PURPOSE The aim of this study was to evaluate the clinical and functional outcomes of patients with large post-traumatic tibial bone defects managed by double-level bone transport using the Ilizarov technique and compare it with one-level bone transport technique. METHODS A retrospective cohort study was conducted on 26 patients with open tibial fracture from January 2010 to January 2017. All cases were Gustilo III. Depending on the site of osteotomy, the patients were divided into single-level (n = 13) and double-level groups (n = 13). The bone transport time, consolidation time of the distraction gap, docking site healing time, external fixation time, external fixation index, soft tissue defect area, soft tissue growth index, operating time, and surgical bleeding volume were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. RESULTS The mean duration of follow-up was 28.5 ± 5.8 months (range 13-38 months) since the Orthofix fixator was removed, all patients achieved complete union in the docking site and consolidation in the regenerate bone; moreover, the wound was closed The mean bone defect length after debridement was 7.2 cm (range 5.8-9.0 cm) in single-level group vs. 10.7 cm (range 7.5-15.0 cm) in the double-level group (P < 0.05). The mean docking site healing time was 10.85 ± 1.52 months in the single-level group vs. 8.93 ± 2.29 months in the double-level group (P < 0.05); external frame time was 18.06 months (range 15-20 months) in single-level group vs. 12.71 months (range 9.5-16.0 months) in the double-level group (P < 0.05); external fixation index was 2.52 months/cm (range 2.15-2.94 months/cm) versus 1.22 months/cm (range 0.96-1.67 months/cm) in double-level group (P < 0.01); and soft tissue growth index was 0.29 months/cm2 (range 0.21-0.45 months/cm2) in the single-level group versus 0.62 months/cm2 (range 0.47-0.86 months/cm2) in the double-level group (P < 0.01). According to the ASAMI classification, the clinical and functional results in the double-level group were better than in the single-level group. CONCLUSION The Ilizarov technique of double-level bone transport with Orthofix external fixator can be used successfully to repair and reconstruct the tibial bone loss and accompanying soft tissue defect.

中文翻译：

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使用Orthofix固定器进行双层和单层骨运输的疗效比较，以治疗具有大量骨缺损的胫骨骨折。

目的本研究的目的是评估使用Ilizarov技术通过双层骨转运治疗的大创伤后胫骨缺损患者的临床和功能结局，并将其与一级骨转运技术进行比较。方法回顾性队列研究从2010年1月至2017年1月对26例胫骨开放性骨折患者进行研究。所有病例均为Gustilo III。根据截骨部位，将患者分为单组（n = 13）和双组（n = 13）。记录两组的骨运输时间，撑开间隙的巩固时间，对接部位愈合时间，外固定时间，外固定指数，软组织缺损面积，软组织生长指数，手术时间和手术出血量，并进行比较。根据Ilizarov方法研究与应用协会（ASAMI）标准评估骨骼和功能结果。结果自从移除Orthofix固定器以来，平均随访时间为28.5±5.8个月（范围13-38个月），所有患者均在对接部位完全愈合，并在再生骨中巩固。此外，伤口闭合。清创术后平均骨缺损长度为单级组7.2 cm（范围5.8-9.0 cm），而双级组为10.7 cm（范围7.5-15.0 cm）（P <0.05） 。单水平组的平均对接位愈合时间为10.85±1.52个月，而双水平组为8.93±2.29个月（P <0.05）；单层组的外部框架时间为18.06个月（范围15-20个月），而12.71个月（范围9.5-16）。双层组为0个月（P <0.05）；外固定指数为2.52个月/厘米（2.15-2.94个月/厘米），而双水平组为1.22个月/厘米（0.96-1.67个月/厘米）（P <0.01）；单层组的软组织生长指数为0.29个月/ cm2（范围为0.21-0.45个月/ cm2），双层组为0.62个月/ cm2（范围为0.47-0.86个月/ cm2）（P <0.01） 。根据ASAMI分类，双水平组的临床和功能结果优于单水平组。结论采用Orthofix外固定架的Ilizarov双水平骨运输技术可以成功地修复和重建胫骨骨丢失以及伴随的软组织缺损。双层组22个月/厘米（范围0.96-1.67个月/厘米）（P <0.01）; 单层组的软组织生长指数为0.29个月/ cm2（范围为0.21-0.45个月/ cm2），双层组为0.62个月/ cm2（范围为0.47-0.86个月/ cm2）（P <0.01） 。根据ASAMI分类，双水平组的临床和功能结果优于单水平组。结论采用Orthofix外固定架的Ilizarov双水平骨运输技术可以成功地修复和重建胫骨骨丢失以及伴随的软组织缺损。双层组22个月/厘米（范围0.96-1.67个月/厘米）（P <0.01）; 单层组的软组织生长指数为0.29个月/ cm2（范围为0.21-0.45个月/ cm2），双层组为0.62个月/ cm2（范围为0.47-0.86个月/ cm2）（P <0.01） 。根据ASAMI分类，双水平组的临床和功能结果优于单水平组。结论采用Orthofix外固定架的Ilizarov双水平骨运输技术可以成功地修复和重建胫骨骨丢失以及伴随的软组织缺损。双层组为86个月/平方厘米（P <0.01）。根据ASAMI分类，双水平组的临床和功能结果优于单水平组。结论采用Orthofix外固定架的Ilizarov双水平骨运输技术可以成功地修复和重建胫骨骨丢失以及伴随的软组织缺损。双层组为86个月/平方厘米（P <0.01）。根据ASAMI分类，双水平组的临床和功能结果优于单水平组。结论采用Orthofix外固定架的Ilizarov双水平骨运输技术可以成功地修复和重建胫骨骨丢失以及伴随的软组织缺损。