Mechanism of delayed union and nonunion of the docking site after bone transport and standardized clinical application technology

doi:10.3969/j.issn.2095-4344.2905

Abstract

Abstract:

BACKGROUND: Bone transport technology is one of the commonly used technologies for the treatment of large bone loss. However, the delayed union and nonunion rate of the docking site during the treatment is high and needs to be solved urgently.

OBJECTIVE: To summarize the current reports on delayed union and nonunion of the docking site after limb

bone transport, to clarify the current treatment methods, existing problems and future research directions.

METHODS: The PubMed, CNKI, and Wanfang Med Online Database were searched for relevant literatures on bone transport and docking site published from January 2009 to December 2019. The English and Chinese search key words were “docking site, bone transport, distraction osteogenesis”.

RESULTS AND CONCLUSION: (1) Bone transport is the gold standard for the treatment of long bone defects in the limbs, especially in the case with infection. Delayed union and nonunion of the docking site are the common complications. The incidence rate in the literature is 73%, at a high level overall. (2) There are many reasons that lead to delayed union and nonunion of the docking site, including reduction of the area of contact, incarceration of soft tissue in the gap, and poor blood supply. (3) Prevention should focus on preoperative evaluation, precise operation, regular postoperative review, and early intervention. The treatment method is mainly based on incision and bone grafting. In addition, surgery under arthroscopy, combined fixation with plates, intramedullary pins, and non-surgical treatment are derived. It can assist extracorporeal shock wave therapy, electromagnetic field stimulation, hyperbaric oxygen therapy, and gene therapy. (3) “Accordion” technique is one of the conservative treatment methods. It has the advantages of fewer traumas, low cost, and no bone grafting. However, the “accordion” technique schemes are different; there are few cases reported; and the mechanism is not clear, which limits the further promotion of the technology. (4) In the future, the clinical research should be further expanded, and the mechanism of the technology should be studied in depth. The unified operation scheme should be optimized to further promote the “accordion” technique application.

Key words: bone, bone transport, Ilizarov technique, docking site, complication, bone nonunion, delayed union, bone grafting

CLC Number:

Yin Haiyang, Zhang Yonghong. Mechanism of delayed union and nonunion of the docking site after bone transport and standardized clinical application technology[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5858-5863.

Figures/Tables 2

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