Ilizarov technique with compression and distraction osteogenesis for treatment of traumatic femoral shaft defects / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical effect of Ilizarov technique with compression and distraction osteogenesis in treatment of traumatic femoral shaft defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 52 patients with traumatic femoral shaft defects admitted to West China Hospital of Sichuan University from September 2015 to September 2019，including 32 males and 20 females at age of 19-60 years［（40.3 ± 12.1）years］. There were 15 patients with fractures at the proximal 1/3，20 at middle 1/3 and 17 at distal 1/3 part of femoral shaft. Types of bone defects were bone defect after open fracture in 2 patients，infectious nonunion in 29 and atrophic nonunion in 21. Length of bone defects after debridement and osteotomy was 3.0-5.8 cm［（4.2 ± 0.8）cm］. A total of 24 patients underwent primary direct shortening and compression as well as re-lengthening of the broken ends；28 patients were operated by osteotomy and compression，and then by re-lengthening of the broken ends at Ⅱ stage with the average interval of 2.8 months. Postoperative wound healing，bone healing time，external fixation index（EFI）and complications were observed. Preoperative and postoperative levels of white blood cell count（WBC），C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were measured. Association for the study and application of the method of Ilizarov（ASAMI）score was used to evaluate bone healing and functional recovery at the latest follow-up.Results:All patients were followed up for 20-60 months［（36.5 ± 10.3）months］. All wounds were healed at Ⅰ stage，with no infection or sinus tract recurrence. Bone healing time was 9-20 months［（14.5 ± 3.8）months］，and EFI was 1.2-1.9 months/cm［（1.5 ± 0.2）months/cm］. Nail tract infection was found in 14 patients，with the infection rate of 27%. Poor healing of broken ends fracture occurred in 4 patients，out of which 3 with infectious nonunion and 1 with atrophic nonunion. Axial deviation was observed in 2 patients and poor mineralization was observed in 1 patient. In 2 patients，the affected side was shortened by 1.8 cm and 2.0 cm when compared to the healthy side. At the latest follow-up，levels of WBC［（6.0 ± 1.4）× 10 9/L］，CRP［（6.8 ±1.7）mg/L］and ESR［（10.5 ± 6.1）mm/h］were lower than those before surgery［（9.2 ± 2.2）× 10 9/L，（31.7 ± 22.1）mg/L，（45.8 ± 31.3）mm/h］（ P < 0.01）. At the latest follow-up，bone healing rated on ASAMI score was excellent in 31 patients，good in 13 and fair in 8，with the excellent and good rate of 85%；limb function rated on ASAMI score was excellent in 28 patients，good in 14，fair in and good in 3，with the excellent and good rate of 81%. Conclusions:For traumatic femoral shaft defects，Ilizarov technique with compression and distraction osteogenesis can fully remove infection or ischemic bone lesions. Distraction osteogenesis technology can complete continuous compression of broken ends to further promote healing of broken ends and limb lengthening and attain limb reconstruction and bone healing and functional recovery.