Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany.
Department of Radiological Diagnostics, Interventional Radiology and Nuclear Medicine, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany.
Injury. 2021 Jun;52(6):1606-1613. doi: 10.1016/j.injury.2020.12.028. Epub 2020 Dec 31.
Segmental tibia defects remain challenging for orthopedic surgeons to treat. The aim of this study was to demonstrate bone-related and functional outcomes after treatment of complex tibial bone defects using Ilizarov bone transport with a modified intramedullary cable transportation system (CTS).
We conducted a single-center, retrospective study including all 42 patients treated for tibial bone loss via Ilizarov bone transport with CTS between 2005 and 2018. Bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Complication and failure rates were determined by the patients' medical files.
Patients had a mean age of 45.5 ± 15.1 years. The mean bone defect size was 7.7 ± 3.4 cm, the average nonunion scoring system (NUSS) score was 59 ± 9.5 points, and the mean follow-up was 40.8 ± 24.4 months (range, 13-139 months). Complete bone and soft tissue healing occurred in 32/42 patients (76.2%). These patients had excellent (10), good (17), fair (2), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 19 patients had excellent, 10 good, and 3 fair results. In total, 37 minor complications and 62 major complications occurred during the study. In 7 patients, bone and soft tissue healing occurred after CTS failure with either an induced membrane technique or classic bone transport; 3 patients underwent lower leg amputation. Patients with treatment failure were significantly older (57.6 vs. 41.8 years; p = 0.003). Charlson score and treatment failure had a positive correlation (Spearman's rho 0.43; p = 0.004).
Bone transport using both intramedullary CTS and Ilizarov ring fixation is viable for treating patients with bone loss of the tibia and complex infection or soft tissue conditions. However, a high number of complications and surgical revisions are associated with the treatment of this severe clinical entity and should be taken into account.
节段性胫骨缺损仍然是骨科医生治疗的难题。本研究旨在通过 Ilizarov 骨搬运结合改良髓内电缆搬运系统（CTS）治疗复杂胫骨骨缺损，展示其与骨相关的功能结果。
我们进行了一项单中心回顾性研究，纳入了 2005 年至 2018 年间采用 CTS 行 Ilizarov 骨搬运治疗胫骨骨缺损的 42 例患者。根据 Association for the Study and Application of Methods of Ilizarov（ASAMI）评分系统评估骨相关和功能结果。并发症和失败率通过患者的病历确定。
患者的平均年龄为 45.5 ± 15.1 岁。骨缺损大小的平均值为 7.7 ± 3.4 cm，非愈合评分系统（NUSS）评分的平均值为 59 ± 9.5 分，平均随访时间为 40.8 ± 24.4 个月（范围 13-139 个月）。32/42 例患者（76.2%）完全愈合。这些患者根据 ASAMI 功能评分，结果分别为优秀（10 分）、良好（17 分）、一般（2 分）和差（3 分）。关于骨量，19 例患者结果为优秀，10 例为良好，3 例为一般。研究期间共发生 37 例小并发症和 62 例大并发症。在 7 例患者中，CTS 失败后采用诱导膜技术或经典骨搬运技术，骨和软组织愈合；3 例患者行小腿截肢。治疗失败的患者年龄明显较大（57.6 岁 vs. 41.8 岁；p = 0.003）。Charlson 评分与治疗失败呈正相关（Spearman 相关系数 0.43；p = 0.004）。
髓内 CTS 和 Ilizarov 环固定联合骨搬运治疗胫骨骨缺损合并复杂感染或软组织情况是可行的。然而，这种严重的临床实体治疗相关的并发症和手术修正数量较多，应予以考虑。
