Clinical Research Of Ilizarov Technique On Treatment Of Femoral Infected Bone Defect

Objective:Open injury and iatrogenic infection often lead to femoral osteomyelitis,if combined with bone and soft tissue defects,femoral infected bone defect formed.Infected bone defects has become a common and difficult problem in the traumatic orthopedics world wide.Traditional methods possess the characteristics of long treatment cycle,multiple surgery and heavy economic burden.This study was to investigate the clinical efficacy of Ilizarov technique on treatment of femoral infected bone defect,and to analyze the advantages and disadvantages of the technique and its best indications.Methods:From January 2013 to December 2016,17 cases of femoral infected bone defects were analyzed retrospectively.Among them,14 cases were males,3 cases were females,and age ranged from 5 to 57 years old(average,30.2years).Eight cases were traffic injuries,6 cases were fall from height,1 case was compression injury,and 2 cases were blood-borne osteomyelitis.The length of bone defect ranged from 3-13.5cm(average,6.9cm).Three cases associated with soft tissue defects.Twelve cases were treated by debridement,external fixation,primary bone osteotomy and transportation,while other 5 cases were treated by debridement,external fixation,3～6 week postponed secondary bone osteotomy and transportation.Healing rate,complications and function were recorded during the follow-up period.Postoperative X-ray radiography examination was taken regularly to evaluate bone healing process by the Paley fracture healing score.The SF-36 scores was used to evaluate the quality of life before operation and the last follow-up.Results:All patients were followed-up from 14 to 48 months(average,22.8 months).All bone and soft-tissue defects healed,with bone healing time of 6-18.5 months(average,11.19 months).Primary bone healing acquired in 11 cases.Bone healing obtained by reoperation of eliminating embedded soft-tissue between fracture ends and axial compression in 5 cases,whereas iliac cancellous bone graft conducted in addition to above reoperative methods in one case.Complication of pin infection appeared in7 cases and were cured by oral antibiotics,serial dressing and debridement.Axial displacement presented in 3 cases and were corrected after adjustment the external fixation and Schanz screws.Skin traction pain observed in 9 cases and relived by slow the pulling speed and oral analgesics.The Postoperative scope of knee activity reached the range of 30° to 80°(average,58°),significantly improved than those at pre-operation range of 20° to 65 °(average,40.8°).The Limb length restored well and no discrapancy appeared compared with the healthy side.According to the Paley fracture healing score,7 cases were excellent,7cases were good,giving an excellent to good rate of 82.4%.Conclusion:Ilizarov technique is an effective way in the treatment of femoral infected bone defect,it is especially appropriate for the treatment of large bone defect associated with soft tissue defects and limb shortening.