Clinical Comparative Analysis Of Two Metheds For Treatment Of Tibial Bone Defect Bone Transport Technique VS Bone Graft And Internal Fixation

OBJECTIVE:A retrospective analysis was performed for exploring clinical effect of bone transport technique with bone graft and internal fixation in treatment of tibia bone defect and comparing both the advantages and disadvantages of the two metheds of treatments. Besides, we tried to discuss the contraindications, indications and complications, and aimed to provide reference for the clinical care of tibia defect.METHODS:Totally 37 patients were finally recruited in The First Affiliated Hospital of Guangxi Medical University from June 2005 to February 2015. Respectively,15 cases were treated with tibial bone transport technique (bone transport group) with a follow-up time of 7 to 15 months, and 22 cases were treated for bone grafting and internal fixation (bone graft and internal fixation group) with a follow-up time of 3.2 to 10 months. The length of bone defect repaired, incision length, operative time, intraoperative bleeding volume, postoperative management, fracture healing rate and healing time, complications, hospitalization time and cost were compared, also with the advantages and disadvantages, optimum indications were also discussed.RESULTS:37 cases were all followed up,the follow up times in bone transport group were averagely 10.7 months and in bone fixation group averagely 6.4 months. We obtained significant difference in the following sections:the operation incision length, operation time, intraoperative bleeding volume, fracture healing time, hospitalization time and cost of hospitalization with all P< 0.05. In bone transport group, the operation incision was shorter and the bleeding during operation was less, but with a longer the operation time, fracture healing time, and hospitalization time, and the hospital costs are relatively higher. For bone transport group, the average length of repaired bone defect was 6.3±3.4cm (2.5～14cm), and 4 cases with bone nonunion were treated with autologous bone grafting,4 cases complication with slight ankle plantar-flexion contracture,4 cases with Pin-track infection. The overall healing rate was 73.3%. For bone grafting and internal fixation group, the average length of repaired bone defect was 3.1±0.5cm (2.3～4.2cm).6 cases complicated with bone nonunion,3 of which were cured by autogenous bone grafting,the other 3 were cured by bone transporting with liliac bone area infection,loperation area infection.The overall healing rate was 72.7% and 6 patients still with limb shortening of 0.8～1.5cm.CONCLUSION:The two methods of treatment were all gained satisfying effect Bone transport method have the advantages of no bone grafting and could reduce bone grafting complications, especially applied in large segmental bone defect and chronic osteomyelitis. In addition, this method was with a relatively lower requirement of the soft tissue condition. Bone graft internal fixation was also a good treatment fors mall bone defect with advantage of simpler operation technique and less complication.