Clinical research of Ilizarov technique for treatment of lower limb infected bone defect / 中华骨科杂志

ABSTRACT

Objective To explore the clinical efficacy of Ilizarov technique for infected-bone defect in lower extremity.Methods From January 2013 to December 2016,data of 31 consecutive patients with lower limb infected bone defect were retrospectively analyzed.There were 23 males and 8 females,with an average age of 35.8 years (range,5-57 years).16 cases of infected bone defect were on femur while the other 15 were on tibia.The infected bone defects were developed from blood-borne osteomyelitis in 3 cases,from open fracture (according to Gustlio classification,Gustilo Ⅱ 8,Ⅲ a 5,Ⅲ b 4) surgery in 17 cases (12 cases after external fixation and 5 cases after internal fixation),and from closed fracture surgery of plate or intramedullary nail fixation in 11 cases.Soft-tissue defects were observed in 5 cases,including 1 femur and 4 tibia.The previous operations were performed with an average operation time of 3.2 (range,2-5 times) and treatment duration of 9.6 months (range,3-21 months).The operation process was one stage debridement,external fixation,combined with bone osteotomy and transportation.Bone transportation started 7 to 10 days after osteotomy with a speed of 1 mm/d,and 0.25 mm/time.Healing rate and complications were recorded during the follow-up period and were assessed by Paley fracture healing score.Results The length of bone defect after debridement was 6.9 cm (range,3-13.5 cm).There were 27 cases positive in bacterial culture,who were treated by sensitive antibiotics.The other 4 cases were negative and treated by broad-spectrum antibiotics.The bone lengthening speed was 0.76 mm/d (range,0.56-0.86 mm/d).All bone and soft-tissue defects healed,with average bone healing time of 11.5 months (range,6-18.5 months).All patients were followed-up for 12 to 48 months (average,25.5 months).Pin infection appeared in 11 cases (8 cases on femur and 3 cases on tibia)who were cured by oral antibiotics,serial dressing and debridement.Axial displacement was presented in 4 cases on femur and were corrected by external fixation adjustment.No recurrent infection was observed and the limb length restored normal.Postoperative complications in femur were 106.3％ (17/16) comparing 46.7％ (7/15) in tibia.According to Paley fracture healing score,12 cases were excellent,14 were good and 5 were fair,yielding an excellent to good rate of 83.9％ (26/31).Conclusion Ilizarov technique is an effective way in the treatment of infected-bone defects.The complication rates on femur observed in this study were slightly higher than that on tibia.