Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia
Comparison of Ilizarov Bifocal, Acute Shortening and Relengthening with Bone Transport in the Treatment of Infected, Segmental Defects of the Tibia
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DOI：
10.3390/jcm9020279
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发表时间：
2020-02-01
影响因子：
3.9
通讯作者：
McNally, Martin A.
中科院分区：
文献类型：
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作者：
Sigmund, Irene K.;Ferguson, Jamie;McNally, Martin A.
这项前瞻性研究在一系列复杂的胫骨感染不愈合和骨髓炎中比较了双焦点急性缩短和再延长（ASR）与骨运输（BT），以重建手术切除感染时产生的节段缺损。患有感染性胫骨节段缺损（> 2 cm）的患者符合纳入条件。根据缺损大小、软组织状况和腓骨状态（完整或分开），使用标准化方案将患者分配至 ASR 或 BT。我们记录了Weber-Cech分类、既往手术、外固定时间、外固定指数（EFI）、随访时间、愈合时间、ASAMI骨和功能评分以及并发症。总共纳入 47 名患者（ASR：20 名患者，BT：27 名患者），中位随访时间为 37.9 个月（范围 16-128）。在 ASR 组中，平均骨缺损尺寸为 4.0 厘米，平均框架时间为 8.8 个月。 BT 组的平均骨缺损尺寸为 5.9 厘米，平均框架时间为 10.3 个月。 ASR 和 BT 之间的 EFI 没有统计学上的显着差异（分别为 2.0 和 1.8 个月/cm）（p = 0.223）。在 Ilizarov 治疗期间，总共有 3/20 名 ASR 患者和 15/27 名 BT 组患者需要进一步进行计划外手术（p = 0.006）。 BT 中的对接部位手术明显更频繁； 66.7%，与 ASL 相比； 5.0%（p < 0.0001）。最终随访时两组感染根除率均为100%。两组的最终 ASAMI 功能评分和骨骼评分相似。采用 Ilizarov 法进行节段切除对于感染性胫骨缺损的重建是有效且安全的，可以根除感染并提高愈合率。然而，英国电信的计划外手术率较高，尤其是对接部位修改。急性缩短和重新延长不会降低固定器指数。这两种技术在治疗完成后都能提供良好的功能结果。
This prospective study compared bifocal acute shortening and relengthening (ASR) with bone transport (BT) in a consecutive series of complex tibial infected non-unions and osteomyelitis, for the reconstruction of segmental defects created at the surgical resection of the infection. Patients with an infected tibial segmental defect (>2 cm) were eligible for inclusion. Patients were allocated to ASR or BT, using a standardized protocol, depending on defect size, the condition of soft tissues and the state of the fibula (intact or divided). We recorded the Weber-Cech classification, previous operations, external fixation time, external fixation index (EFI), follow-up duration, time to union, ASAMI bone and functional scores and complications. A total of 47 patients (ASR: 20 patients, BT: 27 patients) with a median follow-up of 37.9 months (range 16-128) were included. In the ASR group, the mean bone defect size measured 4.0 cm, and the mean frame time was 8.8 months. In the BT group, the mean bone defect size measured 5.9cm, and the mean frame time was 10.3 months. There was no statistically significant difference in the EFI between ASR and BT (2.0 and 1.8 months/cm, respectively) (p = 0.223). A total of 3/20 patients of the ASR and 15/27 of the BT group needed further unplanned surgery during Ilizarov treatment (p = 0.006). Docking site surgery was significantly more frequent in BT; 66.7%, versus ASL; 5.0% (p < 0.0001). The infection eradication rate was 100% in both groups at final follow-up. Final ASAMI functional rating scores and bone scores were similar in both groups. Segmental resection with the Ilizarov method is effective and safe for reconstruction of infected tibial defects, allowing the eradication of infection and high union rates. However, BT demonstrated a higher rate of unplanned surgeries, especially docking site revisions. Acute shortening and relengthening does not reduce the fixator index. Both techniques deliver good functional outcome after completion of treatment.