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.	马翔宇, 王东.开放性骨折修复:创面感染、植入物选择及预后评价.中国组织工程研究, 2015, 19(26):4258-4264.
3.	李艳兵, 李展振, 刘志安, 等.四肢开放性骨折伴骨缺损治疗方法的研究.中国骨与关节损伤杂志, 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.	张盈帆, 江华, 袁相斌, 等.难治性感染缺损创面的整形外科修复.组织工程与重建外科杂志, 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技术在中国大陆20年(1991~2011年).中国矫形外科杂志, 2012, 20(7):662-666.
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10.	郑大伟, 郭杰, 马乐, 等.皮肤扩张术在头皮缺损修复中的应用.中国修复重建外科杂志, 2006, 20(10):1034-1036.
11.	郭新雯, 马娟, 马少林.皮肤软组织扩张术在整形修复中的临床应用.中国美容医学, 2014, 23(20):1675-1680.
12.	孟长安.皮肤扩张术修复四肢瘢痕挛缩疗效观察.现代中西医结合杂志, 2013, 22(18):1988-1989.
13.	刘家国, 刘莹松, 罗斌, 等. VSD技术序贯背阔肌皮瓣游离移植治疗胫腓骨严重开放性骨折骨外露.创伤外科杂志, 2016, 18(2):78-81.
14.	Eralp L, Kocaoğlu M, Özkan 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.	蒋守海, 邱东新, 董长红, 等.应用Ilizarov技术Ⅰ期修复伴有皮肤缺损的胫骨创伤性骨髓炎骨缺损.中国骨伤, 2015, 28(12):1125-1128.
17.	赵娟, 俞红, 徐义明, 等.物理治疗促进坐骨神经损伤再生的实验研究.中国修复重建外科杂志, 2011, 25(1):107-111.
18.	蔡源源, 李光早.血管内皮生长因子的调控及其作用研究进展.组织工程与重建外科杂志, 2011, 7(1):51-54.
19.	夏和桃.肢体延长的基础进展及临床有关问题.中国矫形外科杂志, 2007, 15(8):605-612.
20.	张军, 武永刚, 魏武.应用Orthofix重建外固定架治疗下肢长骨感染性大段骨缺损.生物骨科材料与临床研究, 2012, 9(3):19-21.

1. 余斌.开放性骨折治疗进展.国际骨科学杂志, 2013, 34(1):6-10.
2. 马翔宇, 王东.开放性骨折修复:创面感染、植入物选择及预后评价.中国组织工程研究, 2015, 19(26):4258-4264.
3. 李艳兵, 李展振, 刘志安, 等.四肢开放性骨折伴骨缺损治疗方法的研究.中国骨与关节损伤杂志, 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. 张盈帆, 江华, 袁相斌, 等.难治性感染缺损创面的整形外科修复.组织工程与重建外科杂志, 2007, 3(5):264-267.
6. Ilizarov GA. Transosseous Osteosynthesis. Berlin:Springer, 1992: 399.
7. 臧建成, 秦泗河.从Wolff定律和Ilizarov张力-应力法则到骨科自然重建理念.中国骨伤, 2013, 26(4):287-290.
8. 秦泗河, 葛建忠, 郭保逢, 等. Ilizarov技术在中国大陆20年(1991~2011年).中国矫形外科杂志, 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. 郑大伟, 郭杰, 马乐, 等.皮肤扩张术在头皮缺损修复中的应用.中国修复重建外科杂志, 2006, 20(10):1034-1036.
11. 郭新雯, 马娟, 马少林.皮肤软组织扩张术在整形修复中的临床应用.中国美容医学, 2014, 23(20):1675-1680.
12. 孟长安.皮肤扩张术修复四肢瘢痕挛缩疗效观察.现代中西医结合杂志, 2013, 22(18):1988-1989.
13. 刘家国, 刘莹松, 罗斌, 等. VSD技术序贯背阔肌皮瓣游离移植治疗胫腓骨严重开放性骨折骨外露.创伤外科杂志, 2016, 18(2):78-81.
14. Eralp L, Kocaoğlu M, Özkan 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. 蒋守海, 邱东新, 董长红, 等.应用Ilizarov技术Ⅰ期修复伴有皮肤缺损的胫骨创伤性骨髓炎骨缺损.中国骨伤, 2015, 28(12):1125-1128.
17. 赵娟, 俞红, 徐义明, 等.物理治疗促进坐骨神经损伤再生的实验研究.中国修复重建外科杂志, 2011, 25(1):107-111.
18. 蔡源源, 李光早.血管内皮生长因子的调控及其作用研究进展.组织工程与重建外科杂志, 2011, 7(1):51-54.
19. 夏和桃.肢体延长的基础进展及临床有关问题.中国矫形外科杂志, 2007, 15(8):605-612.
20. 张军, 武永刚, 魏武.应用Orthofix重建外固定架治疗下肢长骨感染性大段骨缺损.生物骨科材料与临床研究, 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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