Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
BMC Musculoskelet Disord. 2024 Apr 12;25(1):284. doi: 10.1186/s12891-024-07377-2.
The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection.
Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification.
A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B.
Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.
本研究旨在评估和比较环形或单侧外固定架结合髓内钉骨搬运术治疗感染引起的胫骨骨缺损的临床疗效。
2010 年 5 月至 2019 年 1 月，收集并分析了感染引起骨缺损患者的临床和影像学资料。13 例患者采用单侧外固定架结合髓内钉进行骨搬运（A 组），12 例患者采用环形外固定架结合髓内钉治疗（B 组）。采用伊利扎罗夫方法的应用与研究协会（ASAMI）标准评估两组骨与功能结果，并根据 Paley 分类评估术后并发症。
共 25 例患者成功接受外固定架结合髓内钉骨搬运治疗，平均随访时间为 31.63±5.88 个月。A 组和 B 组在年龄、性别、每位患者的既往手术次数、感染持续时间、缺损大小和随访时间方面无统计学差异（P>0.05）。然而，手术时间（187.13±21.88 min 与 255.76±36.42 min，P=0.002）、术中出血量（39.26±7.33 mL 与 53.74±10.69 mL，P<0.001）、外固定时间（2.02±0.31 月与 2.57±0.38 月，P=0.045）、外固定指数（0.27±0.08 月/cm 与 0.44±0.09 月/cm，P=0.042）和骨愈合时间（8.37±2.30 月与 9.07±3.12 月，P=0.032）有统计学差异。A 组骨与功能结果的优良率高于 B 组（76.9%比 75%和 84.6%比 58.3%）。A 组功能结果（优/良/可/差，5/6/2/0 与 2/5/4/1，P=0.013）和每位患者并发症（0.38 与 1.16，P=0.012）有统计学差异。
髓内钉结合外固定架骨搬运术治疗感染引起的胫骨骨缺损是一种有效的方法。与环形外固定架相比，单侧外固定架结合髓内钉骨搬运术可减少外固定时间，减少并发症，获得更好的功能结果。
