embedded bone graft

Embed bone grafting is to remove a cortical bone piece of a certain length and width at both ends of the diseased bone. Then, a whole piece of bone piece of the same size is inserted into the bone groove, and the bone plate is fixed on the diseased bone with a screw to achieve stimulation. Osteogenesis and internal fixation promote bone healing. The advantage of this method is that the diameter of the diseased bone after bone grafting is not increased. The disadvantage is that it requires certain equipment (such as double saw blade saw). The internal fixation is not as reliable as bone grafting. If the bone defect is applied, the operation is more unreliable. Therefore, it is mostly used for fractures without bone defects. Non-healing and various joint fusion techniques. Treatment of diseases: congenital sacral pseudoarticular femoral head necrosis 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 According to the diseased bone site, a suitable incision is selected to reveal the nonunion area of the fracture, and part of the periosteum is cut and peeled to expose the cortical bone surface. According to the operation design, a long cortical bone was cut at the ends of the non-union of the fracture with a saw with two saw blades and adjustable spacing (the width is 1/6 to 1/4 of the diameter of the bone, and the length is the diseased bone. 5 times the diameter, generally at least 4 to 6 cm) to form a bone groove. Then, the same size bone strip is taken from the contralateral humerus, embedded in the bone groove, and fixed with screws. The bone graft can also utilize bone strips removed from the diseased bone. That is, the two trapezoidal bone pieces are sawn and grown at the ends of the non-union of the fracture. The long one is slightly wider, the shorter one is slightly narrower, and then the longer cortical bone piece is embedded in the non-union of the fracture, and the width is not wide. The diameter can be used for internal fixation. It can be used without a screw or a double-sliced saw to cut a long cortical bone piece 2 to 3 cm at the non-union end of the fracture, and then cut the double-length cortical bone at the other end according to the same width and axis. The piece is inserted into the position of the two bone pieces, so that the long bone piece spans the fracture end and is fixed by screws. When the joint is fused, it is often fused in the joint, and the embedded bone graft is used for extra-articular fusion to promote bone healing and strengthen fixation. After intra-articular fusion, the joint is placed in the functional position, first a bone groove or a bone tunnel is made on the short bone forming the joint, and then an equal width is obtained on the other long bone forming the joint, and the length is a short bone groove or A double strip of bone in the tunnel, spanning the joint, embedded in the bone groove or inserted into the tunnel. For example, bone fragments cannot be taken on the joints of the joints, or they can be simply grooved, and the autologous or allogeneic bone pieces are embedded, and then the screws are used for internal fixation.

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