Abstract：
OBJECTIVE: Refracture is one of the main complications of bone transport, which brings additional physical and mental burden to surgeries and patients. We aimed to raise a new classification system of refracture-related bone transport based on the Simpson classification and to present our experience on treatment.
METHODS: This retrospective analysis included 19 patients with refracture-related bone transport (average age of 37.7 years; 18 men). We developed a modified Simpson classification system to assist decision-making (conservative versus surgical). The ASAMI criteria were used to assess the outcomes at last follow-up.
RESULTS: The mean follow-up was 12.3 ± 3.2 months. Complete union was achieved in all patients, with no reinfection. Based on the modified Simpson classification, refracture was Ia type (within regeneration area) in three cases, Ib (collapsed fracture at the regeneration area) in one case, Ic (stress fracture) in three cases, II (at the junction between the regenerate and original bone) in one case, III (at the docking site) in nine cases, and V (at distant site) in two cases. Refracture was managed conservatively in six cases and surgically in 13 cases. Average time to bone union was 2.8 ± 1.2 months in the conservative group versus 4.4 ± 1.4 months in the surgery group. Assessment at the final follow-up using the ASAMI criteria revealed excellent bone result in all patients, excellent functional results in six patients (31.6%), and good functional results in 13 patients.
CONCLUSIONS: The modified Simpson classification could include refracture at the docking site and stress fracture in the regeneration zone and provide some guidance in determining the appropriate treatment strategy.
METHODS: This retrospective analysis included 19 patients with refracture-related bone transport (average age of 37.7 years; 18 men). We developed a modified Simpson classification system to assist decision-making (conservative versus surgical). The ASAMI criteria were used to assess the outcomes at last follow-up.
RESULTS: The mean follow-up was 12.3 ± 3.2 months. Complete union was achieved in all patients, with no reinfection. Based on the modified Simpson classification, refracture was Ia type (within regeneration area) in three cases, Ib (collapsed fracture at the regeneration area) in one case, Ic (stress fracture) in three cases, II (at the junction between the regenerate and original bone) in one case, III (at the docking site) in nine cases, and V (at distant site) in two cases. Refracture was managed conservatively in six cases and surgically in 13 cases. Average time to bone union was 2.8 ± 1.2 months in the conservative group versus 4.4 ± 1.4 months in the surgery group. Assessment at the final follow-up using the ASAMI criteria revealed excellent bone result in all patients, excellent functional results in six patients (31.6%), and good functional results in 13 patients.
CONCLUSIONS: The modified Simpson classification could include refracture at the docking site and stress fracture in the regeneration zone and provide some guidance in determining the appropriate treatment strategy.
摘要：
目的：再骨折是骨运输的主要并发症之一，这给手术和患者带来了额外的身心负担。我们旨在基于Simpson分类提出一种新的与再骨折相关的骨运输分类系统，并介绍我们的治疗经验。
方法：该回顾性分析包括19例与再骨折相关的骨转运患者（平均年龄37.7岁；18例男性）。我们开发了一种改进的Simpson分类系统来辅助决策（保守与手术）。最后随访时使用ASAMI标准评估结果。
结果：平均随访12.3±3.2个月。所有患者都实现了完全的结合，没有再感染。基于改进的辛普森分类，三种情况下的再骨折为Ia型(在再生区域内)，Ib(再生区域的塌陷裂缝)在一种情况下,Ic（应力性骨折）三例，II（在再生骨和原始骨之间的交界处）在一种情况下，III（在对接地点）在9个案例中，和V(在远处)在两种情况下。保守治疗6例，手术治疗13例。保守组平均骨愈合时间为2.8±1.2个月，手术组为4.4±1.4个月。使用ASAMI标准进行的最终随访评估显示，所有患者的骨效果都很好。6名患者（31.6%）的功能表现优异，13例患者的功能良好。
结论：改良的Simpson分类可以包括对接部位的再骨折和再生区的应力性骨折，并为确定适当的治疗策略提供一些指导。
方法：该回顾性分析包括19例与再骨折相关的骨转运患者（平均年龄37.7岁；18例男性）。我们开发了一种改进的Simpson分类系统来辅助决策（保守与手术）。最后随访时使用ASAMI标准评估结果。
结果：平均随访12.3±3.2个月。所有患者都实现了完全的结合，没有再感染。基于改进的辛普森分类，三种情况下的再骨折为Ia型(在再生区域内)，Ib(再生区域的塌陷裂缝)在一种情况下,Ic（应力性骨折）三例，II（在再生骨和原始骨之间的交界处）在一种情况下，III（在对接地点）在9个案例中，和V(在远处)在两种情况下。保守治疗6例，手术治疗13例。保守组平均骨愈合时间为2.8±1.2个月，手术组为4.4±1.4个月。使用ASAMI标准进行的最终随访评估显示，所有患者的骨效果都很好。6名患者（31.6%）的功能表现优异，13例患者的功能良好。
结论：改良的Simpson分类可以包括对接部位的再骨折和再生区的应力性骨折，并为确定适当的治疗策略提供一些指导。
