Shanxi Medical University, Taiyuan, China.
The Second Hospital of Shanxi Medical University, Taiyuan, China.
Orthop Surg. 2024 Sep;16(9):2264-2272. doi: 10.1111/os.14234.
At present, due to the lack of early observation methods, the effect of the 'accordion' technique on the treatment of nonunion of the docking site varies greatly. In this study, color Doppler ultrasound was used to observe the docking site's local changes and investigate the relationship between local microenvironment changes and bone healing after the accordion technique.
30 patients with tibial bone transport treated at the Department of Orthopedics, Second Hospital of Shanxi Medical University, from May 2018 to June 2022, were analyzed retrospectively. Paired-sample t-tests were used for data that conformed to a normal distribution, and paired rank-sum tests were used for before-and-after comparisons that did not conform to a normal distribution. There were 26 males and 4 females, aged 47.3 ± 11.7 years. Before bone transport, the defect gap between tibial bone ends was 6.80 ± 3.61 cm. The steps of the accordion technique were as follows: compression for 7 days, ultrasonic study of the microenvironment at the docking site, distraction for 12 days, latency for 7 days, compression for 14 days, then static fixation and radiological study until complete bone healing. Ultrasound was used to detect the size of the hematoma after 7 days of pressure, and the changes in blood flow before and after the 'accordion' operation.
All patients were followed up for 11.9 ± 1.9 months. At the last follow-up, 22 patients achieved bone healing at the docking site after the treatment of the 'accordion' technique. There was a linear negative correlation between the size of the hematoma and the time of bone healing at the docking site (r = -0.639, p < 0.01). According to the Paley healing criteria, 18 of the 22 patients were excellent, and 4 patients were good.
Hematoma is necessary for the 'accordion' technique's success in the treatment of nonunion. The size of the hematoma is negatively related to the time of bone healing. The 'accordion' technique can increase the blood flow of tissue around the docking site. Ultrasound can be used to monitor the changes in the microenvironment at the docking site during the 'accordion' technique and guide the exact plan and prognosis of the 'accordion' technique.
目前，由于缺乏早期观察方法，“风琴”技术对对接部位不愈合的治疗效果差异很大。本研究采用彩色多普勒超声观察对接部位局部变化，探讨“风琴”技术后局部微环境变化与骨愈合的关系。
回顾性分析 2018 年 5 月至 2022 年 6 月山西医科大学第二医院骨科收治的 30 例胫骨骨搬运患者，符合正态分布的数据采用配对样本 t 检验，不符合正态分布的前后比较采用配对秩和检验。男 26 例，女 4 例；年龄 47.3±11.7 岁。骨搬运前胫骨断端缺损间隙为 6.80±3.61cm。“风琴”技术步骤：压迫 7d，对接部位微环境超声研究，牵伸 12d，潜伏期 7d，压迫 14d，然后静态固定和影像学研究直至完全骨愈合。超声检测压迫后 7d 血肿大小，“风琴”术前后血流变化。
所有患者均获得 11.9±1.9 个月随访。末次随访时，22 例患者经“风琴”技术治疗后对接部位骨愈合。血肿大小与对接部位骨愈合时间呈线性负相关（r=-0.639，p<0.01）。根据 Paley 愈合标准，22 例患者中 18 例优，4 例良。
血肿是“风琴”技术治疗骨不连成功的必要条件，血肿大小与骨愈合时间呈负相关。“风琴”技术可增加对接部位周围组织的血流。超声可用于监测“风琴”技术过程中对接部位微环境的变化，指导“风琴”技术的确切方案和预后。
