目的:当外科医生由于各种原因需要延长而遇到下肢骨缺损时,他们面临的任务变得更加具有挑战性。讨论最多和成功的方法是Illizarov技术,或延长钉(LON):单骨外固定器也广泛使用牵张成骨,并且在过去的十年中,髓内固定钉越来越多地使用。
方法:数据来自PubMed,科克伦图书馆,Embase,和WebofScience的所有可用研究比较了Ilizarov技术和LON技术(从1997年1月1日到2023年11月30日)的结果。感兴趣的结果包括外固定指数(EFI)(月/厘米),平均随访时间(MFT)(月),长度(LG)(厘米),固结指数(Cix)(月/厘米),骨愈合指数(BHI)(月/cm)。并发症包括针道感染率(PTI),轴向偏差率(AD),髓内感染的发生(II),延迟固结率(DC),以及分为三个级别的问题的数据,障碍,和并发症严重程度的后遗症。两名评审员独立评估每个研究的质量和提取的数据。使用纽卡斯尔-渥太华量表(NOS)评估病例对照或相应的队列研究,以确定其技术严谨性。采用Cochrane协作的风险评估工具对随机对照试验进行质量评价。
结果:本综述包括13项研究,共629名患者。与单独的Ilizarov技术相比,LON技术的外固定指数(月/厘米)明显较小[平均差(MD)=-29.59,95%CI-39.68-19.49,P<0.00001]。平均随访时间(月)(MD=-0.92,95%CI-3.49-1.65,P=0.57),长度(厘米)(MD=-0.87,95CI-2.80-1.07,P=0.38),合并指数(月/厘米)(MD=0.66,95%CI-3.44-4.77,P=0.75),骨愈合指数(月/厘米)(MD=-3.33,95%CI-13.07-6.41,P=0.5),没有观察到显著差异.与单独的Ilizarov技术相比,LON技术显示出更低的轴向偏差[几率比(OR)=0.06,95CI0.03-0.16,P<0.00001]和针道感染发生率(OR=0.30,95CI0.18-0.50,P<0.00001)。剩下的并发症,例如髓内感染率(OR=0.93,95CI0.42-2.06,P=0.85)和延迟巩固率(OR=0.61,95CI0.20-1.86,P=0.38),没有表现出统计学上的显著差异。我们的发现表明,与单独的Ilizarov技术相比,LON技术的问题发生率(38.5%vs.58.6%)和后遗症发生率(16.6%vs.30%)较低。然而,两种方法的障碍发生率(32.4%vs.32.3%)相当.
结论:我们的发现表明,使用LON技术治疗的患者的外固定持续时间明显较短,并发症发生率较低(例如,针道感染和轴向偏移)与仅使用Ilizarov技术治疗的患者相比。其他结果指标显示两种技术之间没有显着差异。然而,LON技术提供了巨大的好处,包括减少外固定时间和增加舒适度,这提高了患者的依从性。总之,LON技术是一种安全的,可靠,治疗胫骨和股骨缺损的有效方法。
OBJECTIVE: The task faced by surgeons becomes significantly more challenging when they encounter lower extremity bone defects due to a variety of causes requiring lengthening. The most discussed and successful approach is the Illizarov technique, or lengthening over a nail (LON):distraction osteogenesis is also widely performed with monoliteral external fixators and intramedullarylengthening nails have increasingly been used in the last decade.
METHODS: The data were collected from PubMed, Cochrane Library, Embase, and the Web of Science for all available studies comparing the outcomes of Ilizarov technique alone and LON technique (from January 1, 1997, to November 30, 2023). The outcomes of interest encompassed the external fixation index (EFI) (month/cm), mean duration of follow-up (MFT) (month), length gained (LG) (cm), consolidation index (CIx) (month/cm), and bone healing index (BHI) (month/cm).Complications include pin tract infection rate (PTI), axial deviation rate (AD), occurrence of intramedullary infection (II), delayed consolidation rate (DC), as well as data categorized into three levels of problems, obstacles, and sequelae based on the severity of complications.Two reviewers independently assessed each study for quality and extracted data. The case-control or respective cohort studies were evaluated using the Newcastle-Ottawa scale (NOS) to determine their techniqueological rigor.The Cochrane Collaboration\'s risk assessment tool was employed to perform quality evaluations for randomized controlled trials.
RESULTS: This review included thirteen studies comprising a total of 629 patients.The external fixation index (month/cm) was significantly smaller in the LON technique compared to the Ilizarov technique alone [Mean Difference(MD) = -29.59, 95% CI -39.68--19.49, P < 0.00001].In terms of the mean follow-up time(month) (MD = -0.92, 95% CI -3.49-1.65, P = 0.57), length gained (cm) (MD = -0.87, 95%CI -2.80-1.07, P = 0.38), consolidation index (month/cm) (MD = 0.66, 95% CI -3.44-4.77, P = 0.75), and bone healing index (month/cm) (MD = -3.33, 95% CI -13.07-6.41, P = 0.5), there were no significant differences observed. The LON technique exhibited a lower incidence of axial deviation [Odds Ratio(OR) = 0.06, 95%CI 0.03-0.16, P < 0.00001] and pin tract infection (OR = 0.30, 95%CI 0.18-0.50, P < 0.00001) compared to the Ilizarov technique alone.The remaining complications, such as intramedullary infection rate (OR = 0.93, 95%CI 0.42-2.06, P = 0.85) and delayed consolidation rate(OR = 0.61, 95%CI 0.20-1.86, P = 0.38), did not exhibit statistically significant differences.Our findings demonstrated that the LON technique results in lower incidences of problems (38.5%vs.58.6%) and sequelae (16.6% vs.30.9%) when compared to the Ilizarov technique alone. However, the rates of obstacles (32.4% vs.32.3%) were comparable between the two methods.
CONCLUSIONS: Our findings indicate that patients treated with the LON technique experienced significantly shorter external fixation durations and a lower incidence of complications (e.g., pin tract infections and axial deviation) compared to those treated with the Ilizarov technique alone. Other outcome metrics showed no significant differences between the two techniques. However, the LON technique offers substantial benefits, including reduced external fixation times and increased comfort, which enhance patient compliance. In conclusion, the LON technique is a safe, reliable, and effective method for treating tibial and femoral defects.