Clinical Study Of Ilizarov Bone Transport Technique Combine With Traumatic Yellow-water In The Treatment Of Infectious Bone Defects After Tibial Fracture

Objective:To investigate the clinical efficacy of Ilizarov technique combines with traumatic yellow-water in the treatment of infectious bone defects after tibial fracture trauma.Methods: 60 patients with infectious bone defects after traumatic tibial fracture admitted by Traumatic Orthopedics Department,Foshan Hospital of Traditional Chinese Medicine from June 2014 to June 2016 were regarded as study objects.There were 42 males and 18 females,aged 16-56 years(with the average of 41.2 years old).Their first injuries were open fractures.The duration of the disease was 6 to 24 months,with an average of 14.6 months.The length of the bone defect was 6-14.5cm(with the average of 8.8 ± 1.2 cm).There were no symptoms of systemic infection when patients were admitted;preoperative imaging examination,clinical manifestations,laboratory tests and bacterial culture results showed different levels of infectious bone defects.The 60 patients were randomly divided into four groups,and the differences regarding the gender,age distribution and patients' duration were not statistically significant.Patients in Group A changed their dressing with trauma yellow-water before and after the surgery;patients in Group B changed their dressing with trauma yellow-water before the surgery,and saline after the surgery;patients in Group C changed their dressing with saline before the surgery,and trauma yellow-water after the surgery;Group D was blank control.All patients were treated with sensitive antibiotics to control the infection and improve the preoperative examination,in order to exclude surgical contraindications.Surgery shall be conducted after the infection was stable,bone transport technique of Ilizarov external fixed mount osteotomy was used during the surgery,and flap transfer or open drainage were used at soft tissue defect.10 days after surgery,bone blocks were transported to the defects at the speed of 0.6-1mm/d.After bone transport,the external fixed mount was removed according to the situation of bone mineralization.At this time,pin-related infections in the four groups were compared.Results: All patients were operated smoothly,with an average operation time of(135 ± 26.8)min;the average intraoperative blood loss was(103 ± 21.4)ml.All 36 patients were followed up for 9-24 months and bone transport time was averaged to be(60-150)days,all the fractures were healed,and the healing time was 6-18(8.86 ± 3.31)months,and bone infection was also controlled.The length of traction osteogenesis was 6-14.5cm,with the average of(8.8 ± 1.2)cm.The pin-related infection rate in Group A was 6.67%(1/15).The pin-related infection rate in Group B was 33.33%(5/15).The pin-related infection rate in Group C was 20%(3/15).The pin-related infection rate in Group D was 53.33%(8/15).According to the statistical analysis,there were significant differences among the four groups(P <0.05).Dressing change with trauma yellow-water before and after the operation can effectively reduce the pin-related infection.Axial shift occurred in 9 cases during bone transport,which was corrected after adjustment;11 patients had skin pain due to the traction of steel needle,whose bone transport shall be continued 2-3 days after the traction and the pain was gone.According to Paley fracture healing criteria,37 cases were in excellent,14 cases were in good level and 9 cases were in medium level;the ankle and knee functions of all patients were improved after bone healing.Conclusion: Conclusion: the effect of Illizarov technique combines with traumatic yellow-water in the treatment of infectious bone defects after tibial trauma is significant,and the operation is safe and simple.In addition,the traumatic yellow-water can effectively reduce postoperative pin-related infection,so it is worthy of promoting and applying.