[EFFECTIVENESS COMPARISON OF USING BONE TRANSPORT AND BONE SHORTENING-LENGTHENING FOR TIBIAL BONE AND SOFT TISSUE DEFECTS].

OBJECTIVE: To compare the effectiveness using bone transport and bone shortening-lengthening by Ilizarov technique for tibial bone and soft tissue defects.

METHODS: Between 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.

RESULTS: All 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).

CONCLUSION: Using 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.