Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, P. R. China.
Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, P. R. China.
BMC Musculoskelet Disord. 2023 Nov 16;24(1):891. doi: 10.1186/s12891-023-07001-9.
Ilizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods.
Studies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique.
Sixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity.
Our study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.
伊里扎洛夫（Ilizarov）方法已成为治疗骨缺损的主要方法之一。目前，应用改良伊里扎洛夫方法（例如，使用单侧外固定器或带有皮瓣组织）及其联合方法（例如，伊里扎洛夫方法联合抗生素间隔物或内固定）治疗骨缺损的趋势日益增加。然而，缺乏对这些不断发展的方法的临床效果进行系统评估的研究。本研究旨在对伊里扎洛夫方法及其联合方法治疗下肢长骨缺损的临床效果进行系统评价和荟萃分析。
从最早的索引年份到 2022 年 11 月 1 日，在三个电子数据库（Pubmed、Embase 和 Cochrane Library）中检索研究，并随后提取相关数据。本研究提取了总参与者人数、骨愈合参与者人数、骨结果或功能结果以及相关并发症（包括钉感染、钉松动、疼痛、再骨折、肢体差异、对线不良、关节僵硬、复发性感染和截肢）的相关数据。然后，分别汇总估计愈合率（定义为达到骨愈合的患者比例）和特定并发症发生率（定义为经历特定并发症的患者比例）。相对风险（RR）用于比较各种伊里扎洛夫技术的临床效果。
最终纳入 68 项病例系列研究、29 项对照研究和 3 项随机临床试验。伊里扎洛夫方法治疗胫骨缺损的愈合率为 99.29%（95%CI：98.67%99.86%），股骨缺损的愈合率为 98.81%（95%CI：98.81%100.00%）。伊里扎洛夫方法联合抗生素间隔物和髓内钉治疗胫骨缺损的愈合率分别为 99.58%（95%CI：98.05%100.00%）和 95.02%（95%CI：87.28%100.00%）。与伊里扎洛夫方法相比，胫骨缺损中伊里扎洛夫方法联合抗生素间隔物的愈合率略有增加（RR=1.02，95%CI：1.01~1.04）。同时，与伊里扎洛夫方法相比，我们发现伊里扎洛夫方法联合抗生素间隔物在骨结果方面的优秀率较低，且存在中度至高度异质性。与伊里扎洛夫方法相比，伊里扎洛夫方法联合髓内钉治疗的钉感染率较低，复发性感染和截肢率较高，但两组之间的钉感染和复发性感染比较结果存在高度统计学异质性。
本研究证实了伊里扎洛夫方法及其联合技术对长骨缺损的可靠治疗效果，并发现伊里扎洛夫方法及其联合技术在某些并发症发生率方面存在显著差异。然而，这些发现需要进一步的研究来证实。
