Lovisetti Giovanni, Kirienko Alexander, Myerson Charles, Vulcano Ettore
1 Department of Orthopedics, Menaggio Hospital, Menaggio, Italy.
2 Department of Orthopedics, Humanitas Research Hospital, Milan, Italy.
Foot Ankle Int. 2018 Oct;39(10):1210-1218. doi: 10.1177/1071100718781327. Epub 2018 Jun 4.
Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions.
Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14.6 months (range, 10.6-17.7 months), with an average of 8.6 months in-frame. Thirteen of 21 patients had infected nonunions. Primary endpoints included time to union and American Orthopaedic Foot & Ankle Society (AOFAS) score.
All fractures achieved union. Mean time to union was 37.4 weeks. Mean AOFAS score was 86.3 points (range, 37-100). A score of 37 was observed in 1 patient with preexisting Charcot foot. Radiographic evaluation at 6 months revealed a mean lateral distal tibial angle of 89.2 degrees and a mean anterior distal tibial angle of 76 degrees. Leg length discrepancy was less than 1.2 cm in all patients. Superficial pin infection was observed in 7 patients, and operative wound infection at the level of bone resection was observed in 3 patients.
The ankle-sparing bone transport technique was an effective alternative to bone graft and arthrodesis for the treatment of periarticular nonunions of the distal tibia and was safe for use in patients with infected nonunions in close proximity to the ankle joint.
Level IV, case series.
距踝关节较近的胫骨远端骨不连的治疗颇具挑战。本研究旨在评估接受踝关节保留型骨搬运治疗关节周围胫骨远端骨不连患者的影像学及临床疗效。
2006年1月至2016年7月期间，21例患者接受了踝关节保留型骨搬运治疗。患者平均年龄48.6岁，71%（15/21）为男性。患者平均随访14.6个月（范围10.6 - 17.7个月），平均骨搬运期8.6个月。21例患者中有13例为感染性骨不连。主要终点指标包括骨愈合时间及美国矫形足踝协会（AOFAS）评分。
所有骨折均实现愈合。平均骨愈合时间为37.4周。AOFAS平均评分为86.3分（范围37 - 100）。1例既往有夏科氏足的患者评分为37分。6个月时的影像学评估显示，胫骨远端外侧平均角度为89.2度，胫骨远端前方平均角度为76度。所有患者的下肢长度差异均小于1.2厘米。7例患者出现浅表针道感染，3例患者在骨切除水平出现手术伤口感染。
踝关节保留型骨搬运技术是治疗胫骨远端关节周围骨不连的一种有效替代植骨和关节融合的方法，对于踝关节附近感染性骨不连的患者使用安全。
IV级，病例系列。
