Whitlock Keith G, Brodke Dane J, Khoury Philip H, Li Vivian, Bell Alice, Okhuereigbe David, Sciadini Marcus F, Nascone Jason W, O'Toole Robert V, O'Hara Nathan N, Gage Mark J
Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
J Orthop Trauma. 2025 Apr 1;39(4):161-166. doi: 10.1097/BOT.0000000000002953.
To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length.
Retrospective cohort.
Level I trauma center.
Adult patients with segmental tibial defects (OTA/AO 41, 42, 43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011 and 2022 with a minimum 1-year follow-up were included.
The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder.
Twenty-four patients treated with bone transport [mean age 40 years (18-66), 100% men] and 22 patients treated with Masquelet [mean age 42 years (22-71), 91% men] were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and postinfectious in 21 patients (46%) ( P = 0.23). The median defect size was 7.2 cm (interquartile range 6.1-10.1) for transport and 5.8 cm for Masquelet (interquartile range 4.7-8.0) ( P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (odds ratio, 0.15; 95% confidence interval, 0.03-0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (odds ratio, 0.18; 95% confidence interval, 0.03-0.76; P = 0.03).
Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定骨搬运术或Masquelet技术治疗长度≥4cm的胫骨节段性骨缺损时，非计划再次大手术的发生率是否更高。
回顾性队列研究。
一级创伤中心。
纳入2011年至2022年间接受环形固定器骨搬运术或Masquelet技术手术治疗、胫骨节段性缺损（OTA/AO 41、42、43）≥4cm且至少随访1年的成年患者。
主要结局是截骨术（骨搬运）或自体骨移植术（Masquelet）后非计划再次大手术，包括膝下截肢、深部感染的手术清创或骨不连的手术干预。采用多变量逻辑回归比较环形固定器骨搬运术和Masquelet技术，并将缺损大小作为潜在混杂因素进行校正。
纳入24例接受骨搬运术的患者[平均年龄40岁（18 - 66岁），100%为男性]和22例接受Masquelet技术的患者[平均年龄42岁（22 - 71岁），91%为男性]。25例患者（54%）的缺损病因确定为急性创伤，21例患者（46%）为感染后（P = 0.23）。骨搬运术组缺损大小中位数为7.2cm（四分位间距6.1 - 10.1），Masquelet技术组为5.8cm（四分位间距4.7 - 8.0）（P = 0.08）。与Masquelet技术相比，骨搬运术使非计划再次大手术的几率降低了85%（优势比，0.15；95%置信区间，0.03 - 0.58；P = 0.01）。骨搬运术组患者平均非计划再次大手术次数为0.38次，而Masquelet技术组为0.91次。骨搬运术组深部感染再次手术发生率（21%）显著低于Masquelet技术组（46%）（优势比，0.18；95%置信区间，0.03 - 0.76；P = 0.03）。
对于胫骨节段性骨缺损，与Masquelet技术相比，骨搬运术与再次大手术发生率降低相关。这一发现可能是由于骨搬运术组感染相关手术较少。
治疗性三级。有关证据级别的完整描述，请参阅《作者须知》。
