Boksh Khalis, Kanthasamy Senthooran, Divall Pip, Abraham Alwyn
Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, Leicestershire, United Kingdom.
Strategies Trauma Limb Reconstr. 2022 Sep-Dec;17(3):172-183. doi: 10.5005/jp-journals-10080-1570.
Tibial non-unions present with complex deformities, bone loss, infection, leg length discrepancy (LLD), and other features which influence function. Circular frame-based treatment is popular with the hexapod system used increasingly. This systematic review aims to determine the clinical and radiological outcomes of hexapod fixation when used for tibial non-unions.
The review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The search strategy was applied to MEDLINE and Embase databases on 15 December 2021. Studies reporting either clinical or radiological outcomes following hexapod fixation on tibial non-unions were included. Primary outcomes were radiological union and patient-reported outcome measures (PROMs). Secondary outcomes included LLD, tibial alignment deformity (TAD), return to pre-injury activity and post-operative complications.
After the abstract and full-text screening, 9 studies were included; there were 283 hexapod frame fixations for tibial non-unions. Infection (46.6%) and stiff hypertrophic non-union (39.2%) accounted for most non-unions treated. The average age and mean follow-up were 42.2 years and 33.1 months, respectively. The average time to union was 8.7 months with a union rate of 84.8%. A total of 90.3% of patients had TAD below 5° in all planes, with an LLD ≤1.5 cm of the contralateral leg in 90.5%. Bony and functional results were at least good in over 90% of patients when using the Association for the Study of the Method of Ilizarov (ASAMI) criteria. A total of 84% of patients returned to pre-injury activities. There were complications as follows: a total of 34% developed pin-site infection, almost 9% experienced half-pin breakage and 14% developed an equinus ankle contracture.
Hexapod frames for the treatment of tibial non-unions produce favourable functional outcomes. Complication rates are present and need to be discussed when this modality of treatment is proposed. Further comparative studies will allow for this option to be evaluated against that of the traditional Ilizarov frame and other methods of non-union surgery.
Boksh K, Kanthasamy S, Divall P, . Hexapod Circular Frame Fixation for Tibial Non-union: A Systematic Review of Clinical and Radiological Outcomes. Strategies Trauma Limb Reconstr 2022;17(3):172-183.
胫骨骨不连常伴有复杂畸形、骨缺损、感染、肢体长度差异（LLD）以及其他影响功能的特征。基于环形外固定架的治疗方法很受欢迎，六足系统的应用越来越广泛。本系统评价旨在确定六足固定用于治疗胫骨骨不连的临床和放射学结果。
本评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。检索策略于2021年12月15日应用于MEDLINE和Embase数据库。纳入报告六足固定治疗胫骨骨不连后临床或放射学结果的研究。主要结局为放射学骨愈合和患者报告结局指标（PROMs）。次要结局包括肢体长度差异、胫骨对线畸形（TAD）、恢复伤前活动情况和术后并发症。
经过摘要和全文筛选，纳入9项研究；共283例胫骨骨不连采用六足外固定架固定。感染（46.6%）和僵硬肥大性骨不连（39.2%）占接受治疗的大多数骨不连类型。平均年龄和平均随访时间分别为42.2岁和33.1个月。平均骨愈合时间为8.7个月，骨愈合率为84.8%。所有平面上，90.3%的患者TAD低于5°，90.5%的患者肢体长度差异≤对侧腿1.5 cm。使用伊里扎洛夫方法研究协会（ASAMI）标准时，超过90%的患者骨和功能结果至少为良好。84%的患者恢复了伤前活动。并发症如下：34%的患者发生针道感染，近9%的患者出现半针断裂，14%的患者发生马蹄足踝关节挛缩。
用于治疗胫骨骨不连的六足外固定架产生了良好的功能结果。存在并发症发生率，在提出这种治疗方式时需要进行讨论。进一步的比较研究将使该方法能够与传统的伊里扎洛夫外固定架及其他骨不连手术方法进行评估。
Boksh K, Kanthasamy S, Divall P, . 六足环形外固定架治疗胫骨骨不连：临床和放射学结果的系统评价。《创伤肢体重建策略》2022；17(3):172 - 183。
