背景:创伤引起的四肢长骨失败的临床治疗,感染,肿瘤,骨不连对骨科医生来说是一个挑战。骨运输技术已成为治疗此类骨缺损的唯一方法。然而,在许多研究中已经报道了与骨运输技术相关的不可避免的困难和并发症。
目的:本研究的目的是探讨并发症的危险因素以及Ilizarov骨转运技术治疗胫骨骨缺损的有效性。
方法:该研究于2012年5月至2019年9月在我们机构接受Ilizarov骨运输技术治疗的199例患者中进行。患者人口统计数据,我们收集并回顾性分析了至少2年随访后的并发症和临床结局.此外,对前三名主要并发症进行了危险因素分析.在最后一次临床随访时,使用Ilizarov方法研究和应用协会(ASAMI)标准评估临床结果。
结果:共199例患者接受了12-40个月的随访,平均23.5个月,都实现了骨骼愈合。共发生310例并发症,平均每个患者1.04次轻微并发症和0.48次主要并发症。前3位的并发症为针道感染48例(61.3%),轴向偏差86例(43.2%),延迟愈合50例(25.13%)。多因素分析显示骨缺损长度(P=0.02,OR=5.489),既往手术次数(P=0.003,OR=2.204),外固定指数(P=0.01,OR=1.202)与针道感染显着相关。中段骨缺损1/3(P<0.001,OR=23.769),骨缺损长度(P<0.001,OR=2.776),外固定指数(P<0.001,OR=1.154)与眼轴偏离显著相关。骨缺损长度(P=0.003,OR=1.242),软组织缺损(P=0.013,OR=0.312)和远端1/3骨缺损(P=0.023,OR=4.257)与延迟愈合显著相关。末次随访ASAMI骨评分显示骨优良率95.48%,功能优良率87.94%。
结论:Ilizarov骨转移技术是治疗胫骨骨缺损的有效方法,缩短治疗周期可减少并发症的发生。老年患者和骨缺损时间较长的患者,较高的外固定指数,更多以前的操作,中段和远端1/3的缺损并发症发生率较高。
BACKGROUND: The clinical treatment of long bone defets in the extremities caused by trauma, infection, tumours, and nonunion has been a challenge for orthopaedic surgeons. Bone transport techniques have become the only way to treat such bone defects. However, inevitable difficulties and complications related to bone transport techniques have been reported in many studies.
OBJECTIVE: The purpose of this
study was to investigate the risk factors for complications and the effectiveness of the Ilizarov bone transport technique in the treatment of tibial bone defects.
METHODS: The
study was conducted in 199 patients who underwent treatment with the Ilizarov bone transport technique at our institution from May 2012 to September 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, a risk factor analysis was performed for the top three major complications. The clinical outcomes were evaluated using the Association for the
Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical follow-up.
RESULTS: A total of 199 patients underwent follow-up for 12-40 months, with an average of 23.5 months, and all achieved bone healing. A total of 310 complications occurred, with an average of 1.04 minor complications and 0.48 major complications per patient. The top three complications were pin tract infection in 48 cases (61.3%), axial deviation in 86 cases (43.2%), and delayed union in 50 cases (25.13%). Multivariate analysis showed that the bone defect length (P = 0.02, OR = 5.489), the number of previous surgeries (P = 0.003, OR = 2.204), and the external fixation index (P = 0.01, OR = 1.202) were significantly correlated with pin tract infection. Bone defects of the middle 1/3 (P < 0.001, OR = 23.769), the bone defect length (P < 0.001, OR = 2.776), and the external fixation index (P < 0.001, OR = 1.154) were significantly correlated with axial deviation. The bone defect length (P = 0.003, OR = 1.242), soft tissue defects (P = 0.013, OR = 0.312) and bone defects of the distal 1/3 (P = 0.023, OR = 4.257) were significantly correlated with delayed healing. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.48% and a rate of excellent functional results of 87.94%.
CONCLUSIONS: The Ilizarov bone transfer technique is an effective method for treating tibial bone defects, and shortening the treatment period can reduce the incidence of complications. Older patients and those with longer bone defects, a higher external fixation index, more previous operations, and defects of the middle and distal 1/3 had a higher incidence of complications.