Analysis Of Curative Effect Of Ilizarov Technique And Masquelet Technique On The Treatment Of Infectious Nonunion And Bone Defect

Objective To explore the clinical efficacy of Ilizarov and Masquelet technique on the treatment of infectious bone nonunion and bone defects.Methods Inpatients(Orthopedic Trauma of Orthopedic Center,Lanzhou General Hospital of PLA)from January 2012 to January 2016,of infectious nonunion and bone defects treated by Ilizarov or asquelet technology were analyzed retrospectively.83 patients were enrolled in the study,including 54 males and 29 females,aging from 16 to 64 years.In the Ilizarov technical group,bone loss of femur and tibia were 18 and 27 cases respectively.Analysis of outcome measures including the healing time,the mineralizaiton index,the complications and the limb functional scores were performed after debridement and treatment using Ilizarov technique.In the Masquelet technical group,bone loss of femur and tibia were13 and 25 cases respectively.Analysis of outcome measures including the operating times,the healing time,the complications and the healing scores were performed after debridement and treatment using Masquelet technique.Clinical efficiency between two groups were compared.Results The Ilizarov group was followed up for 18 ~ 24 months,18.04 ± 3.67 months averagely.The healing time was 8 ~ 29 months,18.64 ± 5.38 months averagely.The mineralization index was 1.5~2.74 month / cm,2.02 ± 0.22 month / cm averagely.The total times of operations was 3~8 times,4.3 ± 1.2 times averagely,in which bone reconstruction was 2~5 times,2.8 ± 0.8 times averagely.The total cost of treatment was 50~187 thousands yuan,9.58 ± 2.67 thousands yuan averagely.Complications were observed in 52 patients.According to the classification of complications,21 cases belonged to Problems,including18 cases of nail infection Grade1,3 cases of axial deviation;31 cases belonged to Obstacles,including 5 cases of nail infection Grade2,10 case of axial deviation,8 cases of soft tissue depression in bone defect area,8 cases of unilateral nonunion;no Real complications case.In terms of bone outcomes,according to the Paley score criteria,18 cases were excellent,20 cases were good,6 cases were average,1 case was poor,the excellent rate was 84.4%.In terms of functional outcomes,23 cases were excellent,16 cases were good,5 cases were average,1 case was poor,the excellent rate was 86.7%.The Masquelet technical group was followed up for 12~21 months,17.07 ± 2.69 months averagely.The healing time was 5~9months,6 84 ± 1.29 months averagely.The total times of operations was 2~7 times,4.53 ±1.20 times averagely,in which the reconstruction of bone defect was 1~3 times,1.37 ± 0.54 times averagely.The total treatment costs was 32.3 ~ 133 thousands yuan,61.9 ± 17.2thousands yuan averagely,in which cost of control infection was 10~92 thousands yuan,40.6 ± 17.1 thousands yuan averagely,the cost of reconstruction of bone defects was 10~49thousands yuan,23.6 ± 10.1 thousands yuan averagely.Complications were observed in 17 patients.According to the classification of complications,10 cases belonged to Problems,including 10 cases of nail infection Grade1;6 cases belonged to Obstacles,including 5 cases of bone resorption,1case of nail infection Grade2;3 cases belonged to Real complications.In terms of bone outcomes,according to the Paley score criteria,13 cases were excellent,17 cases were good,5 cases were average,3 case was poor,the excellent rate was 78.9%.In terms of functional outcomes,9 cases were excellent,20 cases were good,6 cases were average,3 case was poor,the excellent rate was 76.3 %.The cost of entire treatment,control infection and bone reconstruction between two groups were analyzed,and the difference were statistically significant(P?0.05).The operational times of entire treatment,control infection and bone reconstruction between two groups were analyzed,and the difference of entire treatment was statistically significant(P?0.05),the difference of control infection and bone reconstruction were not statistically significant(P?0.05).The bone outcomes and functional outcomes between two groups were analyzed,and the difference were were statistically significant(P>0.05).Conclusion Both of Ilizarov technique and Masquelet technique can achieve a higher cure rate in reconstructing large segment of infections nonunion and bone defects.However,Ilizarov technique was more efficiency in repairing large segment of bone defect with deformity,and did not be constrained by bone mass,and had relatively low requirements of soft tissu.As to Ilizarov technique,the operational times and cost of control infection were lower,while the operational times and cost of settling complications were higher,and long-term wear of external fixation has great impact on patients' daily life.As to Masquelet technique,use of antibiotic bone cement increases the concentration of local antibiotics,the induced membrane can stimulate the growth and cortex of graft bone,the fixed device has less complications and impact on patients' daily life.However,the recurrence of infectionincreased the operational times and treatment costs,infection control after the two lines of autologous bone graft,and lack of autologous bone restrains its application in large segment of bone defect in two-stage,where autologous bone particles need to be grafted.