Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3225-3231. doi: 10.1007/s00590-024-04050-1. Epub 2024 Aug 2.
The reconstruction of segmental long bone defects remains one of 'The holy grails of orthopaedics'. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm.
A retrospective review of all patients undergoing treatment for segmental diaphyseal defects of long bones at a tertiary-level limb reconstruction unit between January 2016 and December 2021, was performed. The management of the bone defect was standardised as per the classification by Ferreira and Tanwar (2020).
A total of 96 patients (mean age 39.8, SD 15.2) with a minimum six months follow-up were included. Most bone defects were the result of open fractures (75/96) with 67% associated with Gustilo-Anderson IIIB injuries. There was a statistical difference in the likelihood of union between treatment strategies with more than 90% of cases undergoing acute shortening and bone transport achieving union and only 72% of cases undergoing the induced membrane technique consolidating (p = 0.049). Of those defects that consolidated, there was no difference in the time to bone union between strategies (p = 0.308) with an overall median time to union 8.33 months (95% CI 7.4 - 9.2 months). The induced membrane technique was associated with a 40% risk of sepsis.
This study reported the outcomes of a standardised approach to the management of critical-sized bone defects. Whilst overall results were supportive of this approach, the outcomes associated with the induced membrane technique require further refinement of its indications in the management of critical-sized bone defects.
节段性长骨缺损的重建仍然是矫形学的“圣杯”之一。其最佳治疗方法仍然是一个极具争议的话题。本研究旨在评估基于分类的治疗方案治疗临界尺寸骨缺损的结果。
对 2016 年 1 月至 2021 年 12 月在三级肢体重建单位接受长骨干节段性缺损治疗的所有患者进行回顾性研究。根据 Ferreira 和 Tanwar（2020 年）的分类，对骨缺损的管理进行了标准化。
共纳入 96 例（平均年龄 39.8，SD 15.2），随访时间至少 6 个月。大多数骨缺损是开放性骨折的结果（75/96），其中 67%与 Gustilo-Anderson IIIB 损伤相关。不同治疗策略之间的愈合可能性存在统计学差异，急性缩短和骨搬运术的病例中有超过 90%的病例达到愈合，而诱导膜技术的病例只有 72%的病例达到愈合（p=0.049）。在那些愈合的缺陷中，不同策略之间的骨愈合时间没有差异（p=0.308），总体中位数愈合时间为 8.33 个月（95%CI 7.4-9.2 个月）。诱导膜技术与 40%的败血症风险相关。
本研究报告了一种标准化方法治疗临界尺寸骨缺损的结果。尽管总体结果支持这种方法，但诱导膜技术的结果需要进一步完善其在临界尺寸骨缺损治疗中的适应证。
