| Objectives To compare the efficacy of Ilizarov bone transport and free vascularized fibular graft in the treatment of infected bone defect of forearm.Methods 40 patients with infected bone defect of forearm treated with Ilizarov bone transfer technique or free vascularized fibular graft in Tangshan second Hospital from December 2009 to December 2019 were retrospectively analyzed.Group I was treated with Ilizarov technology,a total of 21 cases,including 17 males and 4 females,bone defect length4.2-9.0cm,average 6.20 cm.In group F,19 patients(15 males and 4 females)were treated with free vascularized fibular graft.The average length of bone defect in group F was 4.2-13 cm,with an average of 6.92 cm.The intraoperative blood loss,operation time,hospital stay,postoperative complications,the range of motion of elbow and wrist and the rotation angle of forearm were compared between the two groups.Quick-Dash score was used to evaluate the patients’ satisfaction with the recovery of the injured limb.Results All 40 patients were followed up completely.The flow-up time of group I was 24-36 months(mean 28.86 months),and that of group F was 20-36 months(mean 27.84 months).There was no eloquent divergence in operation time,intraoperative blood loss,postoperative complications,range of motion of elbow,forearm rotation,range of motion of wrist and Quick-Dash score between group I and group F(p>0.05),but the hospital stay,bone healing time,bone healing index,external fixation time,external fixation index and range of motion of wrist in group I were worse than those in group F(p<0.05).When the bone defect was taken as the independent variable and the change of each follow-up index was the trend,it was found that when the bone defect was greater than 7cm,some of the indexes showed obvious inflection point,so with 7cm as the dividing point,group I and group F were divided into <7cm group and ≥7cm group.In group I,the bone healing time,external fixation time,forearm rotation angle,range of motion of wrist and Quick-Dash score in <7cm group were better than those in ≥7cm group(p<0.05),but there was no eloquent divergence in bone healing index,external fixation index and range of motion of elbow between the two groups(p>0.05).In group F,the supination angle of forearm in <7cm group was better than that in≥7cm group,and the bone healing index and external fixation index in <7cm group were worse than those in ≥7cm group(p<0.05),but there was no eloquent divergence in bone healing time,external fixation time,elbow flexion and extension angle,forearm pronation angle,wrist flexion and extension angle and Quick-Dash score between the two groups(p>0.05).When bone defect ≥7cm,group I was worse than group F in bone healing time,bone healing index,forearm supination angle,wrist flexion and extension angle and QuickDash score(p<0.05),but there was no eloquent divergence in external fixation time,external fixation index,elbow flexion and extension angle and forearm pronation angle between the two groups(p>0.05).When bone defect <7cm,group I was worse than group F in bone healing time,bone healing index and wrist flexion and extension angle,but superior to group F in external fixation time and external fixation index(p<0.05),but there was no eloquent divergence in elbow flexion and extension angle,forearm rotation angle and Quick-Dash score between the two groups(p>0.05).Conclusions 1 Bone transfer and free vascularized fibular graft can achieve satisfactory results in the treatment of infective bone defect of forearm.2 Free vascularized fibular graft technique is recommended for long forearm bone defects larger than 7cm,which can achieve faster healing and functional recovery.For the defect smaller than 7cm,it is suggested that Ilizarov bone transfer technique should be given priority to obtain excellent therapeutic effect and avoid the injury of healthy lower limbs caused by free vascularized fibular graft technique.Figure 3;Table 15;Reference 155... |
PDF Full Text Request