The Application Value Of Ultrasonography In The Treatment Of Bone Union At The Docking Site After Tibial Bone Transport By Accordion Maneuver

Objective: To explore the value of high-frequency color doppler ultrasound in the treatment of bone union at the docking site after tibial bone transport by accordion technique.Methods: Sixteen patients with tibial bone transport were recruited,including 14 males and 2 females,ranging in age from 6 to 61 years,with an average age of 45.25±14.3 years.When the docking site was in contact,accordion operation was carried out.The specific operation process was compression for two weeks,suspension of adjustment for 12 days,distraction for two weeks,retraction for two weeks,and re-contact.After that,the accordion operation was stopped,and the mineralization was consolidated at the docking site.The adjustment rate was 0.83mm/day.High frequency color doppler ultrasound was used to monitor the hematoma,blood flow signal and new callus in and around the docking site at each stage.After the accordion operation,the bone union of the patients was examined by X-ray.Results:(1)At two weeks of compression,hematoma occurred in 14 patients,and no hematoma occurred in two patients.X-ray observation showed that the hematoma occurred in 14 patients with bone healing,with an average healing time of 30.8±4.9 weeks.After 20 weeks of continuous observation,the two patients without hematoma still showed no obvious signs of bone healing at the docking site,so they changed to the operation of bone cortical exfoliation.After surgery,there was hematoma at the docking site,and the accordion operation was continued.Finally,bone healing occurred at 30 and 32 weeks after the operation.(2)In 14 patients with hematoma,the size of hematoma at two weeks of compression was negatively correlated with the bone healing time of the docking site,Pearson correlation coefficient was-0.819(P < 0.001).(3)In the 16 patients,the hematoma size at two weeks of compression was negatively correlated with the blood flow resistance index(RI)at two weeks of distraction,and Pearson correlation coefficient was-0.801(P < 0.001).(4)During the accordion operation,the Adler grading of blood flow at the docking site gradually increased before the recompression in 16 patients,and then gradually decreased.But the degree of callus mineralization continued to rise.(5)At the last followup,according to the Paley evaluation criteria,the results of bone healing were excellent in 12 cases and good in four cases in this group.Conclusion: As a simple and non-invasive monitoring method,high-frequency color doppler ultrasound can dynamically monitor the changes of hematoma,blood flow and new callus at the docking site in the accordion operation.In addition,the RI and Adler grading of blood flow,degree of callus mineralization,and ultimate bone healing time of the docking site is predicted according to the hematoma range formed during compression.