A Comparative Analysis Of The Efficacy Of Combined Technique And Single Technique In The Treatment Of Refractory Osteomyelitis

Objective:To compare the clinical efficacy of Ilizarov bone transplantation technique combined with antibiotic bone cement filling technique,membrane induction technique and single therapy:Papineau technique(open bone grafting technique)and Ilizarov bone transplantation technique in the treatment of refractory long bone.Methods From June 2010 to October 2016,38 cases of refractory osteomyelitis were treated with single technique and combined technique(Ilizarov external fixator fixation and bone removal,antibiotic bone cement filling,membrane-induced osteogenesis,slow distal retraction,etc.)in Xinjiang Military Region General Hospital.25 cases were treated with single method:Papineau technique group,12 cases,Ilizarov technique group.There were 13 cases in the bone transplantation group,all male,13 cases in the combined treatment group,all male;age 20-66 years old,average 36.6 years old;20 cases of traffic accident,8 cases of high fall injury,8 cases of heavy object injury,2 cases of strangulation;10 cases of open fracture and 28 cases of closed fracture;all of them were after internal fixation,11 cases were accompanied by bone exposure,and all cases had sinus tract abscess.The duration of the disease was 1-3 years,with an average of 16.5 months.After thorough debridement,the bone defect ranged from 5 cm to 15 cm,with an average of 9.74 cm.The wound secretions were taken for bacterial culture before operation,pathogenic bacteria were identified,sensitive antibiotics were selected for anti-infection treatment,thorough debridement during operation,bone and surrounding soft tissues infected and necrotic were removed,and Ilizarov bone transplantation technique was used in combination with a variety of methods or a single treatment scheme for further intervention.The operation times,external fixation related data(including external fixation time and index),weight-bearing data(total weight-bearing time and index),hospitalization days,medical expenses and other indicators were compared and evaluated.Postoperative limb function was assessed by the Puno functional score,and the data were analyzed by SPSS24.0.Results 38 patients were followed up for 16 to 40 months,with an average of 29.52 months.Functional assessment is evaluated using the evaluation system proposed by Puno et al.The length of bone defect ranged from 5 cm to 15 cm,with an average of 9.74 cm.There was no significant difference in operation time,bleeding volume,external fixation index and external fixator time among the three methods.There was no significant difference in weight-bearing data and functional scores among the three groups.There were significant differences in the number of operations,recurrences and treatment costs among the three groups.Preoperative data:age,gender,and whether or not there was common peroneal nerve injury had no significant correlation with the outcome of late recovery.Conclusion Combined technique can effectively treat bone defect or limb shortening after thorough debridement.While ensuring thorough debridement,it can also promote the improvement of local blood supply,bone movement and simultaneous movement of soft tissues without skin flap coverage,and wound healing;antibiotic bone cement tablets can not only play a role of space occupier,but also play a role of membrane induction to promote osteogenesis,synchronized with bone removal does not affect bone removal;slow distal retraction shortens the distal part of the removal.The end-to-end rendezvous time prolongs the contact time of the broken end and is conducive to the healing of the bone end.The combination of various methods can effectively improve the cure rate of refractory osteomyelitis,and effectively reduce the number of operations and treatment costs.This technique is a safe and effective treatment method.