Orthopaedic Surgery Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, America Building (19)-2nd Floor, Bethesda, MD 20889, USA.
J Bone Joint Surg Am. 2011 Jun 1;93(11):1016-21. doi: 10.2106/JBJS.J.01038.
The complications of bone-bridging amputations remain ill defined. The purpose of this study was to compare the early and intermediate-term complications leading to reoperation between the modified Burgess and modified Ertl tibiofibular synostosis in combat-related transtibial amputations.
We conducted a retrospective review of consecutive, contemporaneous cohorts of thirty-seven modified Ertl bone-bridge and 100 modified Burgess combat-related transtibial amputations. The primary outcome measure was the need for reoperation following definitive closure.
At a mean follow-up of two years (range, nine to forty-eight months), there was a 53% overall reoperation rate. The overall complications included infection (34%), neuroma excision (18%), heterotopic ossification excision (15%), myodesis failure (4%), and scar revision (7%). A significantly higher rate of overall complications (p = 0.008) was noted in the bone-bridge group. Additionally, there was an increased rate of noninfectious complications in the bone-bridge group (p = 0.02). A positive selection bias was also noted for performing bone-bridge amputations late (p = 0.0002) and outside the zone of injury (p < 0.0001). Bone-bridge-specific complications occurred in 32% of the modified Ertl group. Delayed union or nonunion of the synostosis (11%) and implant-related complications (27%) predominated. Three bone bridges were ultimately removed.
Reoperations were needed at a significantly greater rate overall and for noninfectious complications following bone-bridge synostosis compared with modified Burgess transtibial amputations. Additionally, despite the positive selection bias favoring the bridge synostosis cohort, infection rates were not lower in that group. Detailed patient counseling and careful patient selection are indicated prior to performing modified Ertl amputations, particularly in the absence of convincing evidence regarding objective functional benefits from the procedure.
骨桥截肢的并发症仍不明确。本研究的目的是比较改良 Burgess 和改良 Ertl 胫腓骨融合术治疗战伤胫骨截肢后早期和中期导致再次手术的并发症。
我们对连续的、同期的 37 例改良 Ertl 骨桥和 100 例改良 Burgess 战伤胫骨截肢进行回顾性研究。主要观察指标为确定性闭合后的再手术需求。
平均随访 2 年（9~48 个月），总再手术率为 53%。总的并发症包括感染（34%）、神经瘤切除（18%）、异位骨化切除（15%）、肌皮融合失败（4%）和瘢痕修整（7%）。骨桥组的总体并发症发生率显著更高（p = 0.008）。此外，骨桥组的非感染性并发症发生率也更高（p = 0.02）。对晚期（p = 0.0002）和损伤区外（p < 0.0001）进行骨桥截肢的正选择偏倚也很明显。改良 Ertl 组有 32%的患者发生骨桥特异性并发症。融合处延迟愈合或不愈合（11%）和植入物相关并发症（27%）为主。最终有 3 个骨桥被移除。
与改良 Burgess 胫骨截肢相比，骨桥融合术后整体和非感染性并发症再手术的需求明显更高。此外，尽管桥接融合术组存在有利的正选择偏倚，但该组的感染率并没有降低。在进行改良 Ertl 截肢前，需要对患者进行详细的咨询和仔细的选择，特别是在没有明确的证据表明该手术具有客观的功能益处的情况下。
