EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YINQudong , SUNZhenzhong , GUSanjun , BAOYuefeng , WEIXuming , SONGSheng

Department of Orthopaedics, Wuxi No. 9 People's Hospital, Wuxi Jiangsu, 214062, P. R. China;

Corresponding?author：

YINQudong, Email: yinqudong@sina.com

Keywords：

Tibial bone defect; Soft tissue defect; Ilizarov technique; Bone transport; Bone shortening-lengthening

DOI：

10.7507/1002-1892.20140182

Video：

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Objective To compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. Methods Between January 2004 and May 2012,31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique,the clinical data were retrospectively analyzed.Bone transport was used in 18 cases (group A),and bone shortening-lengthening in 13 cases (group B).There was no significant difference in age,gender,type of fracture,defect location,size of bone and soft defects,and time from injury to operation between 2 groups (P>0.05).Postoperative complications were observed;Paley's criterion was used to assess the bone healing and function recovery of the limb. Results All the flaps survived and healing of wounds by second intention was obtained in all cases of group A;healing of wounds by first intention was obtained in 1 case,delayed healing in 3 cases,and healing by second intention in 9 cases in group B.All patients were followed up 1.5-4.5 years (mean,2.4 years).Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B,and limb length discrepancy in 1 case of group B;there was no significant difference in the rate of complication (χ²=0.003,P=0.955).In the distracted zone,all fractures healed naturally with excellent scale.The healing time was (251±39) days in group A,and was (239±45) days in group B,showing no significant difference (t=0.800,P=0.430);the healing index was (4.26±0.19) d/mm in group A,and was (4.13±0.19) d/mm in group B,showing no significant difference (t=1.775,P=0.086).In the bone defect zone,natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases,with healing time of (341±55) days (excellent in 17 cases and good in 1 case) in group A;natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases,with the healing time of (295±62) days (excellent in 12 cases and good in 1 case) in group B;and there was significant difference in the healing time (t=2.195,P=0.036),but no significant difference in the healing scale (Z=-1.693,P=0.091).At last follow-up,the function recovery was excellent in 7 cases,good in 6 cases,and fair in 5 cases in group A,and was excellent in 3 cases,good in 6 cases,and fair in 4 cases in group B,showing no significant difference (Z=-0.660,P=0.509). Conclusion Using bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects,the overall outcomes are similar,but the healing of bone defect zone is faster when using bone shortening-lengthening.

Citation： YINQudong, SUNZhenzhong, GUSanjun, BAOYuefeng, WEIXuming, SONGSheng. EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 818-822. doi: 10.7507/1002-1892.20140182 Copy

1.	房國軍,吳其常.Ilizarov技術的臨床應用.中國矯形外科雜志,2005,13(20):1579-1581.
2.	夏和桃,彭愛民,羅先正,等.帶鎖髓內釘與骨延長器聯合應用在小腿延長中的作用.中華外科雜志,2005,43(8):495-498.
3.	曾祥偉,蔣衛平,韋冰丹,等.干骺端潛行截骨延長術矯正肢體短肢畸形.中國修復重建外科雜志,2002,16(2):106-108.
4.	李紅宇,才志勇,李玉山,等.Ilizarov外固定架在脛骨截骨延長治療中的應用.中國矯形外科雜志,2005,13(13):985-987.
5.	劉會仁,王立新,張艷茂,等.組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損.中國修復重建外科雜志,2013,27(3):295-298.
6.	武進華,馮志斌,張建河,等.骨段滑移術治療脛骨缺損合并軟組織缺損.實用骨科雜志,2012,18(2):132-136.
7.	Krappinger D,Irenberger A,Zegg M,et al.Treatment of large posttraumatic tibial bone defects using the Ilizarov method:a subjective outcome assessment.Arch Orthop Trauma Surg,2013,133(6):789-795.
8.	McKee MD,Yoo DJ,Zdero R,et al.Combined single-stage osseous and soft tissue reconstruction of the tibia with the Ilizarov method and tissue transfer.J Orthop Trauma,2008,22(3):183-189.
9.	韓立仁,穆衛東,陳志強,等.Ilizarov骨搬移技術治療脛骨大段骨缺損合并軟組織缺損.中華創傷雜志,2011,27(10):901-904.
10.	秦泗河.突破骨不連與骨缺損治愈的瓶頸.中國骨傷,2013,26(4):267-270.
11.	黃雷,趙剛,王慎東,等.短縮-延長肢體治療脛骨骨缺損合并軟組織缺損.中華創傷骨科雜志,2007,9(12):1115-1119.
12.	陳志強,韓立仁,翁海濱,等.Ⅱizarov技術治療急性脛骨骨缺損合并軟組織缺損.中國醫師進修雜志,2010,33(23):27-29.
13.	Robert Rozbruch S,Weitzman AM,Tracey Watson J,et al.Simultaneous treament of tibial bone and soft-tissue defects with the Ilizarov method.J Orthop Trauma,2006,20(3):197-205.
14.	吳偉.Ilizarov技術在急性脛骨缺損合并軟組織缺損治療中的應用.山東醫藥,2011,51(14):72-73.
15.	鄭戰營,薛云峰.急性骨短縮-延長加骨髓移植治療脛骨骨折并骨缺損.中國骨傷,2005,18(11):689-690.
16.	殷渠東,孫振中,顧三軍,等.骨短縮-延長術治療脛骨大段骨缺損合并軟組織缺損.中國修復重建外科雜志,2013,27(12):1462-1465.
17.	Paley D,Herzenberg JE,Paremain G,et al.Femoral lengthening over an intramedullary nail.A matched-case comparison with Ilizarov femoral lengthening.J Bone Joint Surg (Am),1997,79(10):1464-1480.
18.	王序全,李起鴻,許建中,等.脛骨上干骺端緩慢牽伸延長對兔膝關節軟骨形態的影響.中華骨科雜志,2006,26(7):479-482.
19.	劉華彥,吳梅英.肢體延長后延長區的骨愈合.中國修復重建外科雜志,2001,15(1):29-31.
20.	El-Rosasy MA.Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia.J Bone Joint Surg (Br),2007,89(1):80-88.
21.	Hosalkar HS,Jones S,Chowdhury M.Quadricepeplasty for knee stiffness after femoral lengthening in congenital short femur.J Bone Joint Surg (Br),2003,85(2):261-264.
22.	楊華清,王坤正,張明宇,等.應力調節對延長區骨愈合影響的實驗研究.中國矯形外科雜志,2008,16(18):1412-1414.
23.	李剛,秦泗河.牽拉成骨技術的基礎研究進展與帶給骨科的啟示.中華外科雜志,2005,43(8):540-543.
24.	Nakamura E,Mizuta H,Takagi K.Knee cartilage injury after tihial lengthening.Radiographic and histological studies in rabbits after 3-6 months.Acta Orthop Scand,1995,66(4):313-316.
25.	鄭強,潘志軍,李杭,等.混合式單臂外固定架骨延長術治療感染性骨不連.中華骨科雜志,2007,27(7):509-513.

1. 房國軍,吳其常.Ilizarov技術的臨床應用.中國矯形外科雜志,2005,13(20):1579-1581.
2. 夏和桃,彭愛民,羅先正,等.帶鎖髓內釘與骨延長器聯合應用在小腿延長中的作用.中華外科雜志,2005,43(8):495-498.
3. 曾祥偉,蔣衛平,韋冰丹,等.干骺端潛行截骨延長術矯正肢體短肢畸形.中國修復重建外科雜志,2002,16(2):106-108.
4. 李紅宇,才志勇,李玉山,等.Ilizarov外固定架在脛骨截骨延長治療中的應用.中國矯形外科雜志,2005,13(13):985-987.
5. 劉會仁,王立新,張艷茂,等.組織移植結合骨滑移治療小腿皮膚軟組織伴大段脛骨缺損.中國修復重建外科雜志,2013,27(3):295-298.
6. 武進華,馮志斌,張建河,等.骨段滑移術治療脛骨缺損合并軟組織缺損.實用骨科雜志,2012,18(2):132-136.
7. Krappinger D,Irenberger A,Zegg M,et al.Treatment of large posttraumatic tibial bone defects using the Ilizarov method:a subjective outcome assessment.Arch Orthop Trauma Surg,2013,133(6):789-795.
8. McKee MD,Yoo DJ,Zdero R,et al.Combined single-stage osseous and soft tissue reconstruction of the tibia with the Ilizarov method and tissue transfer.J Orthop Trauma,2008,22(3):183-189.
9. 韓立仁,穆衛東,陳志強,等.Ilizarov骨搬移技術治療脛骨大段骨缺損合并軟組織缺損.中華創傷雜志,2011,27(10):901-904.
10. 秦泗河.突破骨不連與骨缺損治愈的瓶頸.中國骨傷,2013,26(4):267-270.
11. 黃雷,趙剛,王慎東,等.短縮-延長肢體治療脛骨骨缺損合并軟組織缺損.中華創傷骨科雜志,2007,9(12):1115-1119.
12. 陳志強,韓立仁,翁海濱,等.Ⅱizarov技術治療急性脛骨骨缺損合并軟組織缺損.中國醫師進修雜志,2010,33(23):27-29.
13. Robert Rozbruch S,Weitzman AM,Tracey Watson J,et al.Simultaneous treament of tibial bone and soft-tissue defects with the Ilizarov method.J Orthop Trauma,2006,20(3):197-205.
14. 吳偉.Ilizarov技術在急性脛骨缺損合并軟組織缺損治療中的應用.山東醫藥,2011,51(14):72-73.
15. 鄭戰營,薛云峰.急性骨短縮-延長加骨髓移植治療脛骨骨折并骨缺損.中國骨傷,2005,18(11):689-690.
16. 殷渠東,孫振中,顧三軍,等.骨短縮-延長術治療脛骨大段骨缺損合并軟組織缺損.中國修復重建外科雜志,2013,27(12):1462-1465.
17. Paley D,Herzenberg JE,Paremain G,et al.Femoral lengthening over an intramedullary nail.A matched-case comparison with Ilizarov femoral lengthening.J Bone Joint Surg (Am),1997,79(10):1464-1480.
18. 王序全,李起鴻,許建中,等.脛骨上干骺端緩慢牽伸延長對兔膝關節軟骨形態的影響.中華骨科雜志,2006,26(7):479-482.
19. 劉華彥,吳梅英.肢體延長后延長區的骨愈合.中國修復重建外科雜志,2001,15(1):29-31.
20. El-Rosasy MA.Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia.J Bone Joint Surg (Br),2007,89(1):80-88.
21. Hosalkar HS,Jones S,Chowdhury M.Quadricepeplasty for knee stiffness after femoral lengthening in congenital short femur.J Bone Joint Surg (Br),2003,85(2):261-264.
22. 楊華清,王坤正,張明宇,等.應力調節對延長區骨愈合影響的實驗研究.中國矯形外科雜志,2008,16(18):1412-1414.
23. 李剛,秦泗河.牽拉成骨技術的基礎研究進展與帶給骨科的啟示.中華外科雜志,2005,43(8):540-543.
24. Nakamura E,Mizuta H,Takagi K.Knee cartilage injury after tihial lengthening.Radiographic and histological studies in rabbits after 3-6 months.Acta Orthop Scand,1995,66(4):313-316.
25. 鄭強,潘志軍,李杭,等.混合式單臂外固定架骨延長術治療感染性骨不連.中華骨科雜志,2007,27(7):509-513.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS

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