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Abstract：
BACKGROUND: The purpose of the study was to assess and compare the clinical efficacy of bone transport with either circular or unilateral external fixators over an intramedullary nail in the treatment of tibial bone defects caused by infection.
METHODS: Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification.
RESULTS: A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B.
CONCLUSIONS: Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.
METHODS: Between May 2010 and January 2019, clinical and radiographic data were collected and analyzed for patients with bone defects caused by infection. Thirteen patients underwent bone transport using a unilateral external fixator over an intramedullary nail (Group A), while 12 patients were treated with a circular external fixator over an intramedullary nail (Group B). The bone and functional outcomes of both groups were assessed and compared using the Association for the Study and Application of the Method of the Ilizarov criteria, and postoperative complications were evaluated according to the Paley classification.
RESULTS: A total of 25 patients were successfully treated with bone transport using external fixators over an intramedullary nail, with a mean follow-up time of 31.63 ± 5.88 months. There were no significant statistical differences in age, gender, previous surgery per patient, duration of infection, defect size, and follow-up time between Group A and Group B (P > 0.05). However, statistically significant differences were observed in operation time (187.13 ± 21.88 min vs. 255.76 ± 36.42 min, P = 0.002), intraoperative blood loss (39.26 ± 7.33 mL vs. 53.74 ± 10.69 mL, P < 0.001), external fixation time (2.02 ± 0.31 month vs. 2.57 ± 0.38 month, P = 0.045), external fixation index (0.27 ± 0.08 month/cm vs. 0.44 ± 0.09 month/cm, P = 0.042), and bone union time (8.37 ± 2.30 month vs. 9.07 ± 3.12, P = 0.032) between Group A and Group B. The excellent and good rate of bone and functional results were higher in Group A compared to Group B (76.9% vs. 75% and 84.6% vs. 58.3%). Statistically significant differences were observed in functional results (excellent/good/fair/poor, 5/6/2/0 vs. 2/5/4/1, P = 0.013) and complication per patient (0.38 vs. 1.16, P = 0.012) between Group A and Group B.
CONCLUSIONS: Bone transport using a combined technique of external fixators over an intramedullary nail proved to be an effective method in treating tibial bone defects caused by infection. In comparison to circular external fixators, bone transport utilizing a unilateral external fixator over an intramedullary nail resulted in less external fixation time, fewer complications, and better functional outcomes.
摘要：
背景：该研究的目的是评估和比较圆形或单侧外固定器在髓内钉上的骨运输治疗感染引起的胫骨骨缺损的临床疗效。
方法：收集2010年5月至2019年1月感染导致骨缺损患者的临床和影像学资料，进行分析。13例患者使用单侧外固定器在髓内钉上进行骨运输（A组），而12例患者接受了圆形外固定器在髓内钉上的治疗（B组）。使用Ilizarov标准的研究和应用协会对两组的骨和功能结果进行评估和比较。术后并发症根据Paley分类进行评估。
结果：共有25例患者使用外固定器在髓内钉上进行了骨运输，平均随访时间31.63±5.88个月。年龄差异无统计学意义,性别,每位患者以前的手术，感染持续时间，缺陷尺寸,随访时间与A、B组比较差异无统计学意义(P>0.05)。然而,手术时间差异有统计学意义（187.13±21.88minvs.255.76±36.42min,P=0.002),术中失血量（39.26±7.33mLvs.53.74±10.69mL,P<0.001)，外固定时间(2.02±0.31个月vs.2.57±0.38个月，P=0.045),外固定指数(0.27±0.08个月/厘米vs.0.44±0.09个月/厘米，P=0.042),骨愈合时间(8.37±2.30个月vs.A组和B组之间为9.07±3.12，P=0.032）。与B组相比，A组骨和功能结果的优良率更高（76.9％vs.75%和84.6%vs.58.3%）。在功能结果方面观察到统计学上的显着差异（优/好/一般/差，5/6/2/0vs.2/5/4/1，P=0.013）和每位患者的并发症（0.38vs.1.16，P=0.012）在A组和B组之间。
结论：在髓内钉上使用外固定器的组合技术进行骨运输被证明是治疗胫骨骨缺损的有效方法由感染引起。与圆形外固定器相比，使用单侧外固定器在髓内钉上进行骨运输可减少外固定时间，并发症少,和更好的功能结果。
方法：收集2010年5月至2019年1月感染导致骨缺损患者的临床和影像学资料，进行分析。13例患者使用单侧外固定器在髓内钉上进行骨运输（A组），而12例患者接受了圆形外固定器在髓内钉上的治疗（B组）。使用Ilizarov标准的研究和应用协会对两组的骨和功能结果进行评估和比较。术后并发症根据Paley分类进行评估。
结果：共有25例患者使用外固定器在髓内钉上进行了骨运输，平均随访时间31.63±5.88个月。年龄差异无统计学意义,性别,每位患者以前的手术，感染持续时间，缺陷尺寸,随访时间与A、B组比较差异无统计学意义(P>0.05)。然而,手术时间差异有统计学意义（187.13±21.88minvs.255.76±36.42min,P=0.002),术中失血量（39.26±7.33mLvs.53.74±10.69mL,P<0.001)，外固定时间(2.02±0.31个月vs.2.57±0.38个月，P=0.045),外固定指数(0.27±0.08个月/厘米vs.0.44±0.09个月/厘米，P=0.042),骨愈合时间(8.37±2.30个月vs.A组和B组之间为9.07±3.12，P=0.032）。与B组相比，A组骨和功能结果的优良率更高（76.9％vs.75%和84.6%vs.58.3%）。在功能结果方面观察到统计学上的显着差异（优/好/一般/差，5/6/2/0vs.2/5/4/1，P=0.013）和每位患者的并发症（0.38vs.1.16，P=0.012）在A组和B组之间。
结论：在髓内钉上使用外固定器的组合技术进行骨运输被证明是治疗胫骨骨缺损的有效方法由感染引起。与圆形外固定器相比，使用单侧外固定器在髓内钉上进行骨运输可减少外固定时间，并发症少,和更好的功能结果。
