Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
BMC Musculoskelet Disord. 2022 Oct 8;23(1):900. doi: 10.1186/s12891-022-05852-2.
The purpose of this study was to investigate the risk factors of transport gap bending deformity (TGBD) in the treatment of critical-size bone defect (CSBD) after the removal of the external fixator.
From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using a unilateral external fixator in our medical institution. TGBD was defined as the bone callus in the distraction area with a deviation to the force line of the femur (> 10°) or tibia (> 12°) after removal of the external fixator. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson's Chi-square test was analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD.
A total of 178 patients were enrolled in the study, with a mean follow-up time of 28.6 ± 3.82 months. The positive result of the bacteria isolated test was observed in 144 cases (80.9%). The rate of excellent and good in the bone outcomes (excellent/good/fair/poor/failure, 41/108/15/14/0) was 83.7%, and 92.3% in the functional results (excellent/good/fair/poor/failure, 50/98/16/14/0) according to the ASAMI criteria. TGBD after removal of external fixator occurred in twenty-two patients (12.3%), including 6 tibias, and 16 femurs. Age > 45 years, BMI > 25 kg/m, femoral defect, diabetes, osteoporosis, glucocorticoid intake, duration of infection > 24 months, EFT > 9 months, EFI > 1.8 month/cm were associated significantly with a higher incidence of TGBD in the binary logistic regression analysis (P < 0.05). The incidence more than 50% was found in patients with femoral defect (76.1%), osteoporosis (72.7%), BMI > 25 kg/m (69.0%), diabetes (59.5%), glucocorticoid intake (54.7%). In the multivariate logistic regression analyses, the following factors were associated independently with TGBD, including age > 45 years, BMI > 25 kg/m, femoral defect, diabetes, and osteoporosis.
Bone transport using a unilateral external fixator was a safe and practical method in the treatment of CSBD caused by infection. The top five risk factors of TGBD included femoral defect, BMI > 25 kg/m, duration of bone infection > 24 months, age > 45 years, and diabetes. Age > 45 years, BMI > 25 kg/m, femoral defect, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.
本研究旨在探讨外固定器去除后治疗大骨缺损（CSBD）时发生交通间隙弯曲畸形（TGBD）的危险因素。
2008 年 1 月至 2019 年 12 月，我院采用单侧外固定架骨搬运治疗感染所致下肢骨缺损患者 178 例。将外固定器去除后骨搬运区骨痂向股骨（>10°）或胫骨（>12°）力线偏斜定义为 TGBD。应用 Association for the Study and Application of the Method of Ilizarov（ASAMI）标准评估骨与功能结局。对 T 检验或 Pearson's Chi-square 检验有统计学意义的指标进行分析，应用 logistic 回归检验计算比值比，以描述与 TGBD 诊断相关的因素。
共纳入 178 例患者，平均随访时间 28.6±3.82 个月。144 例（80.9%）分离培养阳性。根据 ASAMI 标准，骨结局优良率为 83.7%（优/良/可/差/失败，41/108/15/14/0），功能结局优良率为 92.3%（优/良/可/差/失败，50/98/16/14/0）。22 例（12.3%）患者在去除外固定器后发生 TGBD，其中 6 例为胫骨，16 例为股骨。二元逻辑回归分析显示，年龄>45 岁、BMI>25kg/m2、股骨干缺损、糖尿病、骨质疏松、糖皮质激素使用、感染持续时间>24 个月、EFT>9 个月、EFI>1.8 月/cm 与 TGBD 发生率较高显著相关（P<0.05）。股骨缺损（76.1%）、骨质疏松（72.7%）、BMI>25kg/m2（69.0%）、糖尿病（59.5%）、糖皮质激素使用（54.7%）患者的发生率均>50%。多因素逻辑回归分析显示，年龄>45 岁、BMI>25kg/m2、股骨干缺损、糖尿病和骨质疏松与 TGBD 独立相关。
采用单侧外固定架骨搬运治疗感染所致 CSBD 是一种安全有效的方法。导致 TGBD 的前 5 个危险因素包括股骨干缺损、BMI>25kg/m2、骨感染持续时间>24 个月、年龄>45 岁和糖尿病。年龄>45 岁、BMI>25kg/m2、股骨干缺损、骨质疏松和糖尿病是独立的危险因素。较高的 TGBD 发生率可能与更多的危险因素有关。
