Zoller S D, Cao L A, Smith R A, Sheppard W, Lord E L, Hamad C D, Ghodasra J H, Lee C, Jeffcoat D
Department of Orthopaedic Surgery, University of California, Los Angeles (UCLA), 1250 16th St. Suite 2100, Santa Monica CA 90404, United States.
Department of Orthopaedic Surgery, University of Southern California (USC), 1975 Zonal Ave., Los Angeles, CA 90033, United States.
Injury. 2017 Oct;48(10):2248-2252. doi: 10.1016/j.injury.2017.06.018. Epub 2017 Jun 23.
INTRODUCTION: Two-stage limb reconstruction is an option for patients with critical size segmental bone defects following acute trauma or non-union. Reconstruction is technically demanding and associated with a high complication rate. Current protocols for limb reconstruction have well-documented challenges, and no study has reported on patient outcomes using a validated questionnaire. In this study, we aimed to examine the clinical and patient-centered outcomes following our surgical protocol for two-stage limb reconstruction following critical size segmental defects. PATIENTS AND METHODS: A single surgeon performed reconstruction of long bone defects using antibiotic impregnated cement spacers and intramedullary cancellous bone autograft. A retrospective chart review was performed. Three reviewers independently measured time to union based on radiographs. The Lower Extremity Functional Scale (LEFS) survey was administered to patients after most recent follow-up. RESULTS: Ten limbs representing nine patients were included. All patients sustained a lower extremity injury, and one patient had bilateral lower extremity injuries. Average clinical follow-up was 18.3 months (range 7-33) from final surgical intervention, and follow-up to questionnaire administration was 28 months (range 24-37). The mean time between stages was 3.1 months. Average time to unrestricted weight-bearing was 7.9 months from Stage 1 (range 3.4-15.9) and 4.5 months from Stage 2 (range 1.1-11.6). Average time to full union was 16.7 months from Stage 1 (range 6.4-28.6) and 13.5 months from Stage 2 (range 1.8-27). Eight patients (nine limbs) participated in the LEFS survey, the average score was 53.1 (range 30-67), equating to 66% of full functionality (range 38%-84%). Complications included 5 infections, 3 non-unions, and one amputation. There was a moderate positive correlation between infection at any time point and non-union (R=0.65, p=0.03). DISCUSSION AND CONCLUSIONS: Outcomes in this small patient cohort were good despite risks of complication. There is an association between infection and non-union. Further studies addressing clinical and functional outcomes will help to guide expectations for future surgeons and patients.
引言：对于急性创伤或骨不连后出现大段临界性骨缺损的患者，两阶段肢体重建是一种选择。重建技术要求高且并发症发生率高。目前的肢体重建方案存在诸多有据可查的挑战，且尚无研究使用经过验证的问卷报告患者的预后情况。在本研究中，我们旨在研究采用我们的手术方案对大段临界性骨缺损进行两阶段肢体重建后的临床及以患者为中心的预后情况。 患者与方法：由一位外科医生使用抗生素浸渍骨水泥间隔物和髓内松质骨自体骨移植对长骨缺损进行重建。进行了回顾性病历审查。三位评审员根据X线片独立测量骨愈合时间。在最近一次随访后对患者进行下肢功能量表（LEFS）调查。 结果：纳入了代表9名患者的10条肢体。所有患者均为下肢损伤，1例患者为双侧下肢损伤。自最终手术干预后的平均临床随访时间为18.3个月（范围7 - 33个月），至问卷调查时的随访时间为28个月（范围24 - 37个月）。两阶段之间的平均时间为3.1个月。从第一阶段开始到可自由负重的平均时间为7.9个月（范围3.4 - 15.9个月），从第二阶段开始为4.5个月（范围1.1 - 11.6个月）。从第一阶段开始到完全愈合的平均时间为16.7个月（范围6.4 - 28.个月），从第二阶段开始为13.5个月（范围1.8 - 27个月）。8名患者（9条肢体）参与了LEFS调查，平均得分为53.1分（范围30 - 67分），相当于完全功能的66%（范围38% - 84%）。并发症包括5例感染、3例骨不连和1例截肢。在任何时间点的感染与骨不连之间存在中度正相关（R = 0.65，p = 0.03）。 讨论与结论：尽管有并发症风险，但这个小患者队列的预后良好。感染与骨不连之间存在关联。进一步针对临床和功能预后的研究将有助于指导未来外科医生和患者的预期。
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