Sigmund Irene K, Ferguson Jamie, Govaert Geertje A M, Stubbs David, McNally Martin A
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Foundation NHS Trust, Windmill Rd, Headington, Oxford OX3 7HE, UK.
Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, Vienna 1090, Austria.
J Clin Med. 2020 Jan 28;9(2):279. doi: 10.3390/jcm9020279.
This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber-Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16-128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) ( = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment ( = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% ( < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.
本前瞻性研究比较了双焦点急性缩短和延长术（ASR）与骨搬运术（BT）在一系列连续性复杂胫骨感染性骨不连和骨髓炎中的应用效果，旨在重建感染病灶手术切除后形成的节段性骨缺损。入选患者为胫骨节段性感染性骨缺损（>2 cm）者。根据缺损大小、软组织状况及腓骨状态（完整或断裂），采用标准化方案将患者分配至ASR组或BT组。我们记录了Weber-Cech分类、既往手术情况、外固定时间、外固定指数（EFI）、随访时长、骨愈合时间、ASAMI骨与功能评分以及并发症情况。共纳入47例患者（ASR组：20例；BT组：27例），中位随访时间为37.9个月（范围16 - 128个月）。ASR组平均骨缺损大小为4.0 cm，平均外固定架固定时间为8.8个月。BT组平均骨缺损大小为5.9 cm，平均外固定架固定时间为10.3个月。ASR组与BT组的EFI无统计学显著差异（分别为2.0和1.8个月/cm）（P = 0.223）。ASR组20例患者中有3例、BT组27例患者中有15例在Ilizarov治疗期间需要进行计划外的进一步手术（P = 0.006）。BT组的对接部位手术明显更频繁；BT组为66.7%，而ASR组为5.0%（P < 0.0001）。两组在最终随访时感染根除率均为100%。两组最终的ASAMI功能评分和骨评分相似。采用Ilizarov方法进行节段性切除对重建感染性胫骨缺损有效且安全，可根除感染并实现高骨愈合率。然而，BT组计划外手术发生率更高，尤其是对接部位的翻修手术。急性缩短和延长术并未降低固定架指数。两种技术在治疗完成后均能带来良好的功能预后。
