Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Orthopaedic Surgery, El-Helal Hospital, Cairo, Egypt.
J Orthop Trauma. 2019 Oct;33(10):e372-e377. doi: 10.1097/BOT.0000000000001514.
To compare 2 distraction osteogenesis techniques in post-traumatic tibial nonunion patients with composite bone and soft-tissue defects.
Nonrandomized prospective, case series, single-center study.
Department of Orthopaedics and Traumatology, Limb Reconstruction Unit, El-Helal hospital, Cairo, Egypt.
Fifty post-traumatic tibial nonunion patients with composite bone and soft-tissue defects.
Twenty-five patients were treated using bone transport (BT) technique, and 25 patients were treated using acute shortening (AS) and distraction technique.
The external fixation index (EFI); functional and bone results; and complication rates.
All patients were followed for a minimum of 18 months after removal of their Ilizarov frame. AS and BT groups were followed up for a mean of 19.7 and 20.3 months, respectively. The mean bone gap after resection and debridement was 4 cm in AS group and 5.9 cm in BT group (P = 0.06). The mean EFI was statistically significant and lower in the AS group compared with BT group (P = 0.03). There were no other statistically significant differences between either intervention groups.
Both techniques achieved comparable good to excellent results, and the differences in number of complications and ASAMI scores for bone or function were not statistically significant. Yet, it appears that the AS technique may be superior because it has a significantly lower EFI. This may not be feasible in all cases, however, because the AS technique is limited by the defect size and the condition of the surrounding soft tissues.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
比较两种牵张成骨技术在伴有复合骨和软组织缺损的创伤后胫骨骨不连患者中的应用。
非随机前瞻性、病例系列、单中心研究。
埃及开罗 El-Helal 医院骨科和创伤科，肢体重建科。
50 例伴有复合骨和软组织缺损的创伤后胫骨骨不连患者。
25 例患者采用骨搬运（BT）技术治疗，25 例患者采用急性短缩（AS）和牵张技术治疗。
外固定指数（EFI）；功能和骨结果；并发症发生率。
所有患者均在去除伊利扎罗夫架后至少随访 18 个月。AS 和 BT 组的平均随访时间分别为 19.7 和 20.3 个月。AS 组切除和清创后的平均骨间隙为 4cm，BT 组为 5.9cm（P=0.06）。AS 组的平均 EFI 明显低于 BT 组（P=0.03）。两组之间没有其他统计学上的显著差异。
两种技术均取得了良好到优秀的结果，并发症的数量和 ASAMI 评分在骨或功能方面的差异没有统计学意义。然而，AS 技术似乎更具优势，因为它的 EFI 明显较低。然而，这种技术并非在所有情况下都可行，因为 AS 技术受限于缺损的大小和周围软组织的状况。
治疗水平 II。欲了解完整的证据水平描述，请参见作者指南。
