Makhdoom Asadullah, Kumar Jagdesh, Siddiqui Adeel A
Orthopaedic Surgery & Traumatology, Liaquat University of Medical & Health Sciences, Jamshoro, PAK.
Orthopaedic Surgery, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2019 Jun 22;11(6):e4973. doi: 10.7759/cureus.4973.
Introduction Many different methods and variations have been employed to perform osteotomy for deformity correction, bone lengthening, and segmental bone transport. Currently, multiple drill-hole (MDH) and Gigli saw osteotomies are the two most preferred ones, being favoured over other techniques. Our objective is to compare the modified healing index (mHI) of these two commonly used procedures. Methodology This retrospective study was conducted at the department of Orthopedics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. The study population consisted of all skeletally mature patients who underwent tibial bone osteotomy for bone lengthening or bone transport using Ilizarov circular fixator from June 2016 to September 2018. We excluded patients with metabolic bone disease and patients who underwent osteotomy for deformity correction. Preoperative and operative patients' demographics and clinical data were gathered through a review of medical record and mHI was calculated to compare the effectiveness of osteotomy techniques. Results A total of 50 patients, 74% males and 26% females 26% with a mean age of 33.14 ± 12 years were included in the study. Of the 50 patients, 23 (27 osteotomies) had undergone MDH osteotomy (group I), whereas 27 patients (37 osteotomies) had a Gigli saw osteotomy (group II). The overall mHI of both groups was 1.60 ± 0.34 month/cm (range 1.0-2.5 month/cm). When we compared the mHI of both techniques, the mean mHI was 1.72 ± 0.33 month/cm (range 1.2 - 2.5 months/cm) in MDH group and 1.54 ± 0.36 month/cm (range 1.0-2.5 month/cm) in the Gigli saw group. The healing index was significantly lower in the Gigli saw group. None of our patients showed nonunion at the osteotomy site. However, the problems of incomplete osteotomy in two cases and bone fractures in four cases were seen in MDH osteotomy. Conclusion According to our results, percutaneous Gigli saw osteotomy technique by two small incisions minimizes the local soft tissue trauma and periosteal disruption around the osteotomy more than the multiple drill holes osteotomy, resulting in better consolidation following distraction osteogenesis.
引言
为了进行畸形矫正、骨延长和节段性骨转移，人们采用了许多不同的方法和变体。目前，多钻孔（MDH）截骨术和吉利锯截骨术是最常用的两种方法，比其他技术更受青睐。我们的目的是比较这两种常用手术的改良愈合指数（mHI）。
方法
这项回顾性研究在巴基斯坦詹姆肖罗利亚卡特医学与健康科学大学骨科进行。研究对象包括2016年6月至2018年9月期间所有使用伊里扎洛夫环形固定器进行胫骨截骨以延长骨骼或转移骨骼的骨骼成熟患者。我们排除了患有代谢性骨病的患者和接受畸形矫正截骨术的患者。通过查阅病历收集术前和手术患者的人口统计学和临床数据，并计算mHI以比较截骨术技术的有效性。
结果
共有50名患者纳入研究，其中男性占74%，女性占26%，平均年龄为33.14±12岁。在这50名患者中，23名（27例截骨术）接受了MDH截骨术（第一组），而27名患者（37例截骨术）接受了吉利锯截骨术（第二组）。两组的总体mHI为1.60±0.34月/厘米（范围1.0 - 2.5月/厘米）。当我们比较两种技术的mHI时，MDH组的平均mHI为1.72±0.33月/厘米（范围1.2 - 2.5月/厘米），吉利锯组为1.54±0.36月/厘米（范围1.0 - 2.5月/厘米）。吉利锯组的愈合指数明显较低。我们的患者均未出现截骨部位不愈合。然而，在MDH截骨术中发现了2例截骨不完全和4例骨折的问题。
结论
根据我们的结果，经皮双小切口吉利锯截骨术比多钻孔截骨术更能减少截骨周围的局部软组织创伤和骨膜破坏，从而在牵张成骨后实现更好的骨愈合。
