Medical University of Vienna, Department of Orthopedics and Trauma-Surgery, Division of Trauma Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Medical University of Vienna, Department of Orthopedics and Trauma-Surgery, Division of Trauma Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Orthop Traumatol Surg Res. 2021 Dec;107(8):103081. doi: 10.1016/j.otsr.2021.103081. Epub 2021 Sep 25.
Various approaches have been used to evaluate callus stiffness in distraction osteogenesis. This assessment becomes even more critical as inadequate corticalization and premature removal of the frame lead to bending, refracture, and loss of length. This study aimed to verify the objective Pixel Value Ratio (PVR) and define an evaluation scheme to assess callus tissue development during internal and external bone lengthening.
There are no differences between subjective parameters and objective evaluation for external and internal bone lengthening.
We included 24 patients in this retrospective study, treated by distraction osteogenesis of the lower limb. Ten patients were treated with external ring fixators and 14 with intramedullary lengthening devices. The minimum distraction distance was 3cm. Callus tissue was evaluated with the PVR, using digital X-rays during and after treatment. We combined this method with subjective evaluation parameters, including the continuity, signal intensity, and the regeneration tissue's homogeneity, presented in the X-ray Evaluation System for Distraction Osteogenesis (XESDO).
The subjective evaluation showed an increase of continuity and signal-intensity between 4th postoperative weeks and complete healing with significant differences between the external and internal groups for homogeneity only after four weeks and for all parameters at 3C (p<0.05). The PVR showed an increase during consolidation with values between 0.7 and 1.0 for both groups with almost perfect interobserver agreement. Significant lower values were found in the anterior tibial cases.
PVR appears to be a practical tool for radiological evaluation of callus tissue development. In combination with the newly introduced XESDO and the surgeon's experience, these methods can be helpful for decisions during all phases of distraction osteogenesis. It is important for adapting alignment or distraction-rate, as various potential complications can be detected early. However, further studies are necessary to assess the image-based determination of callus tissue stability.
III; cohort study.
在牵张成骨术中，已经使用了各种方法来评估骨痂的刚度。由于皮质化不足和框架过早去除导致弯曲、再骨折和长度丢失，这种评估变得更加关键。本研究旨在验证客观像素值比（PVR）并定义一种评估方案，以评估内外骨延长过程中骨痂组织的发育。
在内外骨延长中，主观参数与客观评估之间没有差异。
我们回顾性纳入了 24 名接受下肢牵张成骨术治疗的患者。10 名患者接受外固定环固定器治疗，14 名患者接受髓内延长装置治疗。最小的牵开距离为 3cm。在治疗过程中和治疗后，使用数字 X 射线通过 PVR 评估骨痂组织。我们将这种方法与主观评估参数（包括连续性、信号强度和再生组织的均匀性）相结合，这些参数在牵张成骨 X 射线评估系统（XESDO）中呈现。
主观评估显示，在术后第 4 周，连续性和信号强度增加，在内部和外部组之间仅在第 4 周时，在均匀性方面存在显著差异，而在所有参数方面在 3C 时存在显著差异（p<0.05）。在巩固期间，PVR 增加，两组的数值在 0.7 到 1.0 之间，观察者间具有几乎完美的一致性。在前胫骨病例中发现了较低的数值。
PVR 似乎是评估骨痂组织发育的一种实用工具。结合新引入的 XESDO 和外科医生的经验，这些方法可以在牵张成骨术的所有阶段都有助于决策。它对于适应对线或牵开率很重要，因为可以早期发现各种潜在的并发症。然而，需要进一步的研究来评估基于图像的骨痂组织稳定性的确定。
III；队列研究。
