Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases.
Reconstruction of massive tibial bone and soft tissue defects by trifocal bone transport combined with soft tissue distraction: experience from 31 cases.
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三焦骨转运联合软组织牵张重建大块胫骨骨及软组织缺损31例体会
DOI：
10.1186/s12891-020-03894-y
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发表时间：
2021-01-07
影响因子：
2.3
通讯作者：
Wen HJ
中科院分区：
文献类型：
--
作者：
Xu YQ;Fan XY;He XQ;Wen HJ
创伤后大面积胫骨骨缺损合并软组织缺损是一种常见的骨科临床问题，使用传统手术方法治疗时效果不佳。该研究旨在探讨采用 Ilizarov 技术进行三焦点骨转运 (TFT) 和软组织转运治疗大面积创伤后胫骨骨和软组织缺损的安全性和有效性。我们回顾性分析了 2009 年 5 月至 2016 年 5 月期间发生的 31 例患有大量外伤后胫骨骨和软组织缺损的患者。所有符合条件的患者均采用 TFT 和软组织转运治疗。中位年龄为 33.4 岁（范围：2-58 岁）。 TFT 根治性切除后骨缺损平均为 11.87cm ± 2.78cm（范围 8.2–18.2cm）。软组织缺损范围为7 cm × 8 cm至24 cm × 12 cm。观察结果包括骨愈合时间、伤口闭合时间和真实并发症。采用伊利扎罗夫方法研究与应用协会（ASAMI）评分系统评估骨和功能结果，并采用Paley分级评估术后并发症。移除框架后的平均随访时间为 32 个月（范围：12-96 个月）。所有病例的伸长部位和对接部位都实现了完全愈合，并消除了感染。平均骨运输时间为 94.04 ± 23.33 天（范围，63.7-147 天）。平均外固定时间为22.74±6.82个月（范围，14-37个月），平均外固定指数（EFI）为1.91±0.3个月/cm（范围，1.2-2.5个月/cm）。骨骼结果优 6 例，良 14 例，中 8 例，差 3 例。功能结果优8例，良15例，中5例，差3例。结论：TFT结合软组织转运技术，可以对大多数患者产生良好的效果（在本文中，64%的患者观察到良好且优异的效果）。软组织输送是在骨端提供良好软组织覆盖的可行方法。尽管它与微血管技术相比没有优势，但在缺乏经验丰富的皮瓣外科医生的情况下，它可能是一个不错的选择。尽管如此，仍需要高质量的对照研究来评估其长期安全性和有效性。
Large post-traumatic tibial bone defects combined with soft tissue defects are a common orthopedic clinical problem associated with poor outcomes when treated using traditional surgical methods. The study was designed to investigate the safety and efficacy of trifocal bone transport (TFT) and soft-tissue transport with the Ilizarov technique for large posttraumatic tibial bone and soft tissue defects. We retrospectively reviewed 31 patients with massive posttraumatic tibial bone and soft tissue defects from May 2009 to May 2016. All of the eligible patients were managed by TFT and soft-tissue transport. The median age was 33.4 years (range, 2–58 years). The mean defect of bone was 11.87 cm ± 2.78 cm (range, 8.2–18.2 cm) after radical resection performed by TFT. The soft tissue defects ranged from 7 cm × 8 cm to 24 cm × 12 cm. The observed results included bone union time, wound close time and true complications. The Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system was used to assess bone and functional results and postoperative complications were evaluated by Paley classification. The mean duration of follow-up after frame removal was 32 months (range, 12–96 months). All cases achieved complete union in both the elongation sites and the docking sites, and eradication of infection. The mean bone transport time was 94.04 ± 23.33 days (range, 63.7–147 days). The mean external fixation time was 22.74 ± 6.82 months (range, 14–37 months), and the mean external fixation index (EFI) was 1.91 ± 0.3 months/cm (range, 1.2–2.5 months/cm). The bone results were excellent in 6 patients, good in 14 patients, fair in 8 patients and poor in 3 patients. The functional results were excellent in 8 patients, good in 15 patients, fair in 5 patients and poor in 3 patients. Conclusion: TFT, in conjunction with soft tissue transport technique, can give good results in most patients (in this article, good and excellent results were observed in 64% of patients). Soft tissue transport is a feasible method in providing good soft tissue coverage on the bone ends. Although it has no advantages over microvascular techniques, it might be an good alternative in the absence of an experienced flap surgeon. Nonetheless, high-quality controlled studies are needed to assess its long-term safety and efficacy.
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DOI：
10.12659/msm.892939
发表时间：
2015-04-27
期刊：
Medical science monitor : international medical journal of experimental and clinical research
影响因子：
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作者：
Hu C;Zhang T;Ren B;Deng Z;Cai L;Lei J;Ping A
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2.3
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DOI：
10.1016/j.injury.2004.10.027
发表时间：
2005-05-01
影响因子：
2.5
作者：
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通讯作者：
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通讯作者：
El-Moghazy, Nabil
影响因子：
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作者：
Lee, Daniel K;Duong, Elizabeth Thu Anh;Chang, Douglas G
通讯作者：
Chang, Douglas G