Analysis Of The Therapeutic Effect Of Bone Transport Via Ilizarov Technique And Vascularized Fibular Transplantation In The Treatment Of Open Tibia Fracture With Large Bone Defect

Objectives:To compare the therapeutic effect of bidirectional and unidirectional bone transport via the Ilizarov technique as well as the vascularized fibular transplantation in the treatment of open tibial fracture with large bone defect.Methods:From September 2014 to September 2021,60 patients treated either by bidirectional bone transport via Ilizarov technique(BBT),unidirectional bone transport via Ilizarov technique(UBT),and vascularized fibular transplantation(VFT)were included.Each group included 20 patients.The BBT group contained 14 male and 6 female patients.Both the UBT group and the VFT group included 15 male and 5 female patients.The routine debridement procedure was performed in each group and followed by one of three interventions.Related factors,including blood loss,duration of surgery,VAS scores,Paley scores,healing time of wound,bony union time,bony union index,Kofoed scores,ROM of knee,EQ-5D scores,and side effects,were all collected throughout the 18-month follow-up.Results:Bony union was obtained in all patients.The average age of BBT group,UBT group,and VFT group were 50.1± 9.07 years,48.15±9.11)years,and 51.15±8.00 years,respectively.The length of tibia defect of these three group were 7.71±1.88 cm,7.52±1.8)cm,and 7.60±1.72 cm,respectively.There was no significant statistical difference in the demographic data and clinical baseline characteristics between these three groups.The average blood loss of BBT group,UBT group and VFT group were 415.50±111.90 ml,354.00±84.82 ml,and501.00±113.83 ml,with significant statistical difference(F= 10.009,P< 0.001).Pairwise comparison result showed that the amount of bleeding in the UBT group was lesser than that in the VFT group,and the difference was statistically significant(t=4.631,P<0.001).However,difference between the VAS scores and duration of surgery of three group had no statistical significance.Meanwhile,the healing time of wound,bony union time,and bony union index in the BBT group were 72.25±17.99 d,235.75±38.94 d,and 32.14±8.64 d/cm,were71.45±13.88 d,287.40±37.47 d,and 41.05±11.00 d/cm in UBT group,and were 72.35±18.22 d,180.35±55.99 d,and 24.29±8.24 d/cm in the VFT group.There was statistical significance among the difference of bony union(F=28.397,P< 0.001).Pairwise comparison result showed that the bone healing time of BBT group was significantly shorter than that of the UBT group(t=4.274,P<0.001).There was a statistically significant difference in healing index among the three groups(F=16.008,P<0.001).Pairwise comparison result showed that the healing index of the BBT group was better than that of the UBT group(t=2.849,P=0.007).The pairwise comparison result found that the BBT group was more effective in reducing the difference between the affected limb and the healthy limb,which was better than that in the VFT group(t=7.633,P<0.001).The final follow-up results according to Paley’s criterion were calculated,and the excellent and good rates in the BBT group,UBT group,and VFT group were 100%,95%,and 85%,respectively.The knee ROM of these three groups also exhibited significant statistical difference(F=5.835,P=0.041),and the pairwise comparison result showed that the VFT group was better than the unidirectional bone graft group(t=3.596,P=0.001).However,the improvement of patients’ quality of life between these three groups had no significant statistical differences(all P> 0.05).Conclusion:BBT,UBT,and VFT all showed good therapeutic effect in the treatment of open tibial fracture with large bone defect.Meanwhile,BBT is superior to other procedures in reducing bony union time,and the improvement of bony union index.