Retrospective Analysis Of Ilizarov Technique In The Treatment Of Tibial Osteomyelitis And Bone Defect

Objective: To study the curative effect of Ilizarov bone transport technique in the treatment of tibial osteomyelitis with Cierny-Mader type Ⅳ by thorough debridement and removal of bone defects after death,summarize its advantages and disadvantages,and put forward suggestions for the prevention of complications.Methods: from May 2016 to May 2020,24 patients with bone defect after debridement of Cierny-Mader type Ⅳ tibial osteomyelitis were treated by Ilizarov bone transport technique in Guangxi bone injury hospital.Among them,16 were male and 8 were female,the average age was 41.4±10.6years old,the age was between 20-56 years old.The patients underwent thorough debridement,removal of dead bone,and fixed with Ilizarov external fixator.The patients received regular reexamination in 1 month,3 months,6months and 1 year after operation.Results: all the 24 patients were followed up for 8-37 months(average 19.9±8.4 months).The bone defect was 3.5-15.2cm,The average length of defect is 6.9±3.8cm,the average length of stay is 51.8days,the average number of operations is 5.6±1.9,the average number of external fixation months is 9±2.3 months,the average external fixation index is1.2-2.2 month/cm,the average value is 1.5±0.5 month / cm;the percentage of bone transport is between 8% and 38%,the average value is 15.3%;the imaging healing index is between 0.9-2.3cm/month,the average value is 1.7±0.4cm/month.The healing time was 8.3-18 months,and the average healing time was 11.3±1.8 months.In the treatment of soft tissue defects,14 cases were covered with skin flaps and grafts,and 10 cases were naturally healed.In the treatment of the commissure,13 cases could be naturally healed by the accordion technique after the cleaning of the broken end,and 11 cases needed to be healed after the bone grafting of the commissure.In terms of postoperative complications,12 patients had nail infection,8 patients had lower limb force line deviation during bone removal,10 patients had limited movement of knee or ankle joint,7 patients had skin traction pain during bone removal,and 3patients had blood vessel and nerve injury during bone removal.According to the Paley bone healing score,15 cases were excellent,7 cases were good,2cases were general,the excellent and good rate was 91.7%.Conclusion: after thorough debridement of Cierny Mader type Ⅳ tibial osteomyelitis,it is easy to have large bone defects.Ilizarov bone transport technology is an effective treatment for bone defects.During the process of bone transport,regular reexamination should be paid attention to to reduce the impact of complications in the treatment process.