Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GE Qihang ¹ ,  WAN Chunyou ² , LIU Yabei ¹ , JI Xu ¹ , MA Jihai ¹ , CAO Haikun ¹ , YONG Wei ¹ , LIU Zhao ³ , ZHANG Ningning ³

1. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
2. Department of Trauma Orthopedics, Tianjin Hospital, Tianjin, 300211, P.R.China;
3. Graduate School, Tianjin Medical University, Tianjin, 300070, P.R.China;

Corresponding author：

WAN Chunyou, Email: wanchunyouxs@163.com

Keywords：

Axial stress stimulation; tibial and fibular open fractures; Taylor space stent

DOI：

10.7507/1002-1892.201703072

Video：

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Objective To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. Methods The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups (P>0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures. Results There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group (P<0.05). After 6 months of external fixator removal, the function of the limb was excellent in 13 cases, good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups (Z=–2.146, P=0.032). Conclusion The axial stress stimulation of Taylor space stent fixation can promote the healing of tibial and fibular open fractures and promote local bone formation at fracture site.

Citation： GE Qihang, WAN Chunyou, LIU Yabei, JI Xu, MA Jihai, CAO Haikun, YONG Wei, LIU Zhao, ZHANG Ningning. Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(8): 931-935. doi: 10.7507/1002-1892.201703072 Copy

1.	Hedia HS, Noha F. Improved Stress Shielding on a Cementless Tibia Tray using Functionally Graded Material. Material Testing, 2013, 55(11-12): 745-751.
2.	Completo A, Fonseca F, Simões JA. Strain shielding in proximal tibia of stemmed knee prosthesis: Experimental study. J Biomech, 2008, 41(3): 560-566.
3.	Cawley DT, Kelly N, Simpkin A, et al. Full and surface tibial cementation in total knee arthroplasty: a biomechanical investigation of stress distribution and remodeling in the tibia. Clin Biomech (Bristol, Avon), 2012, 27(4): 390-397.
4.	Zhao H, Zhao H, Wang J, et al. Stress stimulation induced resistance of plant. Colloids Surf B Biointerfaces, 2005, 43(3-4): 174-178.
5.	Seebohm G, Strutzseebohm N, Ursu ON, et al. Altered stress stimulation of inward rectifier potassium channels in Andersen-Tawil syndrome. FASEB J, 2012, 26(2): 513-522.
6.	Ding ZQ, Gao J. Development of the rap system of stress stimulation and clinical study of on the promoting effect on the healing of closed tibia shaft fracture. J Clin Orthop, 2006, 11(2): 161-163.
7.	全先辉, 万春友, 刘磊, 等. Taylor 空间支架外固定治疗胫腓骨开放性骨折. 中医正骨, 2015, 27(10): 30-31.
8.	卢庆威, 万春友, 张弢, 等. 轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用. 中国修复重建外科杂志, 2016, 30(9): 1085-1088.
9.	Johner R, Wruhs O. Classification of tibial shaft fracturesand correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
10.	赵宇宙. 胫骨干骨折的手术治疗. 中国中医药现代远程教育, 2009, 7(7): 74-75.
11.	Oehler RL, Maldonado A, Mastorides SM, et al. Cryptococcal Osteomyelitis Complicating Intestinal Lymphangiectasia: A Case Report and Review of the Literature. Infectious Disease in Clinical Practice, 2007, 15(2): 125-128.
12.	Ye D, Xu Y, Zhang H, et al. Effects of low-dose microwave on healing of fractures with titanium alloy internal fixation: an experimental study in a rabbit model. PLoS One, 2013, 8(9): e75756.
13.	Chondros TG, Deligianni DD, Milidonis KF, et al. Wire tensioning with integrated load-cell in the Ilizarov orthopedic external fixation system. Mechanism and Machine Theory, 2014, 79: 109-123.
14.	Schievano S, Taylor AM, Capelli C, et al. Patient specific finite element analysis results in more accurate prediction of stent fractures: application to percutaneous pulmonary valve implantation. J Biomech, 2009, 43(4): 687-693.
15.	Zhuang P, Hong J, Chen W, et al. Clinical analysis of the rap stress stimulator applied for crus fracture after skeletal external fixation. Arch Med Sci, 2015, 11(3): 612-618.
16.	王春庆, 李青, 刘刚, 等. 外固定支架在严重多发伤并胫腓骨开放性骨折中应用的病例对照研究. 中国骨伤, 2008, 21(6): 417-418.
17.	张利献, 席学义, 张文献. 骨折后局部血肿对骨痂形成的意义. 中华实用医药杂志, 2005, 5(8): 557.
18.	Snyder BM, Conley J, Koval KJ. Does low-intensity pulsed ultrasound reduce time to fracture healing? A meta-analysis. Am J Orthop (Belle Mead NJ), 2012, 41(2): E12-19.
19.	沈保磊, 丁真奇, 黄国峰, 等. 应力叩击仪促进胫骨骨折外固定架术后骨折愈合的临床观察. 现代生物医学进展, 2016, 16(33): 6491-6494.
20.	王西彬, 孙永强. 纵向生理加压外固定器治疗胫腓骨双骨折的安全性. 中国组织工程研究, 2012, 16(17): 3126-3129.
21.	Wan L, Zhang F, He Q, et al. EPO promotes bone repair through enhanced cartilaginous callus formation and angiogenesis. PLoS One, 2014, 9(7): e102010.
22.	任可, 张存才, 许硕贵, 等. 持续动态压应力对实验性骨折愈合的影响. 第四军医人学学报, 2004, 25(1): 41-45.

1. Hedia HS, Noha F. Improved Stress Shielding on a Cementless Tibia Tray using Functionally Graded Material. Material Testing, 2013, 55(11-12): 745-751.
2. Completo A, Fonseca F, Simões JA. Strain shielding in proximal tibia of stemmed knee prosthesis: Experimental study. J Biomech, 2008, 41(3): 560-566.
3. Cawley DT, Kelly N, Simpkin A, et al. Full and surface tibial cementation in total knee arthroplasty: a biomechanical investigation of stress distribution and remodeling in the tibia. Clin Biomech (Bristol, Avon), 2012, 27(4): 390-397.
4. Zhao H, Zhao H, Wang J, et al. Stress stimulation induced resistance of plant. Colloids Surf B Biointerfaces, 2005, 43(3-4): 174-178.
5. Seebohm G, Strutzseebohm N, Ursu ON, et al. Altered stress stimulation of inward rectifier potassium channels in Andersen-Tawil syndrome. FASEB J, 2012, 26(2): 513-522.
6. Ding ZQ, Gao J. Development of the rap system of stress stimulation and clinical study of on the promoting effect on the healing of closed tibia shaft fracture. J Clin Orthop, 2006, 11(2): 161-163.
7. 全先辉, 万春友, 刘磊, 等. Taylor 空间支架外固定治疗胫腓骨开放性骨折. 中医正骨, 2015, 27(10): 30-31.
8. 卢庆威, 万春友, 张弢, 等. 轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用. 中国修复重建外科杂志, 2016, 30(9): 1085-1088.
9. Johner R, Wruhs O. Classification of tibial shaft fracturesand correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
10. 赵宇宙. 胫骨干骨折的手术治疗. 中国中医药现代远程教育, 2009, 7(7): 74-75.
11. Oehler RL, Maldonado A, Mastorides SM, et al. Cryptococcal Osteomyelitis Complicating Intestinal Lymphangiectasia: A Case Report and Review of the Literature. Infectious Disease in Clinical Practice, 2007, 15(2): 125-128.
12. Ye D, Xu Y, Zhang H, et al. Effects of low-dose microwave on healing of fractures with titanium alloy internal fixation: an experimental study in a rabbit model. PLoS One, 2013, 8(9): e75756.
13. Chondros TG, Deligianni DD, Milidonis KF, et al. Wire tensioning with integrated load-cell in the Ilizarov orthopedic external fixation system. Mechanism and Machine Theory, 2014, 79: 109-123.
14. Schievano S, Taylor AM, Capelli C, et al. Patient specific finite element analysis results in more accurate prediction of stent fractures: application to percutaneous pulmonary valve implantation. J Biomech, 2009, 43(4): 687-693.
15. Zhuang P, Hong J, Chen W, et al. Clinical analysis of the rap stress stimulator applied for crus fracture after skeletal external fixation. Arch Med Sci, 2015, 11(3): 612-618.
16. 王春庆, 李青, 刘刚, 等. 外固定支架在严重多发伤并胫腓骨开放性骨折中应用的病例对照研究. 中国骨伤, 2008, 21(6): 417-418.
17. 张利献, 席学义, 张文献. 骨折后局部血肿对骨痂形成的意义. 中华实用医药杂志, 2005, 5(8): 557.
18. Snyder BM, Conley J, Koval KJ. Does low-intensity pulsed ultrasound reduce time to fracture healing? A meta-analysis. Am J Orthop (Belle Mead NJ), 2012, 41(2): E12-19.
19. 沈保磊, 丁真奇, 黄国峰, 等. 应力叩击仪促进胫骨骨折外固定架术后骨折愈合的临床观察. 现代生物医学进展, 2016, 16(33): 6491-6494.
20. 王西彬, 孙永强. 纵向生理加压外固定器治疗胫腓骨双骨折的安全性. 中国组织工程研究, 2012, 16(17): 3126-3129.
21. Wan L, Zhang F, He Q, et al. EPO promotes bone repair through enhanced cartilaginous callus formation and angiogenesis. PLoS One, 2014, 9(7): e102010.
22. 任可, 张存才, 许硕贵, 等. 持续动态压应力对实验性骨折愈合的影响. 第四军医人学学报, 2004, 25(1): 41-45.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation

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