Clinical Observation Of Ilizarov Technique In The Treatment Of Large Tibial Bone Defect

Research purpose and background: With the development of traffic and the extensive use of machinery,Patients with open injury of the leg also gradually increased,Most of the injury types were Gustilo type III, often with extensive soft tissue necrosis, bone infection and limb shortening and one or two amputation rate is high.Because of the anatomical characteristics of the tibia, it is easy to occur bone nonunion after fracture. Severe open comminuted fracture of tibia usually associated with bone defect, soft tissue defect, bone infection and so on,the rate of bone nonunion is higher.Tibial bone defects with limb shortening,more common in severe open comminuted fracture surgery, osteomyelitis of the large section of the dead bone removal, congenital joint resection of the tibia and the backbone of the tumor resection.At present, there are five methods for the treatment of tibial bone defect and nonunion:bone grafting technique,Ilizarov, Masquelet technology, bone substitute materials and bone tissue engineering, gene therapy.These methods have some technical requirements and defects.While Ilizarov distraction osteogenesis is a minimally invasive surgical technique, was developed in 1956 by the former Soviet Union Department of orthopedics doctor Ilizarov based on the theory of law of tension stress[1,2].The emergence of Ilizarov technology and its basic principles,promote the development of modern medicine, solve the problems that other traditional methods can not solve, in the treatment of bone nonunion, bone defects and limb shortening superiority is more and more prominent[3-5],Ilizarov technology is considered to be the optimal treatment strategy[6] .By using the "law of tension stress",the doctor can use the Ilizarov external fixator to stabilize the bone fracture, and to improve the bone and soft tissue reconstruction[7],Patients can get out of bed early functional exercise.In this paper, we retrospectively analyzed the application of Ilizarov technique in the treatment of tibial bone defects, and summarized the characteristics of Ilizarov and the experience in the treatment of tibial bone defectsMethod : Review the 18 patients of Open fracture of tibia with bone defect or infected nonunion cured by Ilizarov technique therapy in the First Affiliated Hospital of Kunming Medical University from January 2014 to March 2017.Male 14 cases,female 4 cases,Age from 21 to 60 years old,Mean age 40.4±410.96 years?18 patients with open tibial fractures caused by high-energy injury (Gustilo three),Limb injury severity score MESS < 7. There were 13 patients with Postoperative necrosis of skin and soft tissue, bone exposure, bone defect, infection.Take four to seven Operations to Repair wound and control Infection.(Debridement of soft tissue lesion,VSD negative pressure suction,Flap transfer);5 patients with Skin defect, bone,soft tissue infection,Take three to five Operations to Repair wound and control Infection.(Debridement of soft tissue lesion,VSD negative pressure suction,Skin grafting);There were 5 cases of simple infected nonunion after operation,4 cases Simple bone defect nonunion ,9 cases Infection with bone defect nonunion.The mean of bone defect after debridement are 6.53 ± 1.79cm (4-11cm),The average time from injury to hospitalization was o.7 (0.4-1.2) years, to improve the preoperative examination, remove the focus of the tibia,Ilizarov external fixation compression fixation, tibial osteotomy lengthening,3 cases were treated with double slip.Result: 18 patients were followed up by the way of review,the mean follow-up time was 1.5 (0.8-2.7) years.Limb bone defects were repaired.Compared with the healthy side of the basic length (shortened to1cm),Bonelengthening 4-11cm,average6.53 ± 1.79 cm,Bony union of fracture and extension,Bone healing except for fixed time 10 ?32 months,An average of 16 months,no wound infection, no osteomyelitis Occurred.Complication : 3 cases of early mineralization and osteotomy;6 cases of Pin infection cured by Anti-inflammatory and strengthening dressing;7 cases of traction pain,Pain relief after suspension; 4 cases of calf muscle atrophy occurred ;1 cases of malunion of fracture,and corrected by Adjustable external fixator;5 cases of bone fracture were treated with autogenous bone grafting and para alignment bone healing;Cases without vascular nerve injury .All patients recovered full weight-bearing walking function, 14 cases with normal gait,4 cases of left lameness.No bone nonunion and knee stiffness occurred.According to Paley fracture healing score criteria, 12 cases were excellent, good in 5 cases, and fair in 1 cases.Conclusion: Ilizarov technique is an effective method for the treatment of bone defect, Not only can completely remove lesions,Infection control,but also can repair and reconstruction of the affected limb, to restore the length and function of the limb,Reduce hospitalization time and economic burden.After the operation, the patient can get out of bed early to exercise, avoid joint stiffness and decrease function,Compared with the traditional method,the effect is significant,and the repaired tibia is close to normal.