Mohd-Yusof N, Kow R Y, Sulong A F, Nallayan R M, Zainal-Abidin M A
Department of Orthopaedics, Traumatology and Rehabilitation, International Islamic University Malaysia, Kuantan, Malaysia.
Department of Community Medicine, International Islamic University Malaysia, Kuantan, Malaysia.
Malays Orthop J. 2025 Jul;19(2):91-98. doi: 10.5704/MOJ.2507.012.
Bone loss is a serious complication following an open fracture or fracture-related infection in the tibia. Treatment with Ilizarov bone transport in this condition is preferred because it minimises additional soft tissue injury and is able to close the bone and soft tissue defects through distraction osteogenesis. The objective of this study is to evaluate the relationship between functional outcomes of patients with tibial bone loss treated with Ilizarov bone transport and return to work.
A cross-sectional study among 40 patients was carried out in 2 public hospitals. Patient records and radiographs were reviewed for information on the initial injuries, treatment, union of bone, and complications while on treatment. The clinical outcomes were evaluated with ASAMI Bone grading system while the functional outcome of the affected limb was assessed using Lower Extremity Score (LEFS) and ASAMI Functional grading system at least 10 months after the removal of the Ilizarov external fixator.
Thirty-eight (95%) achieved union. Thirty-six (90.0%) patients had excellent and good scores for clinical and functional results, respectively using the ASAMI grading system. The mean LEFS is 80.1% (range 58 to 91%). Thirty-three (82.5%) patients were able to return to work. The clinical outcome has a strong and positive correlation with functional outcome both on ASAMI functional score and LEFS (p<0.001). Patients with good and excellent ASAMI functional scores significantly correlate with higher odds to return to work (p<0.001). Return to work was also associated with a higher LEFS score (p=0.006).
Most patients with tibial non-union treated with Ilizarov bone transport have good and excellent clinical and functional outcomes and are able to return to work. Return to work significantly correlates with good functional outcomes.
骨丢失是胫骨开放性骨折或骨折相关感染后的严重并发症。在这种情况下，采用伊里扎洛夫骨搬运治疗较为可取，因为它能将额外的软组织损伤降至最低，并能通过牵张成骨闭合骨和软组织缺损。本研究的目的是评估接受伊里扎洛夫骨搬运治疗的胫骨骨丢失患者的功能结局与重返工作岗位之间的关系。
在两家公立医院对40例患者进行了横断面研究。查阅患者记录和X线片，以获取有关初始损伤、治疗、骨愈合及治疗期间并发症的信息。临床结局采用ASAMI骨分级系统进行评估，而在拆除伊里扎洛夫外固定器至少10个月后，使用下肢评分（LEFS）和ASAMI功能分级系统评估患肢的功能结局。
38例（95%）实现骨愈合。使用ASAMI分级系统，分别有36例（90.0%）患者的临床和功能结果为优和良。平均LEFS为80.1%（范围58%至91%）。33例（82.5%）患者能够重返工作岗位。临床结局与ASAMI功能评分和LEFS的功能结局均呈强正相关（p<0.001）。ASAMI功能评分优和良的患者重返工作岗位的几率显著更高（p<0.001）。重返工作岗位也与更高的LEFS评分相关（p=0.006）。
大多数接受伊里扎洛夫骨搬运治疗的胫骨骨不连患者具有良好和优异的临床及功能结局，并且能够重返工作岗位。重返工作岗位与良好的功能结局显著相关。
