Liu Kai, Cai Feiyu, Liu Yanshi, Abulaiti Alimujiang, Ren Peng, Yusufu Aihemaitijiang
Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China.
BMC Musculoskelet Disord. 2021 Apr 9;22(1):339. doi: 10.1186/s12891-021-04214-8.
Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis (OA) progression and severity are often associated with the period of external fixator and the greater relative instability of the ankle joint, but few studies have quantified risk factors directly during this technique.
The study was conducted on 236 patients who underwent bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. The cumulative incidence of ankle OA diagnoses in patients after the Ilizarov technique treatment was calculated and stratified by risk factors from preoperative and postoperative management. After the data were significant through the Mann-Whitney U test analyzed, odds ratios were calculated using logistic regression to describe factors associated with the OA diagnosis including gender, age, BMI, location of bone defect, diabetes, hypertension, osteoporosis, the history of metal allergy and glucocorticoid intake, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-HF scale scores, defect size (DS), the type of bone transport, the bone union time, external fixator time (EFT), and external fixator index (EFI).
There were 199 males and 37 females with a mean age of 47 years (range 28-59 years). Out of 236 patients, 49 had an additional treatment for ankle OA after the Ilizarov technique treatment of bone defects (average follow-up time 2.1 years, range 1.6-4.2 years). The incidence of postoperative ankle OA was 20.8 %, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The top five risk factors included double-level bone transport (OR3.79, P = 0.005), EFI > 50days/cm (OR3.17, P = 0.015), age > 45years (OR2.29, P = 0.032), osteoporosis (OR1.58, P < 0.001), BMI > 25 (OR1.34, P < 0.001). Male, BMI > 25, diabetes, osteoporosis, and AOFAS ankle-HF scale scores are the independent risk factors.
Ilizarov external circular fixator is a safe and effective method of treatment for critical bone defects. The double level bone transport, EFI > 50days/cm, age > 45years, osteoporosis, BMI > 25 are the top five relevant risk factors of ankle OA. The probability of developing ankle OA among patients having three or more risk factors is 50-70 %.
使用伊里扎洛夫（Ilizarov）外固定环支架的牵张成骨术已广泛应用于下肢重建手术。踝关节骨关节炎（OA）进展和严重程度的增加通常与外固定器使用时间以及踝关节相对更大的不稳定性有关，但很少有研究在该技术过程中直接对风险因素进行量化。
对2008年至2018年期间使用伊里扎洛夫外固定环支架进行胫骨骨搬运手术的236例患者进行研究。计算伊里扎洛夫技术治疗后患者踝关节OA诊断的累积发病率，并根据术前和术后管理的风险因素进行分层。在通过曼-惠特尼U检验分析数据具有显著性后，使用逻辑回归计算比值比，以描述与OA诊断相关的因素，包括性别、年龄、体重指数（BMI）、骨缺损部位、糖尿病、高血压、骨质疏松症、金属过敏史和糖皮质激素摄入情况、美国矫形足踝协会（AOFAS）踝关节-后足评分、缺损大小（DS）、骨搬运类型、骨愈合时间、外固定器使用时间（EFT）和外固定器指数（EFI）。
共199例男性和37例女性，平均年龄47岁（范围28 - 59岁）。236例患者中，49例在伊里扎洛夫技术治疗骨缺损后接受了踝关节OA的额外治疗（平均随访时间2.1年，范围1.6 - 4.2年）。术后踝关节OA的发生率为20.8%，其中19例为K&L 3级，7例为4级。前五个风险因素包括双平面骨搬运（比值比3.79，P = 0.005）、EFI＞50天/厘米（比值比3.17，P = 0.015）、年龄＞45岁（比值比2.29，P = 0.032）、骨质疏松症（比值比1.58，P＜0.001）、BMI＞25（比值比1.34，P＜0.001）。男性、BMI＞25、糖尿病、骨质疏松症和AOFAS踝关节-后足评分是独立风险因素。
伊里扎洛夫外固定环支架是治疗严重骨缺损的一种安全有效的方法。双平面骨搬运、EFI＞50天/厘米、年龄＞45岁、骨质疏松症、BMI＞25是踝关节OA的前五个相关风险因素。有三个或更多风险因素的患者发生踝关节OA的概率为50 - 70%。
