Yin Peng, Ji Qiunan, Li Tongtong, Li Jiantao, Li Zhirui, Liu Jianheng, Wang Guoqi, Wang Song, Zhang Lihai, Mao Zhi, Tang Peifu
Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing, 100853, P.R. China; School of Medicine, Nankai University, No. 94 Weijin Road, Tianjin, 300071, P.R. China.
School of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
PLoS One. 2015 Nov 3;10(11):e0141973. doi: 10.1371/journal.pone.0141973. eCollection 2015.
Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods.
A comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI). Bone results (excellent, good, fair and poor rate), functional results (excellent, good, fair and poor rate) and complications were analyzed by Stata 9.0.
A total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04-0.12; I2 = 44.1%, P = 0.065) and 10% (95%CI, 0.05-0.14; I2 = 34.7%, P = 0.121) in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%.
Our systematic review showed that the patients with infected nonunion of tibia and femur treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected nonunion of tibia and femur.
胫腓骨感染性骨不连在临床实践中较为常见，然而，这些疾病的治疗仍然是骨科医生面临的挑战。伊里扎洛夫技术能够通过渐进性骨组织再生消除感染、弥补骨缺损并促进骨愈合。本系统评价的目的是回顾目前有关伊里扎洛夫技术治疗胫腓骨感染性骨不连的现有研究，并对骨与功能结果及并发症进行荟萃分析，以评估伊里扎洛夫技术的疗效。
1995年1月至2015年8月期间，全面检索了科学引文索引（SCI）、美国国立医学图书馆生物医学信息数据库（PubMed）、考克兰图书馆以及荷兰医学文摘数据库（Embase）。使用SPSS 13.0软件基于每项研究中的样本量，对一些主要数据进行加权均值统计分析，包括患者数量、平均年龄、既往平均手术次数、平均骨缺损、平均随访时间、骨愈合情况、每位患者的并发症、外固定时间以及外固定指数（EFI）。使用Stata 9.0软件分析骨结果（优、良、可、差率）、功能结果（优、良、可、差率）及并发症。
本系统评价共纳入了来自24项研究的590例患者。所有纳入研究中骨愈合率的平均值为97.26%。采用伊里扎洛夫技术治疗的胫腓骨感染性骨不连患者中，骨结果差率和功能结果差率分别为8%（95%可信区间，0.04 - 0.12；I² = 44.1%，P = 0.065）和10%（95%可信区间，0.05 - 0.14；I² = 34.7%，P = 0.121）。再骨折、畸形愈合、感染复发、膝关节僵硬、截肢、肢体水肿及腓总神经麻痹的发生率分别为4%、7%、5%、12%、4%、13%和13%。
我们的系统评价表明，采用伊里扎洛夫技术治疗的胫腓骨感染性骨不连患者，骨结果和功能结果差率较低。因此，伊里扎洛夫技术可能是治疗胫腓骨感染性骨不连的良好选择。
