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.	房国军,吴其常.Ilizarov技术的临床应用.中国矫形外科杂志,2005,13(20):1579-1581.
2.	夏和桃,彭爱民,罗先正,等.带锁髓内钉与骨延长器联合应用在小腿延长中的作用.中华外科杂志,2005,43(8):495-498.
3.	曾祥伟,蒋卫平,韦冰丹,等.干骺端潜行截骨延长术矫正肢体短肢畸形.中国修复重建外科杂志,2002,16(2):106-108.
4.	李红宇,才志勇,李玉山,等.Ilizarov外固定架在胫骨截骨延长治疗中的应用.中国矫形外科杂志,2005,13(13):985-987.
5.	刘会仁,王立新,张艳茂,等.组织移植结合骨滑移治疗小腿皮肤软组织伴大段胫骨缺损.中国修复重建外科杂志,2013,27(3):295-298.
6.	武进华,冯志斌,张建河,等.骨段滑移术治疗胫骨缺损合并软组织缺损.实用骨科杂志,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.	韩立仁,穆卫东,陈志强,等.Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损.中华创伤杂志,2011,27(10):901-904.
10.	秦泗河.突破骨不连与骨缺损治愈的瓶颈.中国骨伤,2013,26(4):267-270.
11.	黄雷,赵刚,王慎东,等.短缩-延长肢体治疗胫骨骨缺损合并软组织缺损.中华创伤骨科杂志,2007,9(12):1115-1119.
12.	陈志强,韩立仁,翁海滨,等.Ⅱizarov技术治疗急性胫骨骨缺损合并软组织缺损.中国医师进修杂志,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.	吴伟.Ilizarov技术在急性胫骨缺损合并软组织缺损治疗中的应用.山东医药,2011,51(14):72-73.
15.	郑战营,薛云峰.急性骨短缩-延长加骨髓移植治疗胫骨骨折并骨缺损.中国骨伤,2005,18(11):689-690.
16.	殷渠东,孙振中,顾三军,等.骨短缩-延长术治疗胫骨大段骨缺损合并软组织缺损.中国修复重建外科杂志,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,李起鸿,许建中,等.胫骨上干骺端缓慢牵伸延长对兔膝关节软骨形态的影响.中华骨科杂志,2006,26(7):479-482.
19.	刘华彦,吴梅英.肢体延长后延长区的骨愈合.中国修复重建外科杂志,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.	杨华清,王坤正,张明宇,等.应力调节对延长区骨愈合影响的实验研究.中国矫形外科杂志,2008,16(18):1412-1414.
23.	李刚,秦泗河.牵拉成骨技术的基础研究进展与带给骨科的启示.中华外科杂志,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.	郑强,潘志军,李杭,等.混合式单臂外固定架骨延长术治疗感染性骨不连.中华骨科杂志,2007,27(7):509-513.

1. 房国军,吴其常.Ilizarov技术的临床应用.中国矫形外科杂志,2005,13(20):1579-1581.
2. 夏和桃,彭爱民,罗先正,等.带锁髓内钉与骨延长器联合应用在小腿延长中的作用.中华外科杂志,2005,43(8):495-498.
3. 曾祥伟,蒋卫平,韦冰丹,等.干骺端潜行截骨延长术矫正肢体短肢畸形.中国修复重建外科杂志,2002,16(2):106-108.
4. 李红宇,才志勇,李玉山,等.Ilizarov外固定架在胫骨截骨延长治疗中的应用.中国矫形外科杂志,2005,13(13):985-987.
5. 刘会仁,王立新,张艳茂,等.组织移植结合骨滑移治疗小腿皮肤软组织伴大段胫骨缺损.中国修复重建外科杂志,2013,27(3):295-298.
6. 武进华,冯志斌,张建河,等.骨段滑移术治疗胫骨缺损合并软组织缺损.实用骨科杂志,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. 韩立仁,穆卫东,陈志强,等.Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损.中华创伤杂志,2011,27(10):901-904.
10. 秦泗河.突破骨不连与骨缺损治愈的瓶颈.中国骨伤,2013,26(4):267-270.
11. 黄雷,赵刚,王慎东,等.短缩-延长肢体治疗胫骨骨缺损合并软组织缺损.中华创伤骨科杂志,2007,9(12):1115-1119.
12. 陈志强,韩立仁,翁海滨,等.Ⅱizarov技术治疗急性胫骨骨缺损合并软组织缺损.中国医师进修杂志,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. 吴伟.Ilizarov技术在急性胫骨缺损合并软组织缺损治疗中的应用.山东医药,2011,51(14):72-73.
15. 郑战营,薛云峰.急性骨短缩-延长加骨髓移植治疗胫骨骨折并骨缺损.中国骨伤,2005,18(11):689-690.
16. 殷渠东,孙振中,顾三军,等.骨短缩-延长术治疗胫骨大段骨缺损合并软组织缺损.中国修复重建外科杂志,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,李起鸿,许建中,等.胫骨上干骺端缓慢牵伸延长对兔膝关节软骨形态的影响.中华骨科杂志,2006,26(7):479-482.
19. 刘华彦,吴梅英.肢体延长后延长区的骨愈合.中国修复重建外科杂志,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. 杨华清,王坤正,张明宇,等.应力调节对延长区骨愈合影响的实验研究.中国矫形外科杂志,2008,16(18):1412-1414.
23. 李刚,秦泗河.牵拉成骨技术的基础研究进展与带给骨科的启示.中华外科杂志,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. 郑强,潘志军,李杭,等.混合式单臂外固定架骨延长术治疗感染性骨不连.中华骨科杂志,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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