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发布于:2019-1-5 12:17:30  访问:93 次 回复:0 篇
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Ter, Denver, CO; and Geisinger Healthcare Center, Danville, PA). Prior to
Prior to study initiation, approval by the two respective Institutional Evaluation Boards was obtained. The databases included all individuals involving 18 and 85 years of age, who have been admitted to one of the two participating centers for surgical remedy of extended bone fracture nonunions involving January 1, 1998 and December 31, 2010 (n = 373; Denver Health), and in between January 1, 2004 and December 31, 2010 (n = 201; Geisinger), respectively. Individuals that did not demand adjunctive bone grafting (n = 362) or had a nonunion of your forearm (n = 30) have been excluded in the analysis. GSK-690693 MedChemExpress Patients who had been lost to follow-up prior to a minimum of 12 months postoperatively or prior to clinical and radiographic union had been excluded. The remaining 182 individuals who required adjunctive bone grafting for nonunions in the tibia (n = 98), femur (n = 46), or humerus (n = 38) have been incorporated for final analysis. The flowchart in Figure 1 depicts the patientselection method in detail. Figures two,3,four,5 illustrate a representative case instance of a 31-year-old male who sustained an isolated type IIIB open PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28506461 segmental tibia fracture. The patient underwent initial surgical debridement and external fixation, followed by staged conversion to an intramedullary nail. He created a tibial nonunion, requiring exchange nailing and autologous bone grafting. In accordance with the definition by the US Federal Drug Administration (FDA), nonunion was defined as a fractured bone which had not totally healed within 9 months of injury and which had not shown indicators of progression towards healing for three consecutive months on serial radiographs [19]. Nonunions have been classified based on the Weber and Cech classification program into hypertrophic, normotrophic, or atrophic [19]. Nonunions have been treated either by plate osteosynthesis (employing {mce|medchemexpress|Active small molecules traditional plates or locking plate systems), intramedullary nail fixation (including exchange nailing), or by external ring fixator in combination with bone grafting, depending on the person surgeon‘s preference. Sufferers were stratified into the following cohorts PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28388412 for evaluation, determined by the bone grafting modality: (1) autograft (n = 105), (2) allograft (n = 38), (three) allograft in mixture with autograft (n = 16), and (4) rhBMP-2 with or without the need of adjunctive bone grafting substitute (n = 23). The rhBMP-2 item was mixed with sterile saline and prepared right away prior to use from a kit containing all required components, based on the manufacturer‘s directions (Infuse? Medtronic, Memphis, TN, USA). In six patients, rhBMP-2 was administered with out bone grafting adjunct, even though within the remaining 17 individuals rhBMP-2 was combined with allograft. All patients have been followed postoperatively for a minimum of 12 months, or till clinical and radiographic bone healing occurred. `Clinical union‘ was defined as painless weight bearing and lack of regional tenderness over the nonunion website on physical examination [20,21]. `Radiographic union‘ was defined as bridging bone on a minimum of 3 cortices on standard antero-posterior and lateral radiographs. The application of rhBMP-2 for the revision of long bone fracture nonunions was regarded an `off-label‘ indication. Autograft donor web-sites had been as follows: (1) iliac crest (n = 64), (2) femoral reamer-irrigator-aspirator (n = 20), and (3) other (n = 10).Ter, Denver, CO; and Geisinger Medical Center, Danville, PA).
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