Bone defect blocked by bone cement segmental filling in single-plane tibial bone transport / 中国组织工程研究

BACKGROUND:Bone transport has been used for a variety of reasons in bone defects with good clinical results.However,various complications have also attracted the attention of practitioners and the avoidance of non-healing of the docking point has become a common concern for doctors and patients. OBJECTIVE:To explore effective methods of avoiding non-healing of the docking point in the treatment of tibial bone defects by bone transport so as to shorten the treatment period and reduce the pain of patients. METHODS:The clinical data of 21 patients with unilateral tibial bone defect admitted to the No.910 Hospital of Joint Logistics Support Force of Chinese PLA from January 2018 to January 2021 were retrospectively analyzed,including 16 males and 5 females,aged(32.8±10.3)years,with an average bone defect length of 10.2 cm.All 21 patients received bone transport surgery,during which the bone defect area was filled with bone cement to reduce the adverse factors affecting the healing of the docking point.The Association for the Study and Application of the Methods of Ilizarov,healing index and incidence of adverse reactions were evaluated during postoperative follow-up. RESULTS AND CONCLUSION:The 21 patients were followed up for 15 to 24 months after surgery,and the extended area was all well mineralized and had no malformations,and no refractures occurred during treatment.Among them,one patient had foot drop,which could not be completely corrected after surgical release of the Achilles tendon and wearing foot and ankle orthotics.19 patients had different degrees of needle tract infection,and no deep infection occurred after timely needle tract nursing.The healing rate of the docking point was 100%;the healing index was 36-45 d/cm and the average was 38 d/cm.The Association for the Study and Application of the Methods of Ilizarov showed that bone healing was excellent in 17 cases(81%)and poor in 4 cases(19%).The results of limb function were excellent in 18 cases(86%)and good in 3 cases(14%).These findings show that bone cement segmental filling during bone transport is an effective method to solve the non-healing of the docking point,shorten the patient's treatment period and reduce the patient's pain.

Effect of tibial nerve injury on treatment of tibial single-plane osteotomy and bone transport / 中国组织工程研究

BACKGROUND:Peripheral nerves play an important role in bone metabolism.In clinical practice,the specific impact of nerve injury on bone transport technology needs further study. OBJECTIVE:To investigate the effect of tibial nerve injury on the treatment of tibial slip by single-plane osteotomy. METHODS:Thirty-two patients with tibial bone defects admitted to Tangshan Second Hospital from May 2011 to June 2022 were selected.According to the presence or absence of tibial nerve injury,patients were divided into the tibial nerve injury group(n=16)and the non-tibial nerve injury group(n=16).Both groups were treated with single-plane osteotomy and bone slip.After treatment,the patients were followed up to collect the mineralization zone healing index,external fixation index,docking point healing and needle infection.After the removal of external fixation,the bone healing and functional evaluation were evaluated by a classification of the Association for the Study and Application of the Method of Ilizarov(ASAMI). RESULTS AND CONCLUSION:(1)All 32 patients were followed up for(25.28±4.79)months.There were no significant differences in bone healing time,external fixation time,healing index and external fixation index between the two groups(P＞0.05).Needle infection occurred in two cases of the tibial nerve injury group and one case of the non-tibial nerve injury group,all of which were PALEY I,and there was no significant difference between the two groups(P＞0.05).The non-union rate of the occlusal end of the tibial nerve injury group was 31%,and that of the non-tibial nerve injury group was 13%;there was no statistical difference between the two groups(P＞0.05).The excellent and good rate of ASAMI bone healing score in the two groups was 100%;the excellent and good rate of limb score was 81%in the tibial nerve injury group and 94%in the non-tibial nerve injury group;there was no statistical difference between the two groups(P＞0.05).(2)Our research shows that tibial nerve injury has no significant effect on the mineralization speed,external fixation time,union of the occlusal end,infection of the needle tract,and the quality of bone formation in the mineralized area of the single-plane osteotomy.

Tibial transverse bone transport assisted by nose ring drainage for treatment of foot and ankle chronic osteomyelitis / 中华创伤骨科杂志

Objective:To investigate the clinical effects of tibial transverse bone transport assisted by nose ring drainage (NRD) in the treatment of foot and ankle chronic osteomyelitis.Methods:A retrospective study was conducted to analyze the data of 32 patients with foot and ankle chronic osteomyelitis who had been treated at Department of Orthopedics, Beijing Rehabilitation Hospital from March 2013 to February 2022. The patients were assigned into a study group and a control group. In the control group, there were 12 males and 3 females, aged (39.5±8.8) years. The osteomyelitis was located at the distal tibia in 4 cases, at the talus in 1 case, at the calcaneus in 2 cases, at the midfoot in 4 cases and at the forefoot in 4 cases. According to the Crerny-Mader classification, there were 5 cases of type Ⅰ and 10 cases of type Ⅱ. The control group was treated with Ilizarov transverse tibial bone transport in combination with thorough debridement and anti-infection therapy. In the study group, there were 12 males and 5 females, aged (42.3±13.4) years. The osteomyelitis was located at the distal tibia in 4 cases, at the talus in 1 case, at the calcaneus in 3 cases, at the midfoot in 5 cases and at the forefoot in 4 cases. According to the Crerny-Mader classification, there were 7 cases of type Ⅰ and 10 cases of type Ⅱ. The study group was treated with NRD drainage in addition to the procedures in the control group. The curative effects were evaluated by comparing the cure, recurrence, amputation (toe amputation), antibiotic use time, wound healing time, relevant inflammatory indicators [WBC, neutrophil percentage (NEU), erythrocyte sedimentation rate (ESR), procalcitonin, interleukin-6 (IL-6), C-reactive protein (CRP)], and postoperative functional recovery between the 2 groups.Results:The 2 groups were comparable because there was no statistically significant difference in the general data between them ( P>0.05). The follow-up period was (36.0±9.8) months. There was no significant difference between the 2 groups in the cure or amputation (toe amputation) ( P>0.05), but the recurrence rate in the study group was significantly lower than that in the control group ( P<0.05). The antibiotic use time [(20.7±3.6) d] and wound healing time [(88.3±17.1) d] in the study group were significantly shorter than those [(37.9±6.5) d and (102.2±22.6) d] in the control group ( P<0.05). The ESR, IL-6 and CRP at 1 week after operation in the study group were significantly lower than those in the control group ( P<0.05), but there was no significant difference between the 2 groups in the WBC, NEU or PCT at 1 week after operation ( P>0.05). There was no significant difference either in the inflammatory indicators between the 2 groups at 1 month after operation ( P>0.05). In all patients, the inflammatory indicators like WBC, NEU, ESR, PCT, IL-6 and CRP at 1 week and 1 month after operation were significantly better than those before operation, and the Maryland foot functional score at 12 months after operation was significantly higher than the preoperative one ( P<0.05). There was no significant difference between the 2 groups in the Maryland foot functional score at 12 months after operation ( P>0.05). Conclusion:In the treatment of foot and ankle chronic osteomyelitis, compared with the Ilizarov transverse tibial bone transport, our tibial transverse bone transport assisted by NRD can achieve satisfactory therapeutic effects, shorten antibiotic use time and treatment cycle, and reduce recurrence rate.

Establishment of finite element model and biomechanical analysis of external fixation and combined external and internal fixation for bone transport in treatment of a case with bone defect of lower limb / 中华显微外科杂志

Objective:To establish a finite element model for bone transport before surgery in the treatment of femoral and tibial bone defects with external fixation and combined intramedullary nails with external fixations, and evaluate the stability and properties of biomechanics.Methods:Between May 2022 and August 2022, a male volunteer in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University was selected. The right lower limb was scanned using 64-slice CT. Data were imported into Mimics 21.0 to establish normal geometric models of femur and tibia. The models were arranged in 4 groups: a femoral external fixator group, a femoral external fixator combined with intramedullary nail group, a tibial external fixator group and a tibial external fixator combined with intramedullary nail group. Hypermesh 10.0 was used for meshing. Finite element analysis was performed by Ansys v.11 to measure the distribution and characteristics of equivalent stress in the transported bone segment, proximal and distal tibia, and fixtures in the 2 treatment modalities, respectively.Results:Peak Von Mises equivalent stress of cortical bone and external fixation was found higher in both of the femoral and tibial external fixator combined with intramedullary nail groups than that in the external fixator group, with stress reduction on cortical bone at approximately 76.9% and 77.8%, respectively. The stress reduction on external fixator was about 81.4% and 76.3%, respectively. Peak displacement of the structure in both of the femoral and tibial external fixator combined with intramedullary nail groups was lower than that in the external fixator group, with 78.4% and 60.1% reduction in displacement, respectively.Conclusion:Bone transport with intramedullary nailing combined with external fixator in treatment of femoral and tibial defects would offer better biomechanical advantages. It can facilitates bone regeneration and bone mineralisation during distraction phase and consolidation phase.

Bone transport with unilateral external fixation for treatment of massive tibial bone defects / 中华创伤骨科杂志

Objective:To analyze the clinical efficacy of bone transport with unilateral external fixation in the treatment of massive tibial bone defects.Methods:A retrospective study was conducted to review the 21 patients with massive tibial bone defects who had been treated by bone transport with unilateral external fixation from February 2017 to January 2022 at Department of Trauma Orthopedics, Ganzhou People's Hospital. There were 14 males and 7 females with a mean age of (46.3 ± 11.3) years. Causes for bone defects: trauma ( n=5), resection of bone non-union ( n=9), resection of infected bone ( n=6) and resection of bone tumor ( n=1). The mean bone defect length was (8.3 ± 1.7) cm. Bone transport started from 10 to 12 days after operation, with a speed of 1 mm/d, and was completed in 4 times. X-ray films were reviewed every 2 weeks. The bone union time, external fixation time (EFT), external fixation index (EFI), docking site situation and complications were recorded. The clinical efficacy was assessed by Paley score. Results:All patients were followed-up for a mean time of (13.5 ± 5.5) months. The mineralization of regenerated bone was good. The bone union time was (9.6 ± 2.2) months, the EFT (10.3 ± 4.0) months, and the EFI (1.3 ± 0.4) months/cm. All docking sites got united. The docking sites were cleaned in 14 patients, of whom simple compression with external fixation was performed in 5 and bone grafts at the docking sites in 9. Postoperative nail tract infection was observed in 6 cases, tibial alignment deviation in 1 case, foot drop deformity in 5 cases, horseshoe varus foot deformity in 1 case, toe flexion deformity in 3 cases, and refracture after removing the external fixation in 1 case. By the Paley score, the bony outcomes were rated as excellent in 16 and as good in 5 cases. The functional outcomes were excellent in 10, good in 7, and acceptable in 4.Conclusion:Bone transport with unilateral external fixation is an effective treatment for massive tibial bone defects, showing advantages of easy operation and convenient carry.

Three osteotomy methods and bone healing in Ilizarov tibial bone transport / 中华创伤骨科杂志

Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.

Comparison of our modified hybrid bone transport technique and conventional bone transport technique in treatment of distal tibial osteomyelitis with bone defects involving the articular surface / 中华创伤骨科杂志

Objective:To introduce our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate by comparison with conventional bone transport in the treatment of distal tibial osteomyelitis with bone defects involving the articular surface.Methods:The clinical data of 34 patients were retrospectively analyzed who had been treated at Department of Orthopaedics, Honghui Hospital for distal tibial osteomyelitis with bone defects involving the articular surface from September 2014 to September 2019. They were divided into 2 groups according to their way of repairing bone defects. In the modified group of 14 cases subjected to the treatment using the modified hybrid bone transport technique, there were 9 males and 5 females, with an age of (39.4±7.3) years. In the conventional group of 20 cases subjected to the treatment using conventional bone transport technique, there were 12 males and 8 females, with an age of (41.2±6.6) years. The external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS) were recorded and compared between the 2 groups. Healing of bone defects and function were evaluated at the last follow-up according to the criteria of Association for the Study and Application of the Method of Ilizarov (ASAMI) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-posterior foot score, respectively. Complications were recorded according to the Paley classification.Results:There was no significant difference in the general data between the modified group and the conventional group, showing they were comparable ( P>0.05). Thirty-four patients were followed up for 18 to 32 months (average, 27 months) after operation. The modified group had significantly shorter EFT [(3.9±1.6) months] than the conventional group [(9.8±2.2) months], and significantly lower EFI [(0.48±0.09) months/cm] than the conventional group [(1.42±0.32) months/cm] ( P<0.05). The SAS [(48.1±4.7) points] in the modified group was significantly lower than that in the conventional group [(61.2±6.2) points], and the number of complications per capita in the former [(0.8±0.4)/case] was significantly smaller than that in the latter [(1.42±0.32)/case] ( P<0.05). There were no significan differences in the healing of bone defects or AOFSA ankle-posterior foot score ( P>0.05). In the modified group and the conventional group, respectively, 13 versus 12 patients were satisfied while 1 versus 8 patients unsatisfied, 1 versus 8 patients had grade-Ⅱ infection while 13 versus 12 patients did not, and 1 versus 9 patients had grade-Ⅲ infection while 13 versus 11 patients did not. There were significant differences between the 2 groups in the above indexes (all P<0.05). Conclusion:In the treatment of distal tibial osteomyelitis with bone defects involving the articular surface, compared with conventional bone transport technique, our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate may lead to better clinical efficacy due to the advantages of shorter external fixation time, lower external fixation index and fewer complications.

Tratamiento de pseudoartrosis séptica de tibia secundaria a fractura expuesta. A propósito de un caso / Treatment of tibia septic pseudo arthritis secondary to exposed fracture. Apropos of a case

RESUMEN Las fracturas expuestas de tibia han sido uno de los problemas más importantes para los sistemas de atención en salud pública. Se caracterizan por tres factores de riesgo fundamentales: daño óseo y tejidos blandos, gran posibilidad de contaminación y dificultades para el tratamiento conservador y quirúrgico, debido al daño óseo y de partes blandas asociados, que implica un alto índice de complicaciones. El tratamiento de estas fracturas es un tema ampliamente discutido en cuanto a la técnica quirúrgica a utilizar. Debido la pobre vascularización y poca cantidad de tejidos blandos que cubren la tibia, este hueso es muy vulnerable a la pseudoartrosis y a la infección. El objetivo de este trabajo fue describir la técnica quirúrgica de transportación ósea con fijador externo Ilizarov y evaluar el resultado en defectos óseos de tibia de más de 6 cm, secundario a pseudoartrosis infectada. Como resultado, el paciente evolucionó con una pseudoartrosis séptica de tibia derecha secundaria a fractura expuesta. El seguimiento fue de 18 meses, la pérdida ósea de 6 cm, la velocidad de distracción de 1 mm/día, el período de transportación de 95 días, y el tiempo con fijador de 198 días. Fue necesario realizar un nuevo proceder quirúrgico en el sitio de contacto, con vistas a reavivar los extremos óseos. La transportación ósea con fijador Ilizarov es válida para el tratamiento de la pérdida ósea en fracturas expuestas de tibia o pseudoartrosis séptica (AU).

ABSTRACT Exposed tibia fractures have been one of the most important problems for public health care systems. They are characterized by three main risk factors: bone and soft tissue damage, high possibilities of contamination and difficulties for the surgical and conservative treatment, due to the associated bone and soft tissues damage implying a high rate of complications. The treatment of these fractures is a widely discussed topic regarding the surgical technique to be used. Due to poor vascularization and little quantity of soft tissue covering tibia, this bone is highly vulnerable to pseudoarthritis and infection. The aim of this work was to describe the surgical technique of bone transport with Ilizarov external fixator and to evaluate the result in tibial bone defects of more than 6 cm, secondary to infected pseudoarthritis. As a result, the patient evolved with septic pseudoarthritis of right tibia secondary to exposed fracture. The follow up lasted 18 months; the bone loss was 6 cm; the distraction speed was 1 mm/day; the transportation period was 95 days and the time with fixator was 198 days. It was necessary to perform a new surgical procedure at the contact site to recuperate the bone ends. Bone transport with Ilizarov fixator is valid for the bone loss treatment in tibia exposed fractures or septic pseudo arthritis (AU).

Treatment of Gustilo ⅢC open tibiofibular fractures by microsurgery combined with Ilizarov technique / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

Clinical observation of the treatment of diabetic foot with transverse tibial bone transport / 西安交通大学学报(医学版)

Objective: To compare the clinical effects of transverse tibial bone transport, interventional therapy and conventional therapy on diabetic foot. Methods: We selected 45 diabetic foot patients admitted to the research center from June 2016 to October 2018. We adopted the random number method and divided them into the interventional treatment group, transverse tibial bone transport group and conventional treatment group, with 15 patients in each. Patients in each group received routine clinical treatment, interventional treatment or lateral tibial transposition. Doppler ultrasound was used to measure and monitor the blood flow velocity of dorsal artery before and after treatment. Each group was recorded for the highest systolic blood pressure of the malleolus artery and the highest systolic blood pressure of the brachial artery to measure the malleolus brachial index (ABI), the skin temperature and pain VAS scores of the affected limbs and feet before and after surgery. The healing of ulcerated foot surface was observed before and after operation to evaluate the clinical therapeutic effects of these methods. Results: All the 45 patients were followed up for an average of 6.7 months (4-10 months). Compared with those in conventional treatment group, the postoperative ABI and the blood flow velocity of the dorsal artery in interventional treatment group and transverse tibial bone transport group were significantly better(P0.05). Conclusion: Compared with conventional basic treatment, transverse tibial bone transport and interventional treatment can significantly improve the blood flow parameters of diabetic foot patients, relieve the pain of the patients and promote the healing of ulcer surface. Transverse tibial bone transport is more effective, and its postoperative skin temperature and postoperative brachial-ankle index are better than those of interventional treatment.

Possibility of treating large bone defect and reducing the amount of autogenous bone using masquelet technique / 中国组织工程研究

BACKGROUND: Masquelet technique is one of the effective methods to repair large bone defects. This technique requires the use of more autologous bone in the second stage of surgical treatment. However, the source of autologous bone is limited and the complications in the donor area are inevitable. How to reduce the use of autologous bone is an urgent problem to be solved. OBJECTIVE: By combining with the development status of induced membrane technology at home and abroad, this review introduced some effective methods to reduce the amount of autologous bone in induced membrane technology, including filling bone graft replacement materials and some special surgical methods. METHODS: The first author used a computer to retrieve the literature published in PubMed, CNKI and Wanfang databases from January 1996 to September 2019. The search terms were “Masquelet technique; induced membrane; bone transport technique; autologous bone; bone defect; bone graft; 3D printing; tissue engineering”. RESULTS AND CONCLUSION: Since the emergence of the Masquelet technique, the technique has been constantly improved and innovated by scholars. However, there is no international consensus on how to reduce the use of autologous bone in the second stage of Masquelet technique. At present, each of improvement methods has its own advantages and disadvantages, and clinicians need to choose according to objective conditions. The method proposed by Jong-Keon Oh, using gelfoam as the bone grafting center and the peripheral ring for bone grafting, is simple and practical. Tissue engineering technology has potential for development. With the further study of seed cells and scaffold materials, it will gradually replace the existing treatment schemes. According to the existing research, the research direction of Masquelet technique in the future can be roughly summarized into four directions: The improvement of membrane technology, the improvement of surgical methods, the application of combined materials, and the application of 3D printing and tissue engineering technology. These directions need further exploration and development by scholars.

Advantages and improvement strategies of ilizarov technique in the treatment of tibial bone defect / 中国组织工程研究

BACKGROUND: Ilizarov technique has obvious advantages in the treatment of tibial bone defect and can be used to treat various types of tibial bone defect. However, there are still many shortcomings in this technology, which need to be solved urgently. OBJECTIVE: To review the advantages, shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect. METHODS: PubMed, CNKI and Wanfang databases from 1971 to 2019 were retrieved with the key words of “bone defect, bone transport, accordion maneuver, ultrasonography, energy spectrum CT, pin site infection” in English and Chinese, respectively. Totally 57 eligible articles were included to systematically summarize the advantages, shortcomings and improvement strategies of Ilizarov technique in the treatment of tibia bone defect. RESULTS AND CONCLUSION: (1) Ilizarov technology has obvious advantages in the treatment of the tibia bone defect, combined with soft tissue injury, infection and deformity of the tibia bone defect. (2) New disinfectants, accordion technology, color Doppler ultrasound and energy spectrum CT are effective treatment methods for complications of bone transport technology, such as pin site infection, poor mineralization of new bone in the transfer area, and difficulty in healing at the docking site. These methods can reduce the incidence of complications. (3) It is still necessary to improve the existing treatment techniques or choose new methods to further reduce the incidence of complications.

Advantages and disadvantages of repairing large-segment bone defect / 中国组织工程研究

BACKGROUND: The treatment of large-segment bone defect has always been a major problem in clinical orthopedics. The treatment of large-segment bone defect is characterized by long treatment time, high difficulty and high cost. Therefore, it is of great clinical value and significance to study the treatment of large-segment bone defect. OBJECTIVE: To review the current methods of repairing large-segment bone defect and their advantages and disadvantages. METHODS: PubMed, CNKI and Wanfang databases before April 2020 were retrieved by the first author with the keywords of “bone defect, bone repair, bone graft, intramedullary nail technology, Masquelet, bone transport, vascularized bone graft, bone tissue engineering” in English and Chinese, respectively. Forty eligible articles were included to systematically summarize the repair methods and their advantages and disadvantages in the treatment of large-segment bone defect. RESULTS AND CONCLUSION: (1) Currently, the scope of large bone defects is not clearly defined. In clinical practice, long bone defects with poor healing ability and difficult healing by traditional fixation and autogenous bone graft can be regarded as large-segment bone defect according to experience. (2) There are many repair methods, and different methods can play their unique advantages in the treatment process. However, the disadvantages and related complications of different methods should be paid attention to when choosing the treatment method, so as to improve the bone healing rate. (3) It is still necessary to improve and standardize the existing treatment technology of large-segment bone defect to obtain a more satisfactory treatment effect.

Trifocal bone transport by using monolateral rail system in treatment of bone defects caused by post-traumatic tibial osteomyelitis / 中国修复重建外科杂志

Objective: To study the effectiveness of trifocal bone transport by using monolateral rail system in the treatment of bone defects caused by post-traumatic tibial osteomyelitis. Methods: The clinical data of 28 patients with tibial defects caused by post-traumatic osteomyelitis treated with trifocal bone transport technique by using monolateral rail system between January 2012 and June 2017 were retrospectively analyzed. There were 26 males and 2 females, aged 22-59 years (mean, 41.3 years). The causes of injury included 13 cases of traffic accident injury, 9 cases of falling from height, 4 cases of heavy object injury, and 2 cases of crushing injury. The disease duration was 4.5-17.0 months (mean, 7.1 months). The length of bone defect was 6.5-16.8 cm (mean, 10.3 cm). And the range of soft tissue defect ranged from 3.5 cm×2.0 cm to 18.0 cm×11.0 cm. The bone transporting time, external fixation time, duration of regenerate consolidation, and external fixation index were recorded, and the complications were observed. At last follow-up, the bone and functional results were evaluated according to the criteria given by Association for the Study and Application of the Method of the Ilizarov (ASAMI). Results: All patients were successfully followed up after removing the external fixator with an average of 35 months (range, 24-65 months). The bone transporting time was 41-136 days (mean, 60.2 days), the external fixation time was 7.5-20.0 months (mean, 13.4 months), the external fixation index was 1.1-1.9 months/cm (mean, 1.4 months/cm), the duration of regenerate consolidation was 6.0-16.5 months (mean, 10.5 months). Pin tract infection occurred in 12 cases, delayed union on docking site was occurred in 9 cases, axial deviation was observed in 2 cases, poor regenerate consolidation was presented in 1 case, and refracture on docking site after fixator removal was occurred in 1 case. There was no recurrence of infection, amputation, vascular and neurologic complications, and osteofascial compartment syndrome. At last follow-up, according to ASAMI criterion, the bone healing results were excellent in 17 cases, good in 7 cases, and fair in 4 cases, with an excellent and good rate of 85.7%; the functional results were excellent in 15 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 89.3%. Conclusion: Trifocal bone transport by using monolateral rail system is an effective method in the treatment of bone defect caused by post-traumatic osteomyelitis which can reduce bone transport time, external fixation time, and complications.

Effect of transverse tibial bone transport on expression of serum angiogenesis-related growth factors / 中国修复重建外科杂志

Objective: To investigate the effect of transverse tibial bone transport on the expression of angiogenesis-related growth factors in the serum of diabetic foot patients. Methods: Between January 2018 and December 2018, 10 patients who suffered from diabetes mellitus accompanied with Wagner stage 4 diabetic foot underwent transverse tibial bone transport. There were 5 males and 5 females with an average age of 59.2 years (range, 51-70 years). The duration of diabetes was 2-60 months, with an average of 24.2 months. The duration of diabetic foot was 30-120 days, with an average of 54.1 days. Peripheral venous blood was taken at 1 day before operation and at 1, 4, 11, 18, 28, and 35 days after operation. The serum was centrifuged and subjected to ELISA test to detect the expression levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and platelet-derived growth factor (PDGF). Results: The levels of serum VEGF, bFGF, and EGF increased rapidly at 11 days after operation, and the expression levels of the factors at 11, 18, 28, and 35 days were significantly higher than those before operation ( P<0.05). The expression level of PDGF increased suddenly at 18 days after operation, and the expression level of PDGF at 18, 28, and 35 days was significantly higher than that before operation ( P<0.05). Conclusion: Transverse tibial bone transport for the treatment of diabetic foot can significantly increase the expression of serum angiogenesis-related growth factors in early stage, which may be the mechanism of promoting the healing of diabetic foot wounds.

Bone transport versus induced membrane technique for large segmental tibial defects / 中华创伤骨科杂志

Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P ＞ 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8％),minor complications (57.6％) and overall complications (83.1％) than the induced membrane technique group (11.2 ± 2.8 months,16.7％,26.7％ and 30.0％,respectively) (P ＜ O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P ＜ 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.

Treatment of forearm diaphyseal defect by distraction compression bone transport and continued distraction for radial head reduction: A case study / 中华创伤杂志(英文版)

Treatment of infected forearm nonunion and defects represents a difficult task for the operating surgeons. Conventional methods like composite and vascularized fibular grafts and the induced membranes filled with cancellous autografts or the Masquelet technique have been reported to be useful and successful, but sometimes it is difficult to predict the outcome and cannot address simultaneous deformities or the need to apply gradual distraction for reduction of a chronically dislocated radial head. Ilizarov technique has an answer for such conditions. We report a 43 years old man with infected ulnar defect and dislocated radial head as a result of infected Monteggia fracture: the patient was successfully treated by Ilizarov bone transport after failed attempts by bone spacer and fibular graft.

Comparison on value of energy spectrum CT and ultrasound in monitoring bone transport / 中国医学影像技术

Objective To compare monitoring value of energy spectrum CT and ultrasound in bone transport process. Methods Eighteen patients who underwent bone transport were examined with energy spectrum CT and ultrasonography at the 2nd, 4th, 6th week and 8th week after surgery, and the construction of lateral callus, the formation of callus in the intramedullary cavity, the range of organized hematoma and the nature of the vesicular area were observed, the length of bone extension area and organized hematoma were measured. The radiation dose of energy spectrum CT scan was also calculated. Results Primary callus structures were observed on CT and ultrasound at the 2nd to 8th week after surgery, and the callus and cortical bone could not be distinguished by ultrasound at the 8th weeks. At the 2nd to 8th week after surgery, both CT and ultrasound could observe the range of organized hematoma and the increased quantity of callus in the intramedullary cavity. There was no statistically significant difference of the length of systemic hematoma nor bone extension area measured with CT and ultrasound at the 2nd and 4th week after surgery (all P>0.05), while significant difference was detected in the length of systemic hematoma and bone extension area measured at the 6th weeks after surgery (both P0.05), while CT energy spectrum curve could identify the nature of fluid vesicles. The effective radiation dose of energy spectrum CT was (0.71±0.71)mSv. Conclusion Energy spectrum CT and ultrasound both have advantages in monitoring the formation of regenerated tissue during bone transport. Energy spectrum technology can be used as a new monitoring method.

One-stage debridement and two-stage Ilizarov bone transport technology for post-traumatic lateral malleolus defect / 中国修复重建外科杂志

Objective: To explore the effectiveness of one-stage debridement and two-stage Ilizarov bone transport technology in repairing post-traumatic lateral malleolus defect. Methods: Between June 2013 and December 2016, 7 patients with bone defect of lateral malleolus were treated. There were 5 males and 2 females with an average age of 45.9 years (range, 35-60 years). There were 6 cases of traffic accident injury and 1 case of strangulation injury. All patients had extensive soft tissue injury and lateral malleolus bone exposure. There were 4 cases of Gustilo type ⅢB and 3 case of Gustilo type ⅢC. The time from injury to admission was 3-10 hours (mean, 6.3 hours). Through one-stage thorough debridement, exploration and repair of vessels and nerves, external fixation of scaffolds and coverage of wounds, free fibulas were removed in 3 cases at one-stage and fibulas were resected in 4 cases after expansion. The bone defects ranged from 4.5 to 15.0 cm in length (mean, 8.2 cm). The Ilizarov circular external fixators were used to transport with fibula osteotomy for repairing bone defect of lateral malleolus when the wound healing. Results: During fibular osteotomy, the stents were adjusted 2-4 times (mean, 2.8 times) and the external fixators were removed after 10-16 months (mean, 12.8 months). The nail tract infection occurred in 2 cases during transporting and was controlled after symptomatic treatment. All patients were followed up 24-48 months (mean, 32.9 months). The shape of lateral malleolus was close to normal without obvious varus or valgus deformity. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score was 86-92 (mean, 90.3), and 5 cases were excellent and 2 cases were good. X-ray film showed that there was no obvious widening of the gap between the ankle points and no sign of absorption of the lateral malleolus. Conclusion: The one-stage debridement combined with two-stage Ilizarov bone transport technology can maintain the stability of ankle joint structure and obtain better effectiveness in repairing post-traumatic lateral malleolus defect.

Application of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion / 中国修复重建外科杂志

Objective: To summarize the effectiveness of bone transport with unilateral external fixator combined with locked plate internal fixation in treatment of infected tibial nonunion. Methods: Between January 2010 and December 2014, 23 patients with infected tibial nonunion were treated with bone transport with unilateral external fixator combined with locked plate internal fixation. There were 19 males and 4 females with an average age of 37.8 years (range, 19-54 years). The mean length of the bone defect was 6.5 cm (range, 5.2-8.1 cm). The number of previous operations ranged from 2 to 4 times, with an average of 2.5 times. The time from injury to this treatment was 7-23 months, with an average of 11.8 months. The time of bone transport, time of the external fixation, fracture healing time, external fixation index, healing index, and complication were recorded; and the Association for the Study and Application of the Methods of Ilizarov (ASAMI) bone healing and function scores were used to evaluate the effectiveness. Results: All patients were followed up 3-6 years with an average of 4.8 years. Wounds and bone defects healed in all patients. No complication such as infection recurrence, nonunion, re-fracture, malunion, iatrogenic nerve paralysis, or stiffness of knee and ankle joints occurred. Five patients had needle infections which were treated by local care and no deep infection occurred. The time of bone transport was 65-120 days (mean, 75.6 days); the time of the external fixation was 75-145 days (mean, 97.8 days); the fracture healing time was 4-17 months (mean, 8.7 months); the external fixation index was 18-28 days/cm (mean, 22.4 days/cm); and the healing index was 31-52 days/cm (mean, 40.2 days/cm). At last follow-up, according to ASAMI criteria, the result of bone healing was excellent in 15 cases and good in 8 cases, and the result of function was excellent in 18 cases and good in 5 cases, all with the excellent and good rate of 100%. Conclusion: For infected tibial nonunion, bone transport with unilateral external fixator combined with locked plate internal fixation can reduce the time of external fixation and related complications, with a satisfactory effectiveness.