Analysis Of The Efficacy Of Vascularized Fibular Graft And Bone Transport Technology In The Treatment Of Large Segmental Bone Defects Of The Lower Extremity

Objective: To investigate the clinical efficacy of vascularized fibular transplantation and bone transport technique in the treatment of large segmental bone defects in the lower limbs,and to provide a reference and clinical basis for the selection of clinical treatment options for large segmental bone defects.Methods: This study retrospectively analyzed the clinical data of patients with large segmental bone defects of the lower extremities treated with the vascularized fibular transplantation from January 2000 to December 2020 and the bone transport technique from January 2014 to December 2020 in the Department of Traumatology and Orthopedics of the Ninth Forty Hospital of the Chinese People’s Liberation Army Joint Security Force.There were a total of 71 cases,50 males and 21 females,aged from 16 to 60 years.A total of 27 cases in the vascularized fibular transplantation group were treated with fibular bone graft with vascularization after focal bone removal.The outcome indexes including operation time,intraoperative significant blood loss,total treatment cost,total hospitalization time,total number of operations,complication rate,bone healing time,full weight-bearing time,one-time bone healing rate,and percent functional recovery of the affected limb were counted.In the bone transport technique group,44 patients were treated with bone transport technique after the bone removal of the lesion.The outcome index of total weight-bearing time was removed,the outcome index of external fixation index and bone healing index were increased,and other outcome indexes were the same as those of the group with vascularized fibular graft.The clinical efficacy of the two treatment modalities was evaluated and compared by analyzing the treatment-related outcomes of patients in both groups.Results:(1)Overall comparison of the efficacy of the two surgical modalities for the treatment of large segmental bone defects of the lower extremities indicated statistically significant differences between the two groups in terms of operative time,intraoperative significant blood loss,number of operations,total hospital stay,total treatment cost,and complication rate(P<0.05).The operating time and intraoperative apparent blood loss were significantly less in the bone handling group than in the fibular bone graft with vascularization group(P<0.05).The number of operations,total hospital stay,total treatment cost,and complication rate were significantly higher in the bone transport technique group than in the vascularized fibular transplantation group(P<0.05).There was no statistically significant difference between the two groups in the comparison of one-time bone healing rate and functional recovery of the affected limb in hundreds(P>0.05).(2)When the length of bone defect was <10 cm,there was a statistically significant difference between the two groups in the comparison of operation time,intraoperative significant blood loss,number of operations,total hospital stay,and total treatment cost(P<0.05).The operating time and intraoperative apparent blood loss in the bone handling group were significantly less than those in the fibular bone graft with vascularization group(P<0.05).The number of operations,total hospital stay,and total treatment cost were significantly more in the bone handling group than in the vascularized fibular transplantation group(P<0.05).There were no statistically significant differences in the complication rate,one-time bone healing rate and percent functional recovery of the affected limb between the two groups(P>0.05).(3)When the length of bone defect was ≥10 cm,there were statistically significant differences between the two groups in terms of operation time,number of operations,total treatment cost,complication rate,and percentage of functional recovery of the affected limb(P<0.05).The operative time in the bone handling group was significantly less than that in the vascularized fibular transplantation group(P<0.05).The number of operations,total treatment costs,and complication rates were significantly higher in the bone handling group than in the fibular graft with vascularization group(P<0.05),while the percentage of functional recovery of the affected limb was significantly lower than in the fibular graft with vascularization group(P<0.05).There was no statistically significant difference in the comparison of intraoperative significant blood loss,total hospital stay,and one-time bone healing rate between the two groups(P>0.05).Conclusion:(1)Vascularized fibular transplantation and bone transport technique are effective methods for treating large segmental bone defects of the lower limbs,and both can achieve satisfactory clinical results.(2)When the length of the bone defect is <10 cm,there is no significant difference between the fibular graft with vascularization and bone transport technique in terms of the incidence of complications,bone healing rate and functional recovery of the affected limb.However,bone transport technique is relatively simple and less traumatic,hence if the economy allows,bone transport technique should be considered as the preferred treatment.(3)When the length of bone defect is ≥10 cm,the complication of bone transport technique increases significantly,while there is no significant change in the complication rate of fibula graft with blood vessels and better functional recovery of the affected limb.When the condition of the affected limb and the level of technology allow,the treatment with vascularized fibular graft is preferred.