改良混合骨搬运技术与传统骨搬运技术治疗胫骨远端骨髓炎伴骨缺损的疗效比较

Comparison of our modified hybrid bone transport technique and conventional bone transport technique in treatment of distal tibial osteomyelitis with bone defects involving the articular surface

目的比较踝关节融合钉结合载抗生素硫酸钙的改良混合骨搬运技术与传统骨搬运技术治疗累及关节面的胫骨远端骨髓炎伴骨缺损的疗效。方法回顾性分析2014年9月至2019年9月西安交通大学医学院附属红会医院骨科收治的34例累及关节面的胫骨远端骨髓炎伴骨缺损的患者资料。根据骨缺损修复方式不同分为2组:改良组14例(接受踝关节融合钉结合载抗生素硫酸钙的改良混合骨搬运技术治疗),男9例,女5例;年龄为(39.4±7.3)岁;传统组20例(接受传统骨搬运技术治疗),男12例,女8例;年龄为(41.2±6.6)岁。随访记录并比较两组患者的外固定戴架时间(EFT)、外固定指数(EFI)、焦虑自评量表(SAS)评分。末次随访时根据Ilizarov技术研究和应用协会(ASAMI)标准和美国足踝外科协会(AOFAS)踝-后足评分分别评估骨缺损愈合和功能恢复情况。根据Paley分类标准记录并发症情况。结果改良组与传统组患者的一般资料比较差异均无统计学意义(P>0.05),具有可比性。34例患者术后获18~32个月(平均27个月)随访。改良组EFT[(3.9±1.6)个月]显著短于传统组[(9.8±2.2)个月],EFI[(0.48±0.09)个月/cm]显著低于传统组[(1.42±0.32)个月/cm],差异均有统计学意义(P<0.05)。改良组SAS评分[(48.1±4.7)分]显著低于传统组[(61.2±6.2)分]、人均并发症数[(0.8±0.4)种/例]显著少于传统组[(1.4±0.3)种/例],差异均有统计学意义(P<0.05)。末次随访时两组间骨愈合结果和AOFAS踝-后足评分比较差异无统计学意义(P>0.05)。改良组与传统组患者满意分别为13、12例,不满意分别为1、8例;Ⅱ级钉道感染分别为1、8例,未发现分别为13、12例;Ⅲ级钉道感染分别为1、9例,未发现感染分别为13、11例,两组间比较差异均有统计学意义(P<0.05)。讨论与传统骨搬运技术相比,踝关节融合钉结合载抗生素硫酸钙的改良混合骨搬运技术在治疗胫骨远端节段性骨缺损方面展现出更好的效果,具有EFT短、EFI低及并发症少等优点。

Objective To introduce our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate by comparison with conventional bone transport in the treatment of distal tibial osteomyelitis with bone defects involving the articular surface.Methods The clinical data of 34 patients were retrospectively analyzed who had been treated at Department of Orthopaedics,Honghui Hospital for distal tibial osteomyelitis with bone defects involving the articular surface from September 2014 to September 2019.They were divided into 2 groups according to their way of repairing bone defects.In the modified group of 14 cases subjected to the treatment using the modified hybrid bone transport technique,there were 9 males and 5 females,with an age of(39.4±7.3)years.In the conventional group of 20 cases subjected to the treatment using conventional bone transport technique,there were 12 males and 8 females,with an age of(41.2±6.6)years.The external fixation time(EFT),external fixation index(EFI),self-rating anxiety scale(SAS)were recorded and compared between the 2 groups.Healing of bone defects and function were evaluated at the last follow-up according to the criteria of Association for the Study and Application of the Method of Ilizarov(ASAMI)and American Orthopaedic Foot and Ankle Society(AOFAS)ankle-posterior foot score,respectively.Complications were recorded according to the Paley classification.Results There was no significant difference in the general data between the modified group and the conventional group,showing they were comparable(P>0.05).Thirty-four patients were followed up for 18 to 32 months(average,27 months)after operation.The modified group had significantly shorter EFT[(3.9±1.6)months]than the conventional group[(9.8±2.2)months],and significantly lower EFI[(0.48±0.09)months/cm]than the conventional group[(1.42±0.32)months/cm](P<0.05).The SAS[(48.1±4.7)points]in the modified group was significantly lower than that in the conventional group[(61.2±6.2)points],and the number of complications per capita in the former[(0.8±0.4)/case]was significantly smaller than that in the latter[(1.42±0.32)/case](P<0.05).There were no significan differences in the healing of bone defects or AOFSA ankle-posterior foot score(P>0.05).In the modified group and the conventional group,respectively,13 versus 12 patients were satisfied while 1 versus 8 patients unsatisfied,1 versus 8 patients had grade-Ⅱinfection while 13 versus 12 patients did not,and 1 versus 9 patients had grade-Ⅲinfection while 13 versus 11 patients did not.There were significant differences between the 2 groups in the above indexes(all P<0.05).Conclusion In the treatment of distal tibial osteomyelitis with bone defects involving the articular surface,compared with conventional bone transport technique,our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate may lead to better clinical efficacy due to the advantages of shorter external fixation time,lower external fixation index and fewer complications.