Efficacy Of One-stage Radical Debridement Using The Ilizarov Ring Fixator For Treating Infected Tibial Nonunion

Objective:To explore whether there are differences in infection clearance,recurrence rate,hospitalization time,number of operations,and treatment costs for one-stage surgery for infected tibial nonunion compared with secondary surgery with Ilizarov technique.Whether the first-stage surgical method can be promoted and applied clinically.Method:From June 2015 to June 2018,40 patients with severely infected nonunion of the lower extremities were included in our study and treat it using the Ilizarov technique.Among them,24 cases were treated with one-stage surgery and 16 cases were treated with second-stage surgery.Patients with one stage were divided into group A(male:15,female: 9).Patients with stage II surgery were divided into group B(male: 12,female: 4).The age of group A was 32±14.5 years old,and that of group B was28±12.6years old.all patient underwent multiple operations before admission,with a longer course and sinus formation.All patients underwent X-ray films,relevant inflammation indicators and routine admission examinations and calibration of the approximate surface area of the skin after surgery.All patients underwent internal fixation for maximal debridement,resection of the diseased bone,and installation of an annular external fixation stent for bone transfer.The wound that can be sutured in one stage should be sutured as much as possible in one stage.If the skin defect is large,the suture can be transplanted or flap grafted after infection control.All patients began to prolong after 1 week.At the same time,the movement of the knee joint and ankle joint was strengthened,the patients were followed up positively,and the observation indexes of the two groups were summarized and compared.Result:All patients were followed up without major trauma and death.Group A: The average follow-up period was 14 months(10~24 months).The average length of bone defect in all patients was 6.5cm(5.3-12.5cm),and the average bone migration timewas 10.5 months(8.2-18.5 months).The patient recovered after the orthodontic correction was performed.Three patients developed a nail infection during the handling process.They were cured by anti-inflammatory treatment and dressing change.One patient had unbearable skin distraction pain and stopped moving for 3days.Symptoms improved,the pain was relieved and then keep moving.One patient was corrected by adjusting the connecting rod and the external fixation ring after the force line was deflected during handling.Group B: mean follow-up of 12.5 months(9-18 months),the average bone defect of the patient was 6.2 cm(4.8-11.2 cm),the average bone movement time was 9.3 months(7.2-16.8 months),and 2 patients appeared the nail infectionand them were cured after dressing change.One patient developed nonunion of the fracture end,and the fracture healed after internal fixation with bone graft.There was a significant difference in hospitalization time,treatment cost,and number of operations between group A and group B(p<0.05).However,the mean age of the patients,the percentage of male patients,the amount of blood loss,the time of surgery,the time of healing,and the incidence of surgical complications were not significantly different(p> 0.05).Comparison of CRP and PCT levels in peripheral blood between the two groups before surgery,1 month after surgery,3months after surgery,and the last follow-up.The variance analysis of repeated measures was used to obtain PCT and CRP at different time points.There was no difference in levels(P>0.05).There were no differences in peripheral blood PCT and CRP levels between the two groups(P>0.05).At the end of follow-up,there were no cases of recurrence of infection in both groups.Conclusion;The use of Ilizarov technology to treat infected nonunion of the tibia is an effective method to restore the lower limb line and length while completely removing the infected lesion.Through retrospective analysis of a large number of clinical cases,we found that patients with primary surgery and secondary surgery did not have significant differences in the inflammatory response and disease recurrence rate of disease control,but the first-stage surgery can greatly reduce the surgery compared with the second-stage surgery.The number of times,hospital times and surgery costs.