| Purpose The aim of this study was to explore the clinical effects of Ilizarovdistraction technique for bilateral leg lengthening and long bone defect.Methods In the first part, we performed a retrospective study of520patients who hadbilateral shortening deformity treated with Ilizarov methods between June1995andJune2011. To explore the clinical effects of the modified Ilizarov apparatus for leglengthening, combined external fixation and nail technique and longitudinal S-osteotomy for leg lengthening. In the second part, we performed a retrospective study of115patients who had bone defects treated by Ilizarov bone transport. To explore theclinical effects of segmental bone trasport(SBT) and compression distraction(CD).Theconsolidation index(CI) were calculated and complications were recorded according toPaley’s classification criteria. And leg lengthening database and bone defect databasewere established with SPSS16.0software.Analysis was performed based on the twodatabase. Frequency and descriptive analysis were performed for all the variables.Descriptive grade analysis were performed for age, the length of leg lengtheing andbone defect. In the leg lengthening database, multiple linear regression was used toanalyze the factors that may affect the bone regerationa and consolidation. In the leglengthening database, S-osteotomy, transverse osteotomy and bifocal osteotomy wereapplied, and lengthening by external fixator, lenthening over a nail, and lengthening andthen nailing(LATN) were aplied. The mean CI between the three ostotomy methods, andthe mean CI and external fixation index(EFI) between three fixation methods werecompared and anlysed with one–factor analysis of variance. Ordinal contingency wasused to analyse the rates of ankle flexion contracture of the diffenrent lengthening grades and Chi-square test was used to compare the diffenrence. In the bone defectdatabase,the length of bone defect and limb shortening of femur,tibia,radius and ulnarwere analysed.The Catagni classification for bone defect was used and analysed.Chi-square test was used to compare and analyse the pin-tract infection rates of thedifferent bone.Results The patients with leg lengthened were followed for a mean of2.5years(1-4).The mean final gain length of leg was8.15±2.05cm(2.5-21.1). The mean CI was73.89±12.06d/cm（35-95.6）. The CI of S-osteotomy was significantly lower than thetransverse osteotomy and bifocal osteotomy. The EFI of lengthening by combinedexternal fixator and nailing was significantly lower than lengthening by external fixator.The CI of LATN was significantly lower than the other two fixation methods.Therewere two obstacles of ankle flexion contracture（2/520,0.38%）.The patients with bonedefect were followed for a mean of2years(1-3). The mean bone defect was7.02±2.22cm（3-18）.The mean limb shortening was2.42±1.50cm(1-5). Bone defect healed inall patients and the mean healing time was15.3±2.52（7-23）months. Infection wascontrolled in69patients with infected nounion and no recurrence occurred duringfollow-up.18patients had bone defect complicated with limb shortening (Catagni B3)and only3patients had residual limb discrepancy (1cm，0.5cm,1.5cm).Conclusions1. The modified apparatus for leg lengthening can effectively preventankle flexion contracture during leg lengthening.2. Combined external fixation andnailing can provide internal fixation for the newly bone and reduce axial deviation andrefracture after fixator removal. The time for external fixation was also significantlyreduced than lengthening by external fixator.3. S-osteotomy can promote boneregeneration and consolidation.4. Both segmental bone trasport and compressiondistraction are effective methods for various kinds of bone defects. The limb shorteningand other complicated deformity can be corrected simultaneously.5. Combined segmental bone transport with lesions removal for infective bone defect can controlinfection effectively and the recurrence was rare. |
PDF Full Text Request