胫骨近端与远端截骨搬运在胫骨骨髓炎治疗中的效果比较

Proximal versus distal tibial bone transport in the treatment of chronic tibial osteomyelitis

目的比较胫骨近端截骨搬运与胫骨远端截骨搬运在治疗胫骨骨髓炎清创所致大段骨缺损时对搬运区骨生长矿化情况及足踝功能的影响。方法回顾性分析2012年7月至2017年7月南方医科大学南方医院骨科采用骨髓炎清创及骨搬运手术治疗的42例慢性胫骨骨髓炎患者资料。根据慢性骨髓炎Cierny-Mader分型:42例患者均为弥散型(Ⅳ型)胫骨骨髓炎。根据搬运部位不同分为2组:32例采用胫骨近端截骨搬运(近端组),男27例,女5例;年龄为17~65岁;左20例,右12例。10例采用胫骨远端截骨搬运(远端组),均为男性;年龄25~63岁;左6例,右4例。比较两组患者术后对合端手术干预数、外固定指数(EFI)和美国足踝外科协会(AOFAS)踝-后足功能评分。结果两组患者性别、年龄、骨髓炎部位等一般资料差异均无统计学意义(P>0.05)。两组患者均获完整随访,近端组与远端组随访时间为(590.1±287.3)、(615.6±130.6)d,差异无统计学意义(P>0.05)。搬运后近端组与远端组分别有3例、2例出现足部马蹄内翻畸形,均需手术干预;术后近端组与远端组分别16、3例对合端需手术干预19例;近端组与远端组EFI分别为(76.2±50.0)、(84.3±59.9)d/cm,以上项目两组间比较差异均无统计学意义(P>0.05)。近端组与远端组AOFAS踝-后足功能评分分别为(81.4±10.1)、(60.0±5.9)分,差异有统计学意义(P<0.05)。结论运用骨搬运治疗胫骨骨髓炎清创所致的骨缺损时,胫骨近端骨搬运与胫骨远端骨搬运对搬运区骨生长及对合端骨愈合无明显影响,但胫骨近端骨搬运对足踝功能的不利影响较小。

Objective To compare the clinical effects on new bone formation and foot-ankle function between proximal tibial bone transport and distal tibial bone transport in the treatment of massive bone defects after tibial osteomyelitis debridement.Methods From July 2012 to July 2017,42 patients with chronic tibial osteomyelitis received bone transport surgery at Department of Orthopaedics,Nanfang Hospital.According to the Cierny-Mader classification for chronic osteomyelitis,all of them belonged to diffusive tibial osteomyelitis(type IV).Of them,32 were treated by proximal tibial bone transport after tibial osteomyelitis debridement.In the proximal group,there were 27 males and 5 females,aged from 17 to 65 years and involving 20 left and 12 right sides.The other 10 cases received distal tibial bone transport.In the distal group,all of them were male,aged from 25 to 63 years and involving 6 left and 4 right sides.The 2 groups were compared in terms of external fixation index(EFI)and American Orthopaedic Foot&Ankle Society(AOFAS)Ankle and Hindfoot Scale.Results There were no significant differences between the 2 groups in the preoperative general data such as gender,age or osteomyelitis site,indicating the 2 groups were comparable(P>0.05).Both groups obtained complete follow-up.The proximal group was followed up for 590.1 d±287.3 d and the distal group for 615.6 d±130.6 d,showing no significant difference between groups(P>0.05).In the proximal group 2 cases developed talipes equinovalgus after bone transport while in the distal group 3 cases did,and surgical intervention was needed for them.Surgical intervention was also carried out for16 cases of non-union at the docking site in the proximal group and for 2 ones in the distal group.The EFI was 76.2 d/cm±50.0 d/cm for the proximal group and 84.3 d/cm±59.9 d/cm for the distal group,showing no significant difference between groups(P>0.05).The AOFAS scores were 81.4±10.1 for the proximal group and 60.0±5.9 for the distal group,showing a significant difference(P<0.05).Conclusion In the treatment of massive bone defects after tibial osteomyelitis debridement,no significant difference has been observed in the effect on bone formation between proximal tibial bone transport and distal tibial bone transport,but the former transport may have a less adverse effect on foot-ankle function.