用于肢体保全的下肢截骨术：适应症、疗效及危险因素。
Lower extremity osteotomies for limb preservation: Indications, outcomes, and risk factors.
作者信息
Rucinski Kylee, Garlapaty Ashwin, Hartwig Jacob, Cook James L, Crist Brett D
机构信息
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
School of Medicine, University of Missouri, Columbia, MO, USA.
出版信息
J Orthop. 2024 Oct 15;62:49-55. doi: 10.1016/j.jor.2024.10.011. eCollection 2025 Apr.
OBJECTIVES
To delineate the key factors associated with treatment success or failure for patients undergoing lower extremity osteotomies to address a spectrum of lower extremity joint and limb deformities at an Integrated Limb Preservation Center (ILPC).
METHODS
Retrospective cohort study. Level I Academic Trauma Center. Patients of the ILPC with at least 1-year of follow-up data regarding previous surgery to correct trauma-or developmental-related deformities between January 1, 2005, and October 1, 2022. Patients were categorized first based on etiology (developmental vs. traumatic) and then based on the nature of deformity (joint, limb, nonunion). Treatment data, demographics including age, sex, body mass index (BMI), tobacco use history, insurance status, marital status, mental health history, and history of comorbidities, concurrent procedures, and post-operative infection, revision, reoperation, and bone healing status were extracted from the medical record and compared. Treatment failure was defined as conversion of the limb preservation surgery (ies) to amputation of any type.
RESULTS
139 patients were included for analysis; 47 patients in the developmental-related cohort, and 92 patients in the trauma-related cohort. The treatment success rate in terms of preserving the affected limb for patients undergoing lower extremity osteotomies was 94.7 % for the developmental-related cohort and 92.4 % for the traumatic-related cohort. 57.4 % of patients in the developmental-related cohort and 59.8 % of patients in the trauma-related underwent unplanned secondary procedures Concurrent osteomyelitis debridement (p = 0.01) and postoperative infection (p = 0.049) were the only factors measured significantly associated with conversion to amputation.
CONCLUSIONS
Patients undergoing osteotomies at an ILPC to address developmental-related or trauma-related joint and/or limb deformities experienced high short-term success (>90 %) with respect to preserving the affected limb. However, 56 % of patients required subsequent unplanned surgeries and improvements in PROMs were only statistically significant in patients with trauma-related deformities.
LEVEL OF EVIDENCE
III.
目的
在综合肢体保全中心（ILPC），明确接受下肢截骨术以治疗一系列下肢关节和肢体畸形的患者治疗成功或失败的关键因素。
方法
回顾性队列研究。一级学术创伤中心。ILPC的患者，有2005年1月1日至2022年10月1日期间关于既往矫正创伤或发育相关畸形手术的至少1年随访数据。患者首先根据病因（发育性与创伤性）分类，然后根据畸形性质（关节、肢体、骨不连）分类。从病历中提取治疗数据、人口统计学信息，包括年龄、性别、体重指数（BMI）、吸烟史、保险状况、婚姻状况、心理健康史、合并症病史、同期手术、术后感染、翻修、再次手术和骨愈合状况，并进行比较。治疗失败定义为肢体保全手术转为任何类型的截肢。
结果
139例患者纳入分析；发育相关队列47例患者，创伤相关队列92例患者。下肢截骨术患者保留患肢的治疗成功率，发育相关队列中为94.7%，创伤相关队列中为92.4%。发育相关队列中57.4%的患者和创伤相关队列中59.8%的患者接受了计划外二次手术。同时进行骨髓炎清创术（p = 0.01）和术后感染（p = 0.049）是与截肢转换显著相关的仅有的测量因素。
结论
在ILPC接受截骨术以治疗发育相关或创伤相关关节和/或肢体畸形的患者，在保留患肢方面短期成功率较高（>90%）。然而，56%的患者需要后续计划外手术，且患者报告结局量表（PROMs）的改善仅在创伤相关畸形患者中有统计学意义。
证据级别
III级
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