Zhang Zhen, Swanson W Benton, Wang Yan-Hong, Lin Wei, Wang Guanglin
Department of Orthopedics, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China.
Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, USA.
BMC Musculoskelet Disord. 2018 Dec 13;19(1):442. doi: 10.1186/s12891-018-2363-5.
Tibia infected nonunion and chronic osteomyelitis are challenging clinical presentations. Bone transportation with external or hybrid fixators (combined external and internal fixators) is versatile to solve these problems. However, the infection-free rates of these fixator systems are unknown. Additionally, the prognosis factors for results of bone transportation are obscure. Therefore, this systematic review and meta-analysis was conducted to answer these questions.
A systematic review was conducted following the PRISMA-IPD guidelines. Relevant publications from January 1995 to September 2018 were compiled from Medline, Embase, and Cochrane. The infection-free rates of external and hybrid fixators were achieved by synthesizing aggregate data and individual participant data (IPD). IPD was analyzed by two-stage method with logistical regression to identify prognosis factors of sequelae.
Twenty-two studies with 518 patients were identified, including 11 studies with 167 patients' IPD, and 11 studies with 351 patients' aggregate data. The infection-free rate of hybrid fixator group was 86% (95%CI: 79-94%), lower than that of external fixator which was 97% (95%CI: 95-98%,). The number of previous surgeries was found predict factor of bone union sequelae (p = 0.04) and function sequelae(p < 0.01); The external fixation time was found predict factor of function sequelae (p = 0.015).
Hybrid fixators may be associated with a greater risk of infection-recurrence in the treatment of tibia infected nonunion and chronic osteomyelitis. The number of previous surgeries and external fixation time can be used as predictors of outcomes. Proper fixators and meticulously designed surgery are important to avoid unexpected operations and shorten external fixation time.
胫骨感染性骨不连和慢性骨髓炎是具有挑战性的临床表现。使用外固定器或混合固定器（外固定与内固定相结合）进行骨搬运是解决这些问题的通用方法。然而，这些固定器系统的无感染率尚不清楚。此外，骨搬运结果的预后因素也不明确。因此，进行了这项系统评价和荟萃分析来回答这些问题。
按照PRISMA-IPD指南进行系统评价。从1995年1月至2018年9月的相关出版物通过Medline、Embase和Cochrane进行汇编。通过综合汇总数据和个体参与者数据（IPD）得出外固定器和混合固定器的无感染率。采用两阶段方法并通过逻辑回归分析IPD以确定后遗症的预后因素。
共纳入22项研究，涉及518例患者，其中11项研究包含167例患者的IPD，11项研究包含351例患者的汇总数据。混合固定器组的无感染率为86%（95%CI：79-94%），低于外固定器组的97%（95%CI：95-98%）。发现既往手术次数是骨愈合后遗症（p = 0.04）和功能后遗症（p < 0.01）的预测因素；发现外固定时间是功能后遗症的预测因素（p = 0.015）。
在治疗胫骨感染性骨不连和慢性骨髓炎时，混合固定器可能与感染复发风险较高相关。既往手术次数和外固定时间可作为预后结果的预测指标。选择合适的固定器并精心设计手术对于避免意外手术和缩短外固定时间很重要。
