| Objective:By analyzing the bone healing time of the docking site,the relationship between the changes of the docking site microenvironment in the early stage and the bone healing after treatment with"accordion"technology was discussed,and the necessary conditions for non-healing of the docking site by"accordion"technology were preliminarily studied.Methods:The clinical data of 30 cases of tibial bone transport admitted to the Department of Orthopedics of the Second Hospital of Shanxi Medical University from May 2018 to June 2022 were analyzed retrospectively.There were 26 males and 4 females,aged(47.3±11.7)years(range:22-65 years).Before bone transport,the length of tibial bone defect was(6.80±3.61)cm(range:3.09～22.1 cm).The operation steps of"accordion"technology:pressurization for 7days,suspension for 7days,extension for 12days,suspension for 7days,retraction for 12days,and then stop the operation to consolidate the bone mineralization at the docking site.During treatment,ultrasound was used to monitor the size of the hematoma after 7 days of compression,the condition of the neonatal callus after 12 days of retraction,and changes in blood flow before and after the"accordion"operation.X-rays should be used later to monitor bone healing at the docking site.The bone healing and functional recovery of the patients were evaluated with paley healing criteria.Results:All 30 patients were followed up for(11.9±1.9)months(range:10.1～20.2 months).At the last follow-up,22 patients achieved bone healing at the docking site after the treatment of the"accordion"technique.The healing time was(30.9±4.3)weeks(range:25～40 weeks).The size of the hematoma was linearly negatively correlated with the bone healing time at the docking site(r=-0.639,P<0.01).The bone healing time decreased by 12.482 weeks when the size of the hematoma increased by 1 cm~2.There were no significant changes in blood flow RI(Resistance index),blood flow PI(Pulsation index),blood flow velocity(MV),blood flow Alder grade and bone healing time before and after accordion treatment in 22 patients(P>0.05).The RI of blood flow of 22 patients was(0.57±0.1)before"accordion"treatment and(0.48±0.1)after treatment.There was a statistical difference between the two groups in the overall mean(d=0.08,95%CI 0.05-0.12,P<0.001);The PI of blood flow before"accordion"treatment was 0.89(0.78,1.09),and that after treatment was 0.73(0.54,0.82).There was a statistical difference in the overall distribution of data between the two groups(Z=3.69,P<0.001);The average blood flow velocity before and after"accordion"treatment had no significant difference(P>0.05);The Alder grading of blood flow before"accordion"treatment was statistically significant compared with that after treatment(Z=-6.339,P<0.001).According to the Paley healing criteria of 22 patients,18 patients were excellent and 4 patients were good.4 patients had broken end alignment and poor alignment during the treatment of"accordion",and were unsuccessful in outpatient adjustment,and then underwent autologous bone grafting.After contact with the docking site,4 patients did not show hematoma at the broken end by ultrasonic examination,and no hematoma was found after compression treatment.Among them,3 patients underwent cortex peeling at the broken end,and 1 patient underwent autologous bone transplantation.Conclusion:Hematoma is a necessary condition for the success of"accordion"technique for the non-healing of the docking site,and the size of the hematoma is positively correlated with bone healing;The"accordion"operation can promote increased blood flow to the tissues around docking site;Ultrasound can monitor the changes of the docking site microenvironment during the treatment of the accordion,and can provide guidance for the formulation of refined operation plans and prognosis judgment of the"accordion"technique. |
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