Objective To investigate the effectiveness of shortening-lengthening method using Ilizarov technique for repairing large tibial bone and soft tissue defects. Methods Between January 2006 and December 2011, 12 patients with large tibial bone and soft tissue defects were treated by shortening-lengthening method using Ilizarov technique. There were 8 males and 4 females with an average age of 39.3 years (range, 18-65 years). The causes were injury in 8 cases and chronic infection in 4 cases. The area of soft tissue defect was 5 cm × 4 cm to 20 cm × 16 cm, and the length of tibial bone defect was 4.5-8.0 cm with an average of 6.2 cm. Results Incision in the lengthening area healed by first intention; healing of wounds by first intention was achieved in 6 cases, delayed healing in 2 cases, and secondary healing in 4 cases, with no common peroneal nerve injury. All patients were followed up 18-54 months with an average of 29 months. In the lengthening area, the bone healing time was 180-365 days (mean, 267 days), and the healing index was 3.8-4.3 days/mm (mean, 4.1 days/mm). In the shortening area, the bone healing time was 195-380 days (mean, 297 days) in the others except 1 case who was repaired with bone grafting. Mild pin-related infection and loosening were observed in all cases, but no infection occurred in the lengthening or shortening area. At last follow-up, weight bearing of the leg was fully recovered in 12 cases. According to Mazur’s criteria, the function of ankle was excellent in 2 cases, good in 6 cases, and fair in 4 cases. Nine patients had equal limb length, and 3 patients had shortened length less than 2 cm. Conclusion Shortening-lengthening method using Ilizarov technique has the advantages of simple surgery, less complications, easy to close the wound, and good effectiveness in repairing of large tibial bone and soft tissue defects．
ObjectiveTo compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects. MethodsBetween January 2004 and May 2012,31 patients with tibial bone and soft tissue defects were managed by Ilizarov technique,the clinical data were retrospectively analyzed.Bone transport was used in 18 cases (group A),and bone shortening-lengthening in 13 cases (group B).There was no significant difference in age,gender,type of fracture,defect location,size of bone and soft defects,and time from injury to operation between 2 groups (P>0.05).Postoperative complications were observed;Paley's criterion was used to assess the bone healing and function recovery of the limb. ResultsAll the flaps survived and healing of wounds by second intention was obtained in all cases of group A;healing of wounds by first intention was obtained in 1 case,delayed healing in 3 cases,and healing by second intention in 9 cases in group B.All patients were followed up 1.5-4.5 years (mean,2.4 years).Pin loosening or pin tract infection occurred in 15 cases of group A and in 10 cases of group B,and limb length discrepancy in 1 case of group B;there was no significant difference in the rate of complication (χ2=0.003,P=0.955).In the distracted zone,all fractures healed naturally with excellent scale.The healing time was (251±39) days in group A,and was (239±45) days in group B,showing no significant difference (t=0.800,P=0.430);the healing index was (4.26±0.19) d/mm in group A,and was (4.13±0.19) d/mm in group B,showing no significant difference (t=1.775,P=0.086).In the bone defect zone,natural healing was obtained in 12 cases and healing after second operation or bone grafting in 6 cases,with healing time of (341±55) days (excellent in 17 cases and good in 1 case) in group A;natural healing was obtained in 11 cases and healing after second operation or bone grafting in 2 cases,with the healing time of (295±62) days (excellent in 12 cases and good in 1 case) in group B;and there was significant difference in the healing time (t=2.195,P=0.036),but no significant difference in the healing scale (Z=-1.693,P=0.091).At last follow-up,the function recovery was excellent in 7 cases,good in 6 cases,and fair in 5 cases in group A,and was excellent in 3 cases,good in 6 cases,and fair in 4 cases in group B,showing no significant difference (Z=-0.660,P=0.509). ConclusionUsing bone transport or bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects,the overall outcomes are similar,but the healing of bone defect zone is faster when using bone shortening-lengthening.
ObjectiveTo compare the effectiveness of percutaneous kyphoplasty (PKP) between by unilateral approach and by bilateral approaches for treating mid-thoracic osteoporotic vertebral compression fracture (OVCF). MethodA prospective randomized controlled study was performed on 22 patients with mid-thoracic OVCF between September 2012 and June 2014. PKP was performed by unilateral approach in 11 cases (group A) and by bilateral approaches in 11 cases (group B). There was no significant difference in gender, age, causes of injury, disease duration, affected segment, preoperative bone mineral density, Cobb angle, compression rate of the anterior verterbral height, and Visual analogue scale (VAS) score between 2 groups (P>0.05) . The operation time, perspective times, hospitalization expenses, the leakage of cement, the sagittal Cobb angle, compression rate of the anterior vertebral height, and VAS scores were compared between 2 groups. ResultsThe operation time, perspective times, and hospitalization expenses of group A were significantly less than those of group B (P<0.05) . Twenty-two patients were followed up 13-34 months (mean, 15.3 months). Primary healing of incision was obtained in all patients, and no early complication of cement leakage, hypostatic pneumonia, or deep vein thrombosis occurred. At last follow-up, no new fracture occurred at the adjacent segments. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05) , but no significant difference was found between at 1 week and at last follow-up (P>0.05) . There was no significant difference in Cobb angle, compression rate of the anterior vertebral height, and VAS score between 2 groups at each time point (P>0.05) . ConclusionsPKP by both unilateral approach and bilateral approaches has the same effectiveness, but unilateral approach has shorter operation time, less perspective times, and less hospitalization expenses than bilateral approaches.
ObjectiveTo compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients. MethodsA retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Fracture was treated with PFNA in the lithotomy position in 28 cases (group A) and in the supine "scissors" position in 30 cases (group B). There was no significant difference in gender, age, side, cause of injury, fracture type, and interval from injury to operation between 2 groups (P>0.05). The incision length, operation time, perspective times, intraoperative blood loss, complications, and fracture healing time were recorded; Harris hip score was used to access the effectiveness. ResultsThe wound healed by first intention without infection, pressure sores, deep vein thrombosis of lower extremity, and other complications. There was no significant difference in incision length between 2 groups (t=1.313, P=0.212). Group B was significantly better than group A in operation time, perspective times, and intraoperative blood loss (P<0.05). All patients were followed up 10-31 months (mean, 15.3 months). Stretch injury at normal side and perineal discomfort occurred in 1 case and 5 cases of group A respectively, and no nonunion and other complications was observed in the other patients. There was no significant difference in fracture healing time and Harris hip score at last follow-up between 2 groups (P>0.05). ConclusionPFNA in the supine "scissors" position has exact effectiveness and advantages of shorter operation time, less intraoperative blood loss, less perspective times, and fewer complications.
ObjectiveTo compare the effectiveness of coracoclavicular ligament reconstruction between by using autologous plantaris tendon graft combined with hook plate fixation and allogeneic tendon graft combined with hook plate fixation for treating acromiocavicular joint dislocation. MethodsThirty-three patients with acromioclavicular joint dislocation who accorded with the inclusion criteria between January 2013 and June 2014 were assigned into 2 groups. The patients were treated with autologous plantaris tendon graft combined with hook plate fixation in group A (n=17), and with allogeneic tendon graft combined with hook plate fixation in group B (n=16). Thirteen-one patients was followed up more than 12 months (15 in group A and 16 in group B). There was no significant difference in gender, age, cause of injury, sides, time between injury and surgery, and type of dislocation (P>0.05). The assessments included operation time, hospitalization time, hospitalization expenses, shoulder range of motion, gap of acromioclavicular, Constant-Murley scores, and visual analogue scale (VAS) for pain. ResultsThe operation time of group A was significantly longer than that of group B, and the hospitalization expense was significantly lower than that of group B (P<0.05). There was no significant difference in hospitalization time (t=1.046, P=0.316). The incisions healed by first intention, and hook plate was removed after 3 months. The mean follow-up time was 21.3 months (range, 19-34 months) in group A and was 23.7 months (range, 18-37 months) in group B. X-ray examination showed no osteolysis. There was no significant difference in gap of acromiocavicular between 2 groups at preoperation, 1 week after operation, and last follow-up (P>0.05). No redislocation of acromioclavicular joint and rejection reaction occurred during follow-up. At last follow-up, there was no significant difference in shoulder range of motion, Constant-Murley score, and VAS score between 2 groups (P>0.05). ConclusionCoracoclavicular ligament reconstruction by autologous plantaris tendon or allogeneic tendon graft combined with hook plate fixation for the treatment of acromioclavicular joint dislocation can achieve good effectiveness. The appropriate treatment should be chosen according to the patient's economic situation.
Objective To investigate the effect of preventing the loss of correction and vertebral defects after thoracolumbar burst fractures treated with recombinant human bone morphogenetic protein 2 (rhBMP-2) and allogeneic bone grafting in injured vertebra uniting short-segment pedicle instrumentation. Methods A prospective randomized controlled study was performed in 48 patients with thoracolumbar fracture who were assigned into 2 groups between June 2013 and June 2015. Control group (n=24) received treatment with short-segment pedicle screw instrumentation with allogeneic bone implanting in injured vertebra; intervention group (n=24) received treatment with short-segment pedicle screw instrumentation combining with rhBMP-2 and allogeneic bone grafting in injured vertebra. There was no significant difference in gender, age, injury cause, affected segment, vertebral compression degree, the thoracolumbar injury severity score (TLICS), Frankel grading for neurological symptoms, Cobb angle, compression rate of anterior verterbral height between 2 groups before operation (P>0.05). The Cobb angle, compression rate of anterior vertebral height, intervertebral height changes, and defects in injured vertebra at last follow-up were compared between 2 groups. Results All the patients were followed up 21-45 months (mean, 31.3 months). Bone healing was achieved in 2 groups, and there was no significant difference in healing time of fracture between intervention group [(7.6±0.8) months] and control group [(7.5±0.8) months] (t=0.336, P=0.740). The Frankel grading of all patients were reached grade E at last follow-up. The Cobb angle and compression rate of anterior verterbral height at 1 week after operation and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference in Cobb angle and compression rate of anterior verterbral height between 2 groups at 1 week after operation (P>0.05), but the above indexes in intervention group were better than those in control group at last follow-up (P<0.05). At last follow-up, there was no significant difference of intervertebral height changes of internal fixation adjacent upper position, injured vertebra adjacent upper position, injured vertebra adjacent lower position, and internal fixation adjacent lower position between 2 groups (P>0.05). Defects in injured vertebra happened in 18 cases (75.0%) in control group and 5 cases (20.8%) in intervention group, showing significant difference (χ2=14.108, P=0.000); and in patients with defects in injured vertebra, bone defect degree was 7.50%±3.61% in control group, and was 2.70%±0.66% in intervention group, showing significant difference (t=6.026, P=0.000). Conclusion Treating thoracolumbar fractures with short-segment pedicle screw instrumentation with rhBMP-2 and allogeneic bone grafting in injured vertebra can prevent the loss of correction and vertebral defects.