Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Çapa Fatih 34050 Istanbul, Turkey.
Biruni University Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
Injury. 2019 Nov;50(11):2075-2083. doi: 10.1016/j.injury.2019.08.021. Epub 2019 Aug 16.
The bone transport technique has been a well-known method in the treatment of osteomyelitis of the long bones with large segmental bone defects. However, one of the major drawbacks with this traditional technique is the long-lasting consolidation period, which may entail infectious and non-infectious complications. To overcome this drawback, several techniques were developed, one of which is acute shortening and re-lengthening. The aims of this study were: 1) to present our experience with a new modified technique of acute shortening and re-lengthening using a monolateral external fixator combined with a retrograde intramedullary nail, and 2) to compare its results with the classic Ilizarov bone transport method in the management of infected non-unions of the distal femur with bone loss.
This retrospective study compared these two techniques. 17 patients were treated using our modified technique of acute shortening and re-lengthening (Group A); 15 patients were treated using segmental bone transport (Group B). The average follow-up was 66 months (range: 24-180) in Group A and 70 months (range: 24-240) in Group B. The mean bone loss was 5.5 cm (range: 3-10) in Group A and 5.9 cm (range: 3-10) in Group B. The primary outcome of the present study was to compare the external fixator time (EFT) and external fixation index (EFI) between the two groups. The bone and functional status were also assessed.
The mean EFI was lower in Group A (mean: 31.8 days/cm; range: 24-50) than in Group B (mean 48.7 days/cm; range: 40-100) (p = 0.02). The mean EFT was shorter in Group A (mean: 120 days; range: 100-150) than in Group B (mean: 290 days; range: 100-400) (p = 0.0003). With respect to the bone and functional results, no difference was observed.
Although both techniques could be employed safely in the treatment of infected non-union of the distal femur with size defects ranging between 3 cm and 10 cm, our modified technique of acute shortening and re-lengthening may confer greater patient satisfaction because of shorter EFI.
骨搬运技术是治疗长骨伴有大段骨缺损的骨髓炎的一种知名方法。然而，这种传统技术的一个主要缺点是愈合时间长，可能会出现感染和非感染性并发症。为了克服这一缺点，已经开发了几种技术，其中一种是急性缩短和再延长。本研究的目的是：1）介绍我们使用单侧外固定架结合逆行髓内钉的急性缩短和再延长的新技术的经验，2）将其结果与经典的伊利扎罗夫骨搬运方法在治疗伴有骨丢失的感染性股骨远端骨不连进行比较。
本回顾性研究比较了这两种技术。17 例患者采用我们的急性缩短和再延长改良技术（A 组）治疗；15 例患者采用节段性骨搬运（B 组）治疗。A 组的平均随访时间为 66 个月（范围：24-180），B 组为 70 个月（范围：24-240）。A 组的平均骨丢失为 5.5cm（范围：3-10），B 组为 5.9cm（范围：3-10）。本研究的主要结果是比较两组的外固定器时间（EFT）和外固定指数（EFI）。还评估了骨和功能状况。
A 组的平均 EFI 低于 B 组（均值：31.8 天/cm；范围：24-50）（p=0.02）。A 组的平均 EFT 短于 B 组（均值：120 天；范围：100-150）（p=0.0003）。在骨和功能结果方面，没有观察到差异。
虽然这两种技术都可以安全地用于治疗伴有 3cm-10cm 大小缺损的感染性股骨远端骨不连，但我们的急性缩短和再延长改良技术可能会因 EFI 更短而获得更高的患者满意度。
