intramedullary bone grafting

Intramedullary bone grafting is a long strip of bone from the end of the autologous humerus or diseased bone. After trimming, it can be inserted into the medullary cavity of the two fracture ends to stabilize the fracture end and stimulate osteogenesis. However, due to the limited length of the medullary cavity and the small diameter of the bone graft, the internal fixation is not so much and it is easy to break, so it is rarely used alone. It is generally only used as an auxiliary surgery for other bone grafts to accelerate the osteogenesis of the endosteeal, or to treat the fracture of the hand and the short bone of the foot. Treatment of diseases: tibiofibular fracture of the humerus 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 fracture site, the fracture end is revealed, the scar and the hardened bone are removed, and the medullary cavity is cut. Then the graft bone is repaired into a bone strip of the same size as the bone marrow cavity, inserted into the proximal medullary cavity, and then the limb is pulled. The fracture end is opened, and the distal medullary cavity is placed on the graft bone, and the two ends of the fracture line are simultaneously pressurized, so that the fracture end is closely joined. Since the elasticity of the soft tissue has a certain limit, the fracture end cannot be opened a lot, and the graft bone strip should be appropriately shortened according to the distance that can be pulled apart (it is too long to be broken at the time of implantation). After bone grafting, the position of the limb should be maintained by a special person to prevent the displacement between the fracture ends until the external fixation is completed, so as not to break the graft bone. If the internal fixation force is to be enhanced, the cortical bone can be cut longitudinally to form a bone groove, and then the graft bone can be convexly embedded into the bone groove and the hip cavity, and then the bone graft can be added; or the fracture is not The longer end of the healing, using a double-saw blade saw to take the long cortical bone, the width should be the same as the medullary cavity, the bone strip is turned 90° and inserted into the medullary cavity, then slammed through the fracture end, into the other end of the fracture Medullary cavity. If you want to increase the strength of internal fixation, you can also perform bone grafting at the same time as bone transplantation in the medullary cavity.

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