背景:异种骨移植,与自体移植相比,应该在没有供体部位发病率的情况下提供结构性益处。迄今为止,在足部手术中使用异种移植物有不同的结果,主要在儿科患者队列中。本研究检查了在六个月的随访期内,使用自体和异种骨移植物对成年患者进行校正的掺入和维持。
方法:在这项回顾性研究中,31名成人患者(共43英尺)在我们的诊所通过外侧跟骨延长截骨术治疗,根据埃文斯的说法,包括2006年1月至2020年12月。根据异种或自体骨移植的使用将患者分为研究组。遵循Worth等人的标准的骨合并。,通过测量滑石舟骨覆盖角(TNCA)进行校正维护,距骨第一跖骨角(TFMA),跟骨俯仰角(PCA)和手术后6个月必要的修正是回顾性的.此外,对医疗档案进行了相关合并症的筛查,尼古丁滥用,BMI,性别和年龄。
结果:总计,使用了27种牛来源的自体(in骨)和16种异种骨移植物。随访时的X射线照片评估表明,自体移植物的平均掺入率为96.3%,异种移植物治疗的患者的平均掺入率为57%(p=0.002)。与自体组相比,异种移植物在术后过程中并没有增加后足对齐的损失,不管是否成立。ΔTNCA,ΔTFMA和ΔPCA在两组中没有显着差异(p=0.45,p=0.42和p=0.10)。
结论:尽管掺入率明显较低,在手术后的前6个月内,使用异种移植物的后足对齐丢失的风险并未增加.术后六个月后的早期翻修不应仅由骨整合不全的影像学照片引起。
BACKGROUND: Xenogeneic bone grafts, when compared to autologous grafts, are supposed to provide structural benefits without donor site morbidity. To date, there have been divergent results in the use of xenogeneic grafts in foot surgery, primarily in pediatric patient cohorts. The present study examines the incorporation and maintenance of the achieved correction using autologous and xenogeneic bone grafts in adult patients with a six-month follow-up period.
METHODS: In this retrospective study, 31 adult patients (43 feet in total) treated in our clinic by a lateral calcaneus-lengthening osteotomy, according to
Evans, between 01/2006 and 12/2020 were included. The patients were assigned to study groups according to the use of xenogeneic or autologous bone grafts. The osseous incorporation following the criteria of Worth et al., correction maintenance by measuring the talo-navicular coverage angle (TNCA), the talo-first metatarsal angle (TFMA), the calcaneal pitch angle (PCA) and necessary revisions six months after surgery were extracted from the medical files retrospectively. Furthermore, the medical files were screened for the relevant comorbidities, nicotine abuse, BMI, sex and age.
RESULTS: In total, 27 autogenous (iliac crest) and 16 xenogeneic bone grafts of bovine origin were used. The evaluation of the radiographs at follow-up demonstrated that there was a mean incorporation rate of 96.3% for the autologous grafts and 57% for the patients treated with xenogeneic grafts (p = 0.002). Compared to the autologous group, xenogeneic grafts did not increase the loss of hindfoot alignment in the postoperative course, regardless of being incorporated or not. ΔTNCA, ΔTFMA and ΔPCA displayed no significant differences in both groups (p = 0.45, p = 0.42 and p = 0.10).
CONCLUSIONS: Despite a significantly lower incorporation rate, the use of xenogeneic grafts was not accompanied with a greater risk of hindfoot alignment loss in the first six months after surgery. Early revision after a postoperative course of six months should not be motivated solely by the radiographic picture of incomplete osseous integration.