Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 650032, Sichuan, China.
BMC Musculoskelet Disord. 2023 Jun 23;24(1):514. doi: 10.1186/s12891-023-06527-2.
The purpose of this study was to report the outcomes of single-level bone transport with a unilateral external fixator for treatment of proximal, intermediate and distal tibial bone defects caused by fracture-related infection (FRI) and compare their complications.
The clinical records and consecutive X-ray photographs of patients with tibial bone defects treated by single-level bone transport using a unilateral external fixator (Orthofix Limb Reconstruction System) were analyzed retrospectively, from January 2012 to December 2018. Patients were divided into the proximal group (P, n = 19), intermediate group (I, n = 25), and distal group (D, n = 18) according to the location of the tibial bone defect. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes and postoperative complications evaluated by the Paley classification.
A total of 62 participants were included in this study, with a median age of 36 ± 7.14 years. Sixty patients with tibial bone defects caused by FRI were successfully treated by single-level bone transport using a unilateral external fixator, with a mean bone union time (BUT) of 7.3 ± 1.71 months. According to the ASAMI criteria, there were statistical differences in bone and function results between the three groups (P vs. I vs. D, P < 0.001). The excellent and good rate of bone result in the intermediate group was higher than the other (P vs. I vs. D, 73.6% vs. 84% vs. 66.7%), and the excellent and good rate of function result in the proximal group was the highest (P vs. I vs. D, 84.2% vs. 80% vs. 73.3%). Complications were observed in 29 out of 62 patients (46.7%), with pin tract infection being the most common (14.8%), followed by axial deviation (14.8%), muscle contractures (12.7%), joint stiffness (12.7%), and soft tissue incarceration (12.7%). Other complications included delayed consolidation (12.7%), delayed union (6.3%), nonunion (4.2%), and neurological injury (8.5%). Two patients (3.2%) required below-knee amputation due to uncontrollable infection and previous surgery failure.
Pin tract infection was the most common complication in tibial bone transport using an external fixator. Complications of distal tibial bone transport are more severe and occur at a higher rate than in other parts. Axial deviation mostly occurred in the intermediate tibial bone transport.
本研究旨在报告使用单侧外固定器进行单节段骨搬运治疗骨折相关感染（FRI）所致胫骨近端、中段和远端骨缺损的结果，并比较其并发症。
回顾性分析 2012 年 1 月至 2018 年 12 月使用单侧外固定器（Orthofix 肢体重建系统）治疗胫骨骨缺损的患者的临床记录和连续 X 线片。根据胫骨骨缺损的位置，患者分为近端组（P 组，n=19）、中段组（I 组，n=25）和远端组（D 组，n=18）。采用 Association for the Study and Application of the Method of Ilizarov（ASAMI）标准评估骨和功能结果，采用 Paley 分类评估术后并发症。
本研究共纳入 62 例患者，中位年龄 36±7.14 岁。60 例 FRI 所致胫骨骨缺损患者成功采用单侧外固定器进行单节段骨搬运治疗，平均骨愈合时间（BUT）为 7.3±1.71 个月。根据 ASAMI 标准，三组之间骨和功能结果存在统计学差异（P vs. I vs. D，P<0.001）。中段组骨结果的优良率高于其他两组（P vs. I vs. D，73.6% vs. 84% vs. 66.7%），而近端组功能结果的优良率最高（P vs. I vs. D，84.2% vs. 80% vs. 73.3%）。62 例患者中有 29 例（46.7%）出现并发症，最常见的是钉道感染（14.8%），其次是轴向偏差（14.8%）、肌肉挛缩（12.7%）、关节僵硬（12.7%）和软组织嵌顿（12.7%）。其他并发症包括延迟愈合（12.7%）、延迟愈合（6.3%）、不愈合（4.2%）和神经损伤（8.5%）。两名患者（3.2%）因感染不可控和先前手术失败而需要进行膝下截肢。
钉道感染是使用外固定器进行胫骨骨搬运最常见的并发症。胫骨远端骨搬运的并发症更严重，发生率更高。轴向偏差多发生在胫骨中段骨搬运。
