Clinical Curative Effecf Study On Treatment Of Tibia Chronic Traumatic Osteomyelitis With Ilizarov Bone Transport Surgical Technique

Background and purpose:Because of high incidence of open tibial fractures, damage the nutrient artery when fracture,and less blood supply from soft tissue, the incidence of tibia chronic traumatic osteomyelitis is higher than other parts of the body. The specific pathological features of chronic osteomyelitis reflecting in proliferative bone shell enfolding sequestrum,drug concentration of lesion is difficult to achieve therapeutic dose. So chronic osteomyelitis is difficult to cure and often relapse. If the surgery is complete removal of the lesion,bone defects will form. This contradiction makes the treatment of chronic osteomyelitis clinical a difficult.The subject summarized the cases on treatment of tibia chronic traumatic osteomyelitis which bring bone defects in the range4～12cm after removing lesions with Ilizarov circular external fixator which used for transport bone, used to observing clinical curative effecfMethods:We cured tibia chronic traumatic osteomyelitis with Ilizarov circular external fixator which used for transport bone from January2005to May2011,20cases were male,8females, average age33.5years;13cases the left side, rightside in15cases;25cases of open tibial fractures; closed fractures after3cases. Admission there was no significant systemic symptoms,22cases with a sinus discharging sinus crossing round, with an average diameter of1.3cm,6cases of skin sinus formation, local swelling and pain. Injured to the hospital stay an average of15.3; previous surgical treatment after1to5. The imaging findings were sequestrum formation. Preoperative sounded check, systemic antibiotic treatment. To be infected with stable, we surgeried with Ilizarov circular external fixator which used for transport bone. If the soft tissue defects,we implemented local skin flap.The speed of0.6～1mm/d after10days after the osteotomy blocks move to the defect,4～6times daily, at the same time generate new bone lengthening in tension-stressrule, the ends of the bones to heal the bone move to join forces, Guided tissue regeneration of sexual or Harbin phenomenon appears. Bone move to the end of May as the X-ray film mineralization remove the external fixator.Results:28cases were fol lowed up for9to24months, with an average of15.2months. Lesions of bone resection of bone defect of4.29.5cm, an average of6.7cm., the average generation of aircraft is8.6months, External fixation index the average42.6g/cm. During follow-up there were no recurrence. Limb limb length and contralateral difference<2cm. This group of patients in one patient postoperative tibial axial offset correctionthrough the bed to adjust the external fixator. In the process of bone removal,5patients due to the needle pulling the skin to cause pain, suspension traction2to3days until the pain disappears and then continue tomove.. Postoperative pin tract infection rate was17.86% (5/28), infection control by local dressing and antibiotics. We found no neurovascular injury, nonunion cases.22cases of transposition flaps survived.28cases of bone defects in patients with final bone healing. All patients before treatment with the rendezvous ends of the bones healing afterknee and ankle joint function showed significant improvement.Conclusion:Application of Ilizarov external fixator osteotomy bone move is the Treatment ofdebridement after bone defect of tibia traumatic chronic osteomyelitis, not onlycleaned up the infection lesions, relapse prevention, and the simple, less invasive, bone marrow for the treatment of traumatic versionan effective way of inflammation.