Опыт клинического применения тканеинженерных конструкций в лечении протяженных дефектов костной ткани

Abstract

Introduction Practical application of regenerative medicine to restore structural and functional properties of damaged tissues and organs using bioactive implants could solve complex problems in contemporary traumatology and orthopedics. Objective To improve treatment results in posttraumatic diaphyseal defects of lower extremities. Material and Methods Treatment outcomes of 19 patients with posttraumatic bone defects of the femur and tibia that averaged of 8.8 ± 3.5 cm were studied. In the main group (9 patients), osteosynthesis of fragments was performed sequentially, first with external fixation and then with intramedullary nailing. Bone defect was bridged by a combination of a biomimetic tissue with a spongy autograft from the iliac wing. In the control group (10 patients), the Ilizarov method of non-free bone plasty was used. Results The results were studied after follow-up of two years. Bone defects were covered in all patients of both groups. However, in the main group, the physiological load on the limb was possible, on average, 7.6 months after surgery, which required 61 % less operations as compared to the control group. Also, the rate of complications was 29.2 % lower in the main group. When assessing the functional results using the LEFS questionnaire, the patients of the main group experienced some minor difficulties in performing physical activities, and patients in the control group experienced moderate difficulties (average score 70.3 and 50.4, respectively). Conclusion The combination of biomimetic tissue with a spongy autograft from the iliac wing under the conditions of stable functional osteosynthesis enables to manage extensive defects of the femur and tibia and improve the functional outcomes.