| Objective Comparative analysis of the advantages and disadvantages of Ilizarov’s standard pulling method and dynamic accordion pulling method,and further exploring the relationship between the pulling method and osteogenesis,in order to provide clinical treatment for nonunion,bone defect,and osteomyelitis Based on this,it provides a certain clinical reference for improving the technology.Method Thirty patients with tibia bone defects treated with Ilizarov technology in our hospital from January 2015 to October 2019 were selected.Ages 21 to 65(5women,25 men),with an average age of 42 years.Gustilo classification system was used to classify the fractures.There were 17 grade IIIA and 5 grade IIIB fractures,and the remaining 8 cases were secondary infections after closed fracture internal fixation(6 cases with plate fixation and 2 cases with intramedullary nails).Detailed records General information of the patient,initial cause of injury,number and severity of comorbidities,surgical procedure,initial fracture classification,preoperative soft tissue injury,and angiography excluded peripheral vascular disease.The patients were randomly divided into a control group(n=15)and a test group(n=15).The control group was subjected to a standard pulling method during the bone transport stage,and the experimental group was subjected to a dynamic accordion pulling method.The bone healing time(BHT)was recorded for each group,Consolidation index(CI),Extenal fixation index(EFI),Extenal fixation time(EFT),Lengthening index(EI),knee joint HSS score,ankle BJ score,and ASAMI healing evaluation,complications during treatment.All patients received standard postoperative management to guide bone elongation and needleway care.Partial weight bearing(not more than 20kg)is encouraged on the first day after surgery,until the impact evidence shows that the weight can be gradually increased after bone healing.After the initial wound healing,the patient was allowed to be discharged from the hospital and reviewed in the outpatient clinic one week after discharge.Postoperative bone extension was reviewed weekly and then every two weeks,until imaging showed bone healing.Results There were no significant differences in age,gender,number of infections,length of bone defect,and follow-up time between the two groups(P>0.05),and the two groups were comparable;Extenal fixation time(EFT)and Bone healing time(BHT)The difference was not statistically significant(P>0.05);Consolidation index(CI): the control group(69.90 ± 15.10)days / cm,the test group(55.83 ± 78.11)days / cm,the Consolidation index of the test group was significantly lower than the control group(P<0.05);Extenal fixation index(EFI): control group(75.07 ± 15.85)days / cm,test group(61.33 ± 10.23)days / cm,outer frame index in the test group was significantly lower than the control group(P < 0.05);Lengthening index(EI):The control group(15.53 ± 5.24)days / cm,the test group(20.53 ± 5.24)days /cm,Lengthening index(EI)of the test group was significantly higher than the control group(P < 0.05);the comparison of ASAMI scores between the two groups,boneiness Results(11 cases were excellent in the control group,4 cases were good;13cases were excellent in the test group,2 cases were good),and functional results(10cases in the control group were excellent,3 were good,and 2 were fair;12 were excellent in the test group,2 were good,1 case),there was no significant difference in the bony and functional results of ASAMI between the two groups(P>0.05);There was no significant difference between the HSS score of the joint and the BJ score of the ankle(P > 0.05).Comparison of complications: The incidence of needleway infection was large,and almost all patients had DAHL1 needleway infection.There were 8 cases(control group 3 cases,trial Group 5 patients)had DAHL grade 2-3infection;7 patients(control group 4 cases,test group 3 cases)had foot drop and horseshoe deformity;10 patients had local stretch pain(control group 6 cases,test group)4 cases);7 cases(control group 3 cases,experimental group 4)patients had poor alignment at the teacher’s end;6 cases(control group 4 cases,experimental group 2 cases)patients had problems with line of force during relocation;Thedifference in limb length was less than 2cm,and there was no significant difference in the incidence of complications between the two groups(P > 0.05).There was no correlation between bone transport time and Consolidation index(CI)between the two groups((P > 0.05),and the difference was not statistically significant;there was a positive correlation between bone transport time and bone defect length between the two groups(r=0.632,r>0,P<0.05),The difference was statistically significant.Conclusions The dynamic accordion pulling method can reduce Consolidation index(CI)and Extenal fixation index(EFI),and decrease the Consolidation time of new bone during bone transport.There is a positive correlation between the two groups of Distraction Time(DT)and the bone defect length.The pulling method has a positive effect on the treatment of tibial bone defects by Ilizarov technology. |
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