Napora Joshua K, Weinberg Douglas S, Eagle Blake A, Kaufman Bram R, Sontich John K
Department of Orthopaedic Surgery, MetroHealth Medical Center, Affiliated With Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2017 Jul;31(7):393-399. doi: 10.1097/BOT.0000000000000840.
The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization.
Retrospective cohort study.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: Seventy-five patients with infected posttraumatic nonunions of the tibia.
Resection of nonunion with application of stacked hexapod frame for bone transport.
Parameters measured included age, sex, diabetes, smoking, use of a free flap, bone defect size, length in frame, external fixation index, and direction of lengthening. Outcomes recorded: removal of frame, below knee amputation, or adjunctive stability. Further analysis evaluated location of nonunion, timing of adjunctive stabilization, and type of fixation.
The average patient age was 45.7 ± 12.5 years, 76% patients were men, 11% were diabetic, and 44% were smokers. Forty two percent had soft tissue defects that required a free flap. Thirty-eight patients had removal of frame, whereas 36 patients required adjunctive stability of the hexapod frame. Patient receiving adjunctive stabilization had a longer length of time in the hexapod frame (P = 0.026) and were more likely to require a free flap (P = 0.053). Ninety-three percent docking site nonunions occurred after the removal of the frame (P = 0.032); whereas 79% regenerate nonunions occurred before the hexapod frame was removed (P = 0.029).
The use of a hexapod frame for the infected tibial nonunions with bone loss is an effective method for achieving union and eradicating infection in a difficult orthopaedic patient population. Use of adjunctive stabilization is a reasonable technique to address delayed regenerate and docking site nonunions.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
堆叠式六足骨搬运技术是治疗伴有骨缺损的感染性胫骨骨不连的有效方法。本研究旨在评估患者需要辅助固定的危险因素及时机。
回顾性队列研究。
一级创伤中心。
患者/参与者：75例创伤后感染性胫骨骨不连患者。
切除骨不连并应用堆叠式六足框架进行骨搬运。
测量的参数包括年龄、性别、糖尿病、吸烟情况、游离皮瓣的使用、骨缺损大小、框架内固定时间、外固定指数及延长方向。记录的结果：框架拆除、膝下截肢或辅助固定。进一步分析评估骨不连的位置、辅助固定的时机及固定类型。
患者平均年龄为45.7±12.5岁，76%为男性，11%患有糖尿病，44%吸烟。42%有软组织缺损，需要游离皮瓣。38例患者拆除了框架，而36例患者需要对六足框架进行辅助固定。接受辅助固定的患者在六足框架内的时间更长（P = 0.026），且更有可能需要游离皮瓣（P = 0.053）。93%的对接部位骨不连发生在框架拆除后（P = 0.032）；而79%的再生部位骨不连发生在六足框架拆除前（P = 0.029）。
对于伴有骨缺损的感染性胫骨骨不连患者，使用六足框架是实现骨愈合和根除感染的有效方法。辅助固定的使用是解决延迟再生和对接部位骨不连的合理技术。
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
