Kliushin Nikolay Mikhailovich, Burnashov Sergy I, Mekki Waleed Ahmed, Leonchuk Darya S, Sudnitsyn Anatoliy Sergeyevich
Russian Ilizarov Scientific Center for Retorative Traumatology and Orthopaedics, 6, M.Ulyanova Street, Kurgan, 640014, Russian Federation.
J Clin Orthop Trauma. 2021 Oct 22;24:101652. doi: 10.1016/j.jcot.2021.101652. eCollection 2022 Jan.
Postoperative Tibial chronic osteomyelitis is one of the most challenging orthopaedic conditions especially when extensive, the anatomy of subcutaneous anteromedial part of the tibia with less soft tissue coverage complicates the situation. The extent of infected tibial part varies in size and duration from one patient to another. We report our experience using Bifocal and Monofocal bone transport techniques with regard to clinical outcome, recurrence of infection and re-fracture rate.
This is a retrospective observational review of 49 patients with postoperative Tibial chronic osteomyelitis which were treated using either Bifocal distraction compression BFDCO technique group I (31 patients) or Monofocal compression osteosynthesis MFCO technique Group II (18 patients). The average age of the patients was (41.6 ± 13.1 years), (range: 17-67 years). Leg length discrepancy was measured in 33 (58.9%) patients with an average of (1.4 ± 1.7 cm). Contracture of the ankle joint and equinus deformity were detected in 36 (64.3%) patients. Pre and Post-operative radiography together with Modified Irzhansky A.A et al. leg functional assessment system were used to assess the functional outcome.
The time spent in the Ilizarov fixator (External Fixation Index) in the first group was (142 ± 72 days) and in the second group was (75 ± 54 days) The infection recurred in 2 patients (6%) in group I and in 5 patients (28%) in group II. Lack of consolidation or re-fracture within 6 months after the dismantling of the apparatus was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in group II. Lack of consolidation or re-fracture within 6 months after dismantling of the apparatus in group I was detected in 6 patients (19.5%) in group I and in 5 patients (27.8%) in Group II. The average functional state score (AFSS) in the first group was (12.45 ± 2.41) on admission and increased to (16.16 ± 2.99) on the final follow-up which corresponded to a "good" result. In the second group II the AFSS was (12.11 ± 2.22) on admission and increased to (15.06 ± 2.88) at the final follow-up which corresponded to a "satisfactory" result.
Treatment of Tibial chronic osteomyelitis using either Bifocal or Monofocal bone transport is an effective method. However our results have demonstrated better functional outcome and less infection recurrence and re-fracture rates when using the Bifocal distraction compression technique (BFDCO).
术后胫骨慢性骨髓炎是最具挑战性的骨科疾病之一，尤其是病变范围广泛时，胫骨前内侧皮下部分解剖结构软组织覆盖较少，使情况更为复杂。感染的胫骨部分范围大小和持续时间因人而异。我们报告了使用双焦点和单焦点骨搬运技术在临床结果、感染复发和再骨折率方面的经验。
这是一项对49例术后胫骨慢性骨髓炎患者的回顾性观察研究，这些患者采用双焦点牵张加压（BFDCO）技术组I（31例患者）或单焦点加压骨固定术（MFCO）技术组II（18例患者）进行治疗。患者的平均年龄为（41.6±13.1岁），（范围：17 - 67岁）。在33例（58.9%）患者中测量了下肢长度差异，平均为（1.4±1.7厘米）。在36例（64.3%）患者中检测到踝关节挛缩和马蹄足畸形。术前和术后的X线摄影以及改良的伊尔赞斯基A.A等人的腿部功能评估系统用于评估功能结果。
第一组患者在伊里扎洛夫固定器中花费的时间（外固定指数）为（142±72天），第二组为（75±54天）。第一组有2例患者（6%）感染复发，第二组有5例患者（28%）感染复发。在第一组中，6例患者（19.5%）在拆除器械后6个月内出现骨不连或再骨折，第二组中有5例患者（27.8%）出现这种情况。第一组患者入院时的平均功能状态评分（AFSS）为（12.45±2.41），在最后一次随访时增加到（16.16±2.99），这相当于“良好”的结果。在第二组II中，入院时AFSS为（12.11±2.22），在最后一次随访时增加到（15.06±2.88），这相当于“满意”的结果。
使用双焦点或单焦点骨搬运治疗胫骨慢性骨髓炎是一种有效的方法。然而，我们的结果表明，使用双焦点牵张加压技术（BFDCO）时功能结果更好，感染复发和再骨折率更低。
