Clinical Research Of Tibia And Femur Infected Nonunion Treated By Ilizarov Methods

Objective:The aim of the study was to explore the clinical effectiveness on the treatment of tibia and femur infected nonunion by Ilizarov methods.Methods:In the first part,we retrospectively reviewed105patients with tibia and femur infected nonunion treated by bone transport.Our study included88males and17females with a mean of age38.75years. According to the classification of infected nonunion recommended by Umiarov, our studies include I type61cases, II type16cases, III type9cases and IV type19cases. Active purulent bone nonunion occurred75patients and the rest were quiescent without drainage. The patients had an average of2.62previous surgical procedures before receiving the treatment of Ilizarov methods. The average length of the bone defects after radical debridement was6.25cm (3-13cm).A comprehensive literature search was performed from thePubMed, Cochrane Library, EMBASE and other relevant English orthopaedic journals between January1995and April2013. Some outcomes, including bone union, complications, external fixation time, external fixation index, amputation rate, and the poor rate in functional results,were statistically analyzed using weighted means based on the sample size in each study by SPSS16.0. Good rate and excellent rate in bone results and functional results were analyzed by STATA11.0.Results:The mean follow-up for all the patients was22.99months (14-46months).10patients was lost to follow-up and We could evaluated bone results and functional outcomes in95patients. All the patients achieved bone union and no recurrence of infection was observed. The time of bone transport takes a mean of68.38days (45-137days), and the mean external fixation index was1.48m/cm (1.15-1.68m/cm). According to a modified Association for the Study and Application of the Method of Ilizarov (ASAMI) classification,63bone results were excellent,22good,8fair and2poor;30functional outcomes were excellent,48good,17fair and no poor.A total of426patients from22studies were included in this systematic review. The average of bone union rate was96.935%. The excellent rate and good rate in bone results were65%(95%CI,0.51-0.79; P=0.000, I2=90.6%) and21%(95%CI,0.14-0.28; P=0.001, I2=63.2%). The excellent rate and good rate in functional results were37%(95%CI,0.22-0.53; P=0.000, I2=91.8%) and33%(95%CI,0.25-0.42; P=0.000, I2=67.7%). The mean complications of every patient was1.567±0.901.The mean external fixation time was10.845±5.339months.Conclusions:Ilizarov methods in the treatment of tibia and femur infected nonunion can acquire satisfied effects in bone results and functional results. Radical debridement is the key step to control bone infection successfully.