胫骨感染性骨不连治疗中不同骨搬运阶段的生活质量及并发症

Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia.

作者信息

Wang Hu, Wei Xing, Liu Ping, Fu Ya-Hui, Wang Peng-Fei, Cong Yu-Xuan, Zhang Bin-Fei, Li Zhong, Lei Jin-Lai, Zhang Kun, Zhuang Yan

机构信息

Department of Orthopedic Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, China.

出版信息

Medicine (Baltimore). 2017 Nov;96(45):e8569. doi: 10.1097/MD.0000000000008569.

Abstract

The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20-55 years). All patients previously undergone an average of 2.9 operations (range: 1-6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3-12 cm), and all patients were suffering from soft tissue defects (range: 5-17 cm). The mean external fixator time (EFT) was 48 weeks (range: 30-62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33-62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS scores increased continuously. After completed consolidation, the average MCS score was comparable to a normal collective, and the average VAS score was 1.87 (range: 0-3).Bone transport is a safe option for the treatment of infected nonunion of the tibia despite the high complication rate. The arduous and demanding nature of this treatment subjects patient to considerable the pain, mental, and physical stress. The average VAS scores, PCS, and MCS scores significantly improve at final follow-up. It is essential to communicate this fact to the patients and their relatives before the application of the frame in order to increase their compliance with the long and emotionally draining treatment.

摘要

本研究的目的是评估在骨搬运手术治疗胫骨感染性骨不连期间,36项简明健康调查问卷(SF-36)评分中的身体成分总结(PCS)、精神成分总结(MCS)以及疼痛的虚拟视觉模拟量表(VAS),并评估相关并发症发生率。这是一项对连续患者队列中前瞻性收集的数据进行的回顾性分析。2012年至2014年期间,对患有胫骨感染性骨不连的患者采用骨搬运治疗。在骨完全愈合后至少随访2年。标准化治疗包括通过节段性切除根除细菌、使用伊里扎洛夫器械进行骨搬运以及对接操作。主要结局指标包括生活质量(PCS和MCS评分)以及治疗不同阶段的疼痛VAS。此外,记录所有并发症。

我们的系列研究包括12名男性和3名女性,平均年龄36.9岁(范围:20 - 55岁)。所有患者此前平均接受过2.9次手术(范围:1 - 6次手术)。所有患者均存在骨缺损,平均大小为7.5厘米(范围:3 - 12厘米),且所有患者均伴有软组织缺损(范围:5 - 17厘米)。平均外固定时间(EFT)为48周(范围:30 - 62周),平均外固定指数为43.1天/厘米(范围:33 - 62天/厘米)。所有患者均实现骨愈合,未观察到感染复发。根据帕利分类,患者出现15例轻度并发症和13例重度并发症。每位患者的平均并发症发生率包括轻度并发症1.0例和重度并发症0.9例。6例患者在对接部位需要进行骨移植。1例患者出现马蹄足畸形,并拒绝进一步手术。我们对15例患者进行了28次手术(每位患者平均1.9次手术)。在骨搬运期间,PCS和MCS评分持续升高。骨愈合完成后,平均MCS评分与正常人群相当,平均VAS评分为1.87(范围:0 - 3)。

尽管并发症发生率较高,但骨搬运仍是治疗胫骨感染性骨不连的一种安全选择。这种治疗的艰巨性和高要求使患者承受了相当大的疼痛、精神和身体压力。在最终随访时,平均VAS评分、PCS和MCS评分显著改善。在应用外固定架之前,必须将这一情况告知患者及其家属,以提高他们对漫长且令人情绪疲惫的治疗的依从性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f99/5690770/168408280d4d/medi-96-e8569-g003.jpg

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