伊利扎洛夫骨搬运技术治疗胫骨骨缺损的 docking 部位并发症分析。
Docking site complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects.
机构信息
Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
出版信息
J Orthop Surg Res. 2023 Nov 22;18(1):889. doi: 10.1186/s13018-023-04356-6.
BACKGROUND
Treating long bone defects of the extremities caused by trauma, infection, tumours, and nonunion has been challenging for clinical orthopaedic surgeons. Bone transport techniques have the potential to treat bone defects. However, inevitable docking site complications related to bone transport techniques have been reported in many studies. The purpose of this study was to investigate the risk factors associated with docking site complications in patients who underwent the Ilizarov bone transport technique for the treatment of tibial bone defects.
METHODS
This retrospective study included 103 patients who underwent bone transport for the treatment of large bone defects in the tibia from October 2012 to October 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, univariate analysis and logistic regression analysis were used to analyse the factors that may affect the development of docking site complications in patients with tibial bone defects treated with the Ilizarov bone transport technique. The clinical outcomes were evaluated using the Association for the Study and Application of the Ilizarov criteria (ASAMI) at the last clinical follow-up.
RESULTS
All 103 patients with an average follow-up of 27.5 months. The docking site complications rate per patient was 0.53, and delayed union occurred in 22 cases (21.4%), axial deviation occurred in 19 cases (18.4%) and soft tissue incarceration occurred in 10 cases (9.7%). According to the results of the logistic regression analysis, the bone defect length (P = 0.001, OR = 1.976), and bone defect of distal 1/3 (P = 0.01, OR = 1.976) were significantly correlated with delayed union. Bone defect length (P < 0.001, OR = 1.981) and external fixation time (P = 0.012, OR = 1.017) were significantly correlated with axial deviation. Soft tissue defects (P = 0.047, OR = 6.766) and the number of previous operations (P = 0.001, OR = 2.920) were significantly correlated with soft tissue incarceration. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.1% and a rate of excellent functional results of 90.3%.
CONCLUSION
The Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect length, external fixation time, the number of previous operations, soft tissue defects and the bone defect of distal 1/3 are statistically significantly associated with the occurrence of docking site complications.
背景
创伤、感染、肿瘤和骨不连引起的四肢长骨缺损的治疗一直是临床骨科医生面临的挑战。骨搬运技术有治疗骨缺损的潜力。然而，许多研究报道了与骨搬运技术相关的不可避免的会师点并发症。本研究旨在探讨接受伊利扎洛夫骨搬运技术治疗胫骨骨缺损的患者中与会师点并发症相关的危险因素。
方法
本回顾性研究纳入了 2012 年 10 月至 2019 年 10 月期间接受骨搬运治疗的 103 例胫骨大骨缺损患者。收集了患者的人口统计学数据、并发症和至少 2 年随访后的临床结果，并进行回顾性分析。此外，采用单因素分析和逻辑回归分析，分析伊利扎洛夫骨搬运技术治疗胫骨骨缺损患者会师点并发症发生的可能影响因素。最后临床随访时采用伊利扎洛夫应用研究协会（ASAMI）标准评估临床结果。
结果
所有 103 例患者平均随访 27.5 个月。每位患者的会师点并发症发生率为 0.53%，其中发生延迟愈合 22 例（21.4%），发生轴向偏移 19 例（18.4%），发生软组织嵌顿 10 例（9.7%）。逻辑回归分析结果显示，骨缺损长度（P=0.001，OR=1.976）和骨缺损远 1/3（P=0.01，OR=1.976）与延迟愈合显著相关。骨缺损长度（P<0.001，OR=1.981）和外固定时间（P=0.012，OR=1.017）与轴向偏移显著相关。软组织缺损（P=0.047，OR=6.766）和既往手术次数（P=0.001，OR=2.920）与软组织嵌顿显著相关。末次随访时 ASAMI 骨评分显示，优良骨结果率为 95.1%，优良功能结果率为 90.3%。
结论
伊利扎洛夫骨搬运技术是治疗胫骨骨缺损的一种实用有效的方法。然而，会师点并发症的发生率较高，其中骨缺损长度、外固定时间、既往手术次数、软组织缺损和骨缺损远 1/3 与会师点并发症的发生有统计学显著相关性。
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