Combined bone plasty interventions for rehabilitation of patients with congenital pseudarthrosis of the tibia

Borzunov D.Y., Gorbach E.N., Mokhovikov D.S., Kolchin S.N.

Abstract


The problem of treating patients diagnosed with congenital pseudarthrosis is due to severe and unpredictable course of this disease, difficulties in choosing surgical techniques, and frequent relapses of the process.
Purpose
Compare the results of treatment of patients with congenital pseudoarthrosisof the tibia (CPT) using non-free Ilizarov bone plasty and a combination of grafting according to Masquelet technique with Ilizarov bone transport.
Materials and methods
The outcomes of 13 patients with CPT aged 1.5 to 35 years who had been treated since 2009 were analyzed. The main group (n = 6) included patients treated using a combination of the Ilizarov and Masquelet methods. In the control group (n = 7), patients were treated only with Ilizarov transosseous osteosynthesis. Histological examination of the periosteum and tissues of the resected pseudarthrosis area was performed. In the index group, fragments of a biomembrane formed around a cement spacer temporarily bridged the diastasis after resection of pseudarthrosis were studied by light and electron scanning microscopy.
Results and discussion
Patients of the analyzed groups had a comparable duration of treatment. In the main group, bone fusion was observed in 83 % of cases, while no relapse was detected in the long-term follow-up. The obtained treatment result was achieved due to good vascularization of the biological membrane formed on the spacer surface, which provides trophic effect at the stages of defect management in the area of resected pseudarthrosis. The presence of poorly differentiated osteogenic cells in it promoted active osteogenesis. In patients of the control group, fusion was achieved in all cases, but relapses in the long-term occurred in 71 % of cases.
Conclusion
The basis of the methodological principles in treating patients with CPT is the use of additional options for osteoplastic interventions and materials in the pseudarthrosis zone. Fixation of a segment without stimulation of bone regeneration does not bring the desired effect. The complex use of non-free Ilizarov bone grafting according to Ilizarov and Masquelet technology achieves bone fusion of the congenital pseudoarthrosis and disease-free course of the conditions.

Keywords


pseudoarthrosis, Ilizarov, Masquelet, biomembrane

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DOI: http://dx.doi.org/10.18019/1028-4427-2019-25-3-304-311

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