoperative complications(iliac depression and numbness) were significantly different between two groups ( P <0.05). There was no significant difference in VAS score between two groups at 2 weeks after operation( P >0.05). VAS scores of drilling group at 6 months and 1 year after operation were lower than those of osteotomy group (1.85±0.61 vs 2.97±0.67, P= 0.000; 1.15±0.56 vs 2.41±0.61, P= 0.000)., Conclusions: When bone graft is no need to have large pieces of special shape or more cortical bone iliac, it is simple to operate and less complications postoperative by drilling type columnar autogenous iliac bone graft. What's more, it has the obvious advantages of promote healing, improve patient quality of life compared with traditional osteotomy., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To discuss the effect of three-dimensional (3D) printing individualized model and guide plate in bone tumor surgery., Methods: Between October 2015 and December 2016, 3D printing individualized model and guide plate for making preoperative surgical planning and intraoperative treatment were used in 5 patients of bone tumor. All the patients were male, with a median age of 32 years (range, 9-58 years). There were 1 case of cystic echinococcosis at left pelvis and pathological fracture of the proximal femur; 1 case of left iliac bone osteoblastoma associated with aneurysmal bone cyst; 1 case of fibrous dysplasia of the left femur (sheep horn deformity) with pathological fracture; 1 case of metastatic carcinoma of right calcaneus (tumor staging was T 2 N 0 M 0 ); and 1 case of Ewing sarcoma of left femur (tumor staging was T 2 N 0 M 0 ). The disease duration ranged from 1 month to 10 years (mean, 2.25 years)., Results: The operation was completed successfully. The operation time was 2.6-7.5 hours (mean, 4.9 hours). The intraoperative blood loss was 200-2 500 mL (mean, 1 380 mL). The intraoperative fluoroscopy times was 1-6 times (mean, 3.8 times). There was no infection after operation, and the blood supply and nerve function were good. All the patients were followed up 3-16 months (mean, 5.4 months). No loosening or breaking of the internal fixator occurred. According to Enneking scoring system, the limb function score was 15-26 (mean, 21); and the results were excellent in 2 cases, good in 2 cases, and fair in 1 case., Conclusion: 3D printing technology can make the implementation of the better preoperative planning and evaluation in bone tumor surgery, and it provides a new reference for individualized treatment in patients with bone tumor.

Purpose: To evaluate the clinical effect of improved alveolar cleft repair with bone grafting., Methods: Forty one cases with alveolar cleft treated by modified operation between 2008-2016 were included. The modified techniques were as follow: incision design, preparation of bone graft bed, bone removal and bone grafting, etc. The therapeutic effect was analyzed., Results: The successful rate was 92.8%. After 6-12 months of follow-up, bone graft survived well with no obvious complications., Conclusions: Iliac bone is a good source for bone graft. Improvement of tight tension-free suture in bone bed is the key to surgical success.

Purpose: To explore the differentially expressed genes between human mandible- and ilium- derived mesenchymal cells., Methods: Differentially expressed genes between the human mandible- and ilium- derived mesenchymal cells were obtained from the GEO database based on the analysis of GEO2R software, then the relationship among these genes were analysed using DAVID and Gene MANIA on-line database., Results: Two hundred and ninety three differentially expressed genes between the human mandible and iliac derived mesenchymal cells were obtained, and most of them were homeobox genes that related to bone development. These genes could also be enriched into different subgroups based on the analysis of DAVID database, such as "skeletal system development", "forebrain development", "limb development" and "WNT signaling pathway". After the analysis from Gene MANIA database, the molecular networks of MSX1, MSX2, HAND2, SIX1, PITX2, OSR2, PAX3 and PRRX1 were built to show that these eight genes exhibited interactions, including co-expression, co-localization, genetic interactions., Conclusions: There are different gene regulating mechanisms between the human mandible- and ilium- derived mesenchymal cells. It implies that genetic modification may be applied to get iliac derived mesenchymal cells to be more suitable for tissue-engineered repair of jaw.

Objective To investigate the clinical effect of individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap for reconstruction of mandibular defects., Methods: From Aug.2010 to Dec.2014,12 cases with mandibular tumor received preoperative maxillofacial CT scans and 3-dimensional reconstruction. Based on the CT results, mirror imaging technology was used to simulate the reconstruction of the defect at affected side. The individual reconstructive titanium plate was prefabricated on the model. The iliac bone-muscular flap was designed according to the defect shape and size, combined with reconstructive plate. All patients underwent CT scan and oral curved surface tomography postoperatively. The maxillofacial function and appearance were also evaluated., Results: According to the CT scan and curved surface tomography, the 12 iliac bone-muscular flaps survived completely with good bone union and good condyle position. Both the functional and cosmetic results were satisfactory. There was no complication on the donor sites., Conclusions: Individual prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap provides an precise method for reconstruction of mandibular defects. The cosmetic and functional results could be expected.

Objective: To evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect., Methods: Six patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia., Results: The skin paddles ranged from 3.5 cmx5.0 cm to 7.0 cmx 10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skin-edge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months' follow-up., Conclusion: DCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when appliedin composite oromandibular defect reconstruction.

Objective: To study the value of CT angiography (CTA) in the surgical treatment of bone tumors with the temporary balloon blocking technique., Methods: A retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years (mean, 46 years). The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique., Results: The CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was (1.545 ± 0.248) cm and (1.060 ± 0.205) cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was (10.818 ± 1.165) cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L1 (16/36, 44.4%) and the abdominal aortic bifurcation mainly located at L4 (22/36, 61.1%). Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months (mean, 21 months). According to Enneking standard, the results were excellent in 9 cases, good in 20 cases, fair in 5 cases, and poor in 2 cases at 3 months after operation. There were 10 cases of dysfunction of urination and defecation, 2 cases of tumor recurrence, and 3 cases of death after surgery., Conclusion: CTA and three-dimensional reconstructions technique can accurately measure the external diameter of aortaventralis and arteria iliaca communis and the distance between low renal artery and abdominal aortic bifurcation and offer great help to choose appropriate balloon and locate the balloon during surgery. The balloon blocking technique under the assistance of CTA can obviously reduce intraoperative blood loss and tumor recurrence, supply a clear view in surgery and shorten the operation time.

Objective: To develop an instrument for sacroiliac joint fixation with less injury and less complications., Methods: Firstly, 18 adult pelvic specimens (8 males and 10 females) were used to measure the anatomical data related to the locking plates and locking screws on the sacrum and ilium, and the polyaxial locking plate screw system of the sacroiliac joint was designed according to the anatomic data. This system was made of medical titanium alloy. Then 4 adult male plevic specimens were harvested and the experiment was divided into 3 groups: group A (normal pelvic), group B (the dislocated sacroiliac joint fixed with sacroiliac screws), and group C (the dislocated sacroiliac joint fixed with polyaxial locking plate screw system). The vertical displacement of sacroiliac joint under the condition of 0-700 N vertical load and the horizontal displacement on angle under the condition of 0-12 N·m torsional load were compared among the 3 groups by using the biological material test system. Finally, the simulated application test was performed on 1 adult male cadaveric specimen to observe soft tissue injury and the position of the locking plate and screw by X-ray films., Results: According to the anatomic data of the sacrum and ilium, the polyaxial locking plate screw system of the sacroiliac joint was designed. The biomechanical results showed that the vertical displacement of the sacroiliac joint under the condition of 0-700 N vertical load in group A was significantly bigger than that in group B and group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The horizontal displacement on angle under the condition of 0-12 N·m torsional load in group A was significantly less than that in group B and group C (P < 0.05). The horizontal displacement on angle under the condition of 0-6 N·m torsional load in group B was bigger than that in group C, and the horizontal displacement on angle under the condition of 6-12 N·m torsional load in group B was less than that in group C, but there was no significant difference between group B and group C (P > 0.05). The test of simulating application showed that the specimen suffered less soft tissue injury, and this instrument could be implanted precisely and safely., Conclusion: The polyaxial locking plate screw system of the sacroiliac joint has the advantages of smaller volume and less injury; polyaxial fixation enables flexible adjustment screw direction. The simulated application test shows satisfactory fixing effect.

Objective: To make a clinical retrospective analysis of reconstruction using autogenous non-vascularized iliac bone graft for patients with mandibular defects, and then to evaluate the treatment effectiveness and operation announcements of this method., Methods: 34 patients who were suffered from discontinued mandibule because of tumor or trauma, were treated with autogenous non-vascularized iliac bone graft. The surgery technique, postoperative outcomes and complications were analyzed., Results: In 34 patients adopted non-vascularized iliac bone graft, 31 patients adopted rigid internal fixation with titanium mini plate, 3 patients with bridging titanium plate. 27 bone grafts survived completely, the overall success rate was 79.41%. 3(8.82%) of the bone grafts healed after infection, 4(11.76%) bone grafts lost because of infection., Conclusion: The autogenous non-vascularized iliac bone graft is one of the most important way for the reconstruction of mandibular defects. The methods of internal fixation includes titanium mini pate and bridging titanium plate.

Objective: To study the clinical manifestations, radiologic findings, pathologic diagnosis and differential diagnosis of primary osteosarcoma in elderly patients., Methods: Twelve cases of primary osteosarcoma occurring in patients older than 60 years were encountered during the period from 1985 to 2010. The clinical manifestations, radiologic features and pathologic findings were studied and the follow-up data were analyzed., Results: The sites of involvement included long bones (number = 7), ilium (number = 1), craniofacial bones (number = 2) and soft tissue (number = 2). Radiologic examination showed a mixture of osteosclerotic and osteolytic lesions in 10 patients, soft tissue lesions with high-density areas in 2 patients and soft tissue lesions with periosteal reaction in 8 patients. Histologically, most cases showed features of conventional osteosarcoma. There were 2 cases of malignant fibrous histiocytoma-like osteosarcoma, 2 cases of chondroblastic osteosarcoma and 1 case of well-differentiated intraosseous osteosarcoma. Immunohistochemical study played little role in pathologic diagnosis. Ten patients had undergone amputation, including one patient who had received adjuvant chemotherapy beforehand. Nine patients had follow-up information available. Three of them died of lung metastasis and 1 died of cardiovascular disease., Conclusions: Primary osteosarcoma rarely occurs in elderly patients and can easily be missed. Correlation with clinical, radiologic and histologic features is important for arriving at a correct diagnosis.

Objective: To study the clinicopathologic features and differential diagnosis of epithelioid sarcoma-like hemangioendothelioma (ES-H)., Methods: The clinical, radiologic and pathologic features of three cases of ES-H were analyzed., Results: All the 3 cases occurred in male adults. The age ranged from 44 to 53 years. The presentations included left neck mass, iliac pain and bilateral shoulder masses. Histologically, ES-H was composed of a mixture of spindle and epithelioid tumor cells. Transition between the two cell types was demonstrated. The tumor cells were arranged in compact sheets, vague nodules or intersecting fascicles, amongst a collagenous stroma. Central coagulative necrosis was identified in one case, reminiscent the morphology that seen in epithelioid sarcoma. There was no evidence of angiogenesis, though focal presence of intracytoplasmic vacuoles was seen in one case, as in classic examples of epithelioid hemangioendothelioma. Immunohistochemical study showed that the tumor cells expressed both epithelial (AE1/AE3, CAM5.2 and epithelial membrane antigen) and endothelial (CD31, Fli-1 and factor VIII-related antigen) markers. Two of the cases were also positive for CD34. All of the patients were treated by surgical resection. Two patients remain well at 14-month and 9-month follow up, respectively. The remaining patient had repeated local recurrences during a 6-year period., Conclusions: ES-H represents a rare morphologic type of hemangioendothelioma. It has some overlapping histologic features with epithelioid sarcoma and epithelioid hemangioendothelioma. The endothelial nature of ES-H is difficult to be verified on the basis of morphologic examination alone. Confirmation of the diagnosis with immunohistochemistry is necessary. ES-H is likely related to epithelioid hemangioendothelioma and may represent a cellular spindle cell variant of epithelioid hemangioendothelioma.

Purpose: To analyze the factors affecting the effect of cleft alveolar repair., Methods: 21 patients with alveolar cleft who were treated in our hospital between 2003-2007 were included in this study. The factors that affected the cleft alveolar repair such as patient's age, cleft type, surgical method, source of bone were analyzed accordingly., Results: (1) The surgical success rate was 95.24%, the clinical success rate was 90.48%; (2) The effect of bone graft correlated with the patient's age;(3) Surgical success rate of unilateral alveolar cleft was higher than that of bilateral alveolar cleft., Conclusions: (1) The younger patients, the greater chance of success in bone graft. Patients aged 9-11 years are appropriate candidates for the surgery , when the canine is erupting; (2) Iliac bone is a good source for bone graft; (3)Good bone bed and tight tension-free suture are the key to surgical success.

Objective: To evaluate the initial clinical effect of the autologous bone marrow integrating artificial bone and ilium periosteum transplantation in treatment of problematic nonunion., Methods: From January 2004 to July 2006, 12 patients (13 limbs)with problematic nonunion were treated with autologous bone marrow integrating artificial bone and ilium periosteum. There were 8 males and 4 females, aged 17-58 years old. The position of nonunion were the tibia in 7 limbs, the femur in 3 limbs, the humerus in 2 limbs. The operated number was 1-4, mean 2.5. The time from injury to therapy was 13 months to 9 years, mean 47.6 months. The bone defect distance was 6-30 mm (mean 15 mm) through 1 : 1 X-rays before operation. Eleven limbs were treated by internal fixation (10 limbs by the bone nail and 1 limb by the limited contact-dynamic compression plate), 2 limbs were treated by the external fixation. The X-ray films were taken at 1 day, 1, 3, 6, 9, 12 months after operation to observe fracture union., Results: All patients were followed up for 12-26 months (mean 17.5 months) and achieved union within 4-7 months (mean 6 months). No deformity of rotation, angulation and crispation occurred in 13 limbs, but functional impairment occurred in 6 limbs after union of fracture., Conclusion: Autologous bone marrow integrating artificial bone and ilium periosteum transplantation for treatment of problematic nonunion has the satisfactory result.

Objective: To analyze the stress and displacement distribution of 3D-FE models in three conjunctive methods of vascularized iliac bone graft for established mandibular body defects., Methods: Using computer image process technique, a series of spiral CT images were put into Ansys preprocess programe to establish three 3D-FE models of different conjunctions., Results: The three 3D-FE models of established mandibular body defects by vascularized iliac bone graft were built up. The distribution of Von Mises stress and displacement around mandibular segment, grafted ilium, plates and screws was obtained., Conclusion: It may be determined successfully that the optimal conjunctive shape be the on-lay conjunction.

Purpose: Prosthetic reconstruction of the upper jaw in patients with extensive bone and soft tissue defects is still a significant challenge. This study evaluated the functional results of zygomatic implants and vascularized bone graft reconstruction of the maxillary defects in 4 patients., Methods: Complex resections of the maxilla produced a three-dimensional defect in 4 patients. On the basis of an axial spiral CT data, anatomical models of natural size by CAD/CAM system was manufactured to enable preoperative measurements of relevant parameters. After tumor resection, reconstruction using the fibula or iliac osteocutaneous flap with titanium osseointegrated implants was performed. Maxillary and zygomatic measurements were also used to obtain information for installing 6 zygomatic implants and 7 dental implants., Results: The bone from the fibula or iliac osteocutaneous flap was contoured to recreate the maxillary arch in 4 patients. The anatomical model and surgical palate was used for preoperative planning and intraoperative control of the insertion of 6 zygomatic fixtures after subtotal maxillectomy. The implants could be positioned precisely as preoperatively planned., Conclusions: The use of zygomatic fixtures after ablative tumor surgery with resection of the maxillary bone is valuable in providing new zygomatic buttresses that play a key role in the form of the midface. Maxillary rehabilitation can be further improved by using the vascularized bone graft and zygomatic implants. Reconstitutions of the buttresses system ensure a stable base for occlusion, which is essential to optimal functional and esthetic maxillary rehabilitation. Supported by Research Fund (No. 2004BA720A27) of National Tenth Five-Year Project.

Objective. To study changes of human dynamic response to landing impact in selected body orientations. Method. Five healthy young men were exposed to 10 G, 50 ms half-sine acceleration pulses. The angle included between human head-ilium axis and impact force direction was 30 degrees-70 degrees. The acceleration responses at head, shoulder, chest and ilium of the subjects were recorded along head-ilium and chest-back directions. Result. Within limits of the experiments, the minimum peak response at the head along head-ilium direction was 10.36 +/- 2.44 G at 50 degrees, and the maximum was 18.07 +/- 3.29 G at 70 degrees. The minimum peak response at the chest along head-ilium direction was 10.39 +/- 3.97 G at 70 degrees, and the maximum was 15.42 +/- 3.61 G at 60 degrees. The minimum peak response at the head along chest-back direction was 7.58 +/- 1.18 G at 30 degrees, and the maximum was 18.89 +/- 1.85 G at 70 degrees. The minimum peak response at the chest along chest-back direction was 7.21 +/- 1.99 G at 30 degrees, and the maximum was 17.67 +/- 2.16 G at 70 degrees. Conclusion. It was inferred that the best body orientation angle for landing impact might be 50 degrees.