Tetsworth Kevin, Paley Dror, Sen Cengiz, Jaffe Matthew, Maar Dean C, Glatt Vaida, Hohmann Erik, Herzenberg John E
Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland School of Medicine, Brisbane, QLD, Australia; Orthopaedic Research Centre of Australia, Brisbane, QLD, Australia.
Paley Institute, St. Mary's Hospital, West Palm Beach, FL, USA.
Injury. 2017 Oct;48(10):2276-2284. doi: 10.1016/j.injury.2017.07.018. Epub 2017 Jul 12.
This study compared bone transport to acute shortening/lengthening in a series of infected tibial segmental defects from 3 to 10cm in length.
In a retrospective comparative study 42 patients treated for infected tibial non-union with segmental bone loss measuring between 3 and 10cm were included. Group A was treated with bone transport and Group B with acute shortening/lengthening. All patients were treated by Ilizarov methods for gradual correction as bi-focal or tri-focal treatment; the treating surgeon selected either transport or acute shortening based on clinical considerations. The principle outcome measure was the external fixation index (EFI); secondary outcome measures included functional and bone results, and complication rates.
The mean size of the bone defect was 7cm in Group A, and 5.8cm in Group B. The mean time in external fixation in Group A was 12.5 months, and in Group B was 10.1 months. The external fixation index (EFI) measured 1.8 months/cm in Group A and 1.7 months/cm in Group B (P=0.09). Minor complications were 1.2 per patient in the transport group and 0.5 per patient in the acute shortening group (P=0.00002). Major complications were 1.0 per patient in the transport group versus 0.4 per patient in the acute shortening group (P=0.0003). Complications with permanent residual effects (sequelae) were 0.5 per patient in the transport group versus 0.3 per patient in the acute shortening group (P=0.28).
While both techniques demonstrated excellent results, acute shortening/lengthening demonstrated a lower rate of complications and a slightly better radiographic outcome. Bone grafting of the docking site was often required with both procedures.
Level III; Retrospective comparative study.
本研究比较了在一系列长度为3至10厘米的感染性胫骨节段性缺损中骨搬运与急性缩短/延长的效果。
在一项回顾性对照研究中，纳入了42例接受治疗的感染性胫骨骨不连且伴有3至10厘米节段性骨缺损的患者。A组采用骨搬运治疗，B组采用急性缩短/延长治疗。所有患者均采用伊里扎洛夫方法进行逐步矫正，作为双焦点或三焦点治疗；治疗外科医生根据临床考虑选择骨搬运或急性缩短治疗。主要结局指标是外固定指数（EFI）；次要结局指标包括功能和骨愈合结果以及并发症发生率。
A组骨缺损的平均大小为7厘米，B组为5.8厘米。A组外固定的平均时间为12.5个月，B组为10.1个月。A组的外固定指数（EFI）为1.8个月/厘米，B组为1.7个月/厘米（P = 0.09）。骨搬运组每位患者的轻微并发症为1.2例，急性缩短组为0.5例（P = 0.00002）。骨搬运组每位患者的严重并发症为1.0例，急性缩短组为0.4例（P = 0.0003）。有永久性残留影响（后遗症）的并发症在骨搬运组每位患者为0.5例，急性缩短组为0.3例（P = 0.28）。
虽然两种技术均显示出良好的效果，但急性缩短/延长的并发症发生率较低，影像学结果略好。两种手术通常都需要对接部位的骨移植。
III级；回顾性对照研究。
