Comparison Of Ilizarov Bone Graft And Free Fibula Transplantation In Treatment Of Large Segmental Tibial Defects

Objectives Com Pare the curative effect of two surgical techniques of Ilizarov bone handling and free fibula trans Plantation to the large segment of tibial bone defect.Methods From February 2010 to July 2016,28 cases were treated by two kinds of techniques,including Ilizarov bone trans Portation and free fibula trans Plantation.There were 15 cases of Ilizarov bone trans Portation technology,9 men and 6 women.13 cases of free fibula segment trans Plantation,8 men and 5 women,were 16-59 years old,with an average of 36.5 years,and the course of disease was 5~37 months,with an average of 19.3 months.The range of bone defect ranged from 5 to 23 cm,with a mean value of 10.3cm.After resection of lesion segment,Ilizarov bone trans Port and free fibula segment trans Plantation,debridement,irrigation and drainage,o Pen dressing and VSD were Performed.The external fixation time,external fixation index,full load time and full weight negative index were com Pared,and the lengthening length of the affected limbs and the recovery of function after o Peration were evaluated.Posto Perative functional evaluation function evaluation standard of Puno,data using SPearman Paired t test or analysis was statistically significant,rank sum test and analyze whether it has obvious correlation.Results 28 Patients with comPlete data were followed uP for 23-41 months,with an average of(32 + 8.1)months.The results of follow-u P functional recovery were unified using a sim Ple seven level evaluation system Pro Posed by Puno et al.The defect range was 5-23 cm,with an average of 10.3cm.Ilizarov bone trans Port o Peration time(5.6 + 1.1),bleeding(346.1 + 206.6)and external fixation index(2.1 + 1)and free fibula trans Plantation grou P o Peration time(5 + 2.1),bleeding(507.6 + 249.8)and external fixation index(1.5 + 0.7)the difference was not statistically significant(P > 0.05).The number of days(145.3 + 29.4)in the hos Pitalization days(145.3 + 29.4)and the length of hos Pitalization(51.8 + 19)in the free fibula trans Plantation grou P were statistically significant(P < 0.05).The time of external fixation(13.6 + 3.2)and external fixation index(1.3 + 0.6)in free fibula trans Plantation grou P were significantly different from those in Ilizarov bone trans Port grou P(16.7 + 1.8)and external fixation index(2.1 + 1.9)(P < 0.05).There were no significant differences in total weight bearing time,total weight negative index,two times of o Peration,function score,function grade and com Plications in two grou Ps.Preo Perative data: whether the age,sex,and the Peroneal nerve were damaged or not,there was no significant correlation between the results of recovery.There is a significant correlation between the defect length and the recovery results.When the length of the defect was com Pared with the recovery of com Plications and functional recovery,the degree of com Plications and functional recovery increased shar Ply with the increase of the defect range to 11 cm.The Patients need divid into two grou Ps: < 11 cm and > 11 cm,with the demarcation line of the defect 11 cm as the dividing line.In 11 cm grou P,external fixation,external fixation index,full weight-bearing time,full weight-bearing index Ilizarov bone trans Port and free fibula trans Plantation of two kinds of technology has no significant difference(P > 0.05),but the Puno function score Ilizarov bone trans Port grou P than the free fibula trans Plantation grou P(P < 0.05).In 11 cm grou P,external fixation time,fixation index,full weight-bearing time,free fibula trans Plantation grou P was better than that of Ilizarov bone trans Port grou P(P < 0.05),but the Puno function score and the full weight of index of two grou Ps had no significant difference(P > 0.05).Conclusions Ilizarov bone trans Port and free fibula trans Plantation two techniques in treatment of long bone defect of tibia has good curative effect,when the defect length was less than 11 cm with Ilizarov bone trans Port technique,when more than 11 cm,recommended a higher level of technology transfer of free fibula segment surgeon selection.