SIMULTANEOUS REPAIR OF TIBIA BONE DEFECT AND REFRACTORY SOFT TISSUE DEFECT BY BONE TRANSPORT TECHNIQUE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIAOQiaosu , ZHANGXianwen , YEJunwu , ZHANGXihai ,  ZHUONaiqiang

Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

ZHUONaiqiang, Email: znq0101@163.com

Keywords：

Tibial fracture; Bone defect; Refractory soft tissue defect; Bone transport technique

DOI：

10.7507/1002-1892.20160195

Video：

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Objective To explore the feasibility and effectiveness of bone transport technique for simultaneous repair of tibia defect and refractory soft tissue defect. Methods Thirty-five patients with tibia bone defect combined with refractory soft tissue defect were treated between January 2010 and December 2014, and the clinical data were retrospectively analyzed. There were 21 males and 14 females with an average age of 29 years (range, 18-47 years). All patients had Gustilo type Ⅲ open tibial fractures, which were caused by traffic accident. Fracture located at the upper 1/3 of the tibia in 1 case, at the middle 1/3 of the tibia in 19 cases, and at the lower 1/3 of the tibia in 15 cases. All patients underwent external fixation after 4-10 hours of trauma, and tibial skin necrosis, infection, and purulent exudation were observed after 5-10 days of operation. The time from injury to admission was 21 days to 5 months (mean, 2 months). After debridement, the average length of tibia defect was 8 cm (range, 6-11 cm); the area of soft tissue defect was 6 cm×5 cm to 10 cm×8 cm. Orthofix external fixation was applied to tract the bone and soft. Results All 35 patients were followed up 12-22 months (mean, 16 months). The average time of bony healing was 15 months (range, 9-20 months), and no obvious force line offset was found. Osteotomy segment was extended from 6 to 11 cm (mean, 8 cm); after treatment, the external fixation support was retained for 2 to 10 months (mean, 5 months). No blood vessel and nerve injuries were found during treatment, and no osteomyelitis and refracture happened after operation. The skin and soft tissue defects healed, and the healing time was 1 to 3 months (mean, 1.3 months). Different degrees of infection occurred in 5 cases, and was cured after dressing change. According to Johner-Wruhs' evaluation criteria after external fixator was removed, the results were excellent in 26 cases, good in 5 cases, and moderate in 4 cases, with an excellent and good rate of 88.6%. Conclusion Bone transport technique can simultaneously repair tibia bone defect and soft tissue defect by continuous bone and soft tissue traction.

Citation： XIAOQiaosu, ZHANGXianwen, YEJunwu, ZHANGXihai, ZHUONaiqiang. SIMULTANEOUS REPAIR OF TIBIA BONE DEFECT AND REFRACTORY SOFT TISSUE DEFECT BY BONE TRANSPORT TECHNIQUE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(8): 961-965. doi: 10.7507/1002-1892.20160195 Copy

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2.	馬翔宇, 王東.開放性骨折修復:創面感染、植入物選擇及預后評價.中國組織工程研究, 2015, 19(26):4258-4264.
3.	李艷兵, 李展振, 劉志安, 等.四肢開放性骨折伴骨缺損治療方法的研究.中國骨與關節損傷雜志, 2006, 21(1):27-29.
4.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
5.	張盈帆, 江華, 袁相斌, 等.難治性感染缺損創面的整形外科修復.組織工程與重建外科雜志, 2007, 3(5):264-267.
6.	Ilizarov GA. Transosseous Osteosynthesis. Berlin:Springer, 1992: 399.
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8.	秦泗河, 葛建忠, 郭保逢, 等. Ilizarov技術在中國大陸20年(1991~2011年).中國矯形外科雜志, 2012, 20(7):662-666.
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11.	郭新雯, 馬娟, 馬少林.皮膚軟組織擴張術在整形修復中的臨床應用.中國美容醫學, 2014, 23(20):1675-1680.
12.	孟長安.皮膚擴張術修復四肢瘢痕攣縮療效觀察.現代中西醫結合雜志, 2013, 22(18):1988-1989.
13.	劉家國, 劉瑩松, 羅斌, 等. VSD技術序貫背闊肌皮瓣游離移植治療脛腓骨嚴重開放性骨折骨外露.創傷外科雜志, 2016, 18(2):78-81.
14.	Eralp L, Kocao?lu M, ?zkan K, et al. A comparison of two osteotomy techniques for tibial lengthening. Arch Orthop Trauma Surg, 2004, 124(5):298-300.
15.	Frierson M, Ibrahim K, Boles M, et al. Distraction osteogenesis. A comparison of corticotomy techniques. Clin Orthop Relat Res, 1994, (301):19-24.
16.	蔣守海, 邱東新, 董長紅, 等.應用Ilizarov技術Ⅰ期修復伴有皮膚缺損的脛骨創傷性骨髓炎骨缺損.中國骨傷, 2015, 28(12):1125-1128.
17.	趙娟, 俞紅, 徐義明, 等.物理治療促進坐骨神經損傷再生的實驗研究.中國修復重建外科雜志, 2011, 25(1):107-111.
18.	蔡源源, 李光早.血管內皮生長因子的調控及其作用研究進展.組織工程與重建外科雜志, 2011, 7(1):51-54.
19.	夏和桃.肢體延長的基礎進展及臨床有關問題.中國矯形外科雜志, 2007, 15(8):605-612.
20.	張軍, 武永剛, 魏武.應用Orthofix重建外固定架治療下肢長骨感染性大段骨缺損.生物骨科材料與臨床研究, 2012, 9(3):19-21.

1. 余斌.開放性骨折治療進展.國際骨科學雜志, 2013, 34(1):6-10.
2. 馬翔宇, 王東.開放性骨折修復:創面感染、植入物選擇及預后評價.中國組織工程研究, 2015, 19(26):4258-4264.
3. 李艷兵, 李展振, 劉志安, 等.四肢開放性骨折伴骨缺損治療方法的研究.中國骨與關節損傷雜志, 2006, 21(1):27-29.
4. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
5. 張盈帆, 江華, 袁相斌, 等.難治性感染缺損創面的整形外科修復.組織工程與重建外科雜志, 2007, 3(5):264-267.
6. Ilizarov GA. Transosseous Osteosynthesis. Berlin:Springer, 1992: 399.
7. 臧建成, 秦泗河.從Wolff定律和Ilizarov張力-應力法則到骨科自然重建理念.中國骨傷, 2013, 26(4):287-290.
8. 秦泗河, 葛建忠, 郭保逢, 等. Ilizarov技術在中國大陸20年(1991~2011年).中國矯形外科雜志, 2012, 20(7):662-666.
9. Kumar G, Narayan B. The Tension-Stress Effect on the Genesis and Growth of Tissues:Part Ⅱ. The Influence of the Rate and Frequency of Distraction//Classic Papers in Orthopaedics. London:Springer, 2014:519-522.
10. 鄭大偉, 郭杰, 馬樂, 等.皮膚擴張術在頭皮缺損修復中的應用.中國修復重建外科雜志, 2006, 20(10):1034-1036.
11. 郭新雯, 馬娟, 馬少林.皮膚軟組織擴張術在整形修復中的臨床應用.中國美容醫學, 2014, 23(20):1675-1680.
12. 孟長安.皮膚擴張術修復四肢瘢痕攣縮療效觀察.現代中西醫結合雜志, 2013, 22(18):1988-1989.
13. 劉家國, 劉瑩松, 羅斌, 等. VSD技術序貫背闊肌皮瓣游離移植治療脛腓骨嚴重開放性骨折骨外露.創傷外科雜志, 2016, 18(2):78-81.
14. Eralp L, Kocao?lu M, ?zkan K, et al. A comparison of two osteotomy techniques for tibial lengthening. Arch Orthop Trauma Surg, 2004, 124(5):298-300.
15. Frierson M, Ibrahim K, Boles M, et al. Distraction osteogenesis. A comparison of corticotomy techniques. Clin Orthop Relat Res, 1994, (301):19-24.
16. 蔣守海, 邱東新, 董長紅, 等.應用Ilizarov技術Ⅰ期修復伴有皮膚缺損的脛骨創傷性骨髓炎骨缺損.中國骨傷, 2015, 28(12):1125-1128.
17. 趙娟, 俞紅, 徐義明, 等.物理治療促進坐骨神經損傷再生的實驗研究.中國修復重建外科雜志, 2011, 25(1):107-111.
18. 蔡源源, 李光早.血管內皮生長因子的調控及其作用研究進展.組織工程與重建外科雜志, 2011, 7(1):51-54.
19. 夏和桃.肢體延長的基礎進展及臨床有關問題.中國矯形外科雜志, 2007, 15(8):605-612.
20. 張軍, 武永剛, 魏武.應用Orthofix重建外固定架治療下肢長骨感染性大段骨缺損.生物骨科材料與臨床研究, 2012, 9(3):19-21.

Chinese Journal of Reparative and Reconstructive Surgery

SIMULTANEOUS REPAIR OF TIBIA BONE DEFECT AND REFRACTORY SOFT TISSUE DEFECT BY BONE TRANSPORT TECHNIQUE

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