单边和环形外架在感染性胫骨骨不连治疗中的对比研究

Comparative study of monolateral and circular fixator in the treatment of infectious tibial nonunion

目的:对比单边和环形外架在感染性胫骨骨不连中的治疗效果,探索成骨能力更好和并发症更少的外固定架构型。方法:回顾性纳入2010年1月至2014年12月治疗的150例感染性胫骨骨不连患者,符合纳入和排除标准的患者根据外固定类型分为单边组和环形组,收集两组患者的一般资料和围手术信息,通过像素比评价新生骨质量,通过并发症评估治疗效果,并根据并发症情况分析治疗注意事项。结果:共64例胫骨中段感染性骨不连患者纳入研究,单边组26例,环形组38例。两组患者一般资料比较差异无统计学意义(P>0.05)。两组患者新生骨像素比分别为0.91~0.97(0.94±0.03)和0.93~0.97(0.95±0.02),差异无统计学意义(P>0.05)。单边组外固定指数为34.1~50.6(42.3±8.3)d/cm,环形组为44.5~56.1(45.8±10.3)d/cm,差异无统计学意义(P>0.05)。单边组7例(26.9%)存在并发症,环形组5例(13.2%),组间比较差异无统计学意义(P>0.05),但单边组5例发生足下垂,通过后续治疗后缓解,环形组无此情况。单边组的下地时间比环形组晚(P<0.05)。结论:在治疗感染性骨不连时,单边和环形外架都能取得满意的骨愈合结果,且效果相当。对于骨质疏松严重,并发症多,需要早期下地的患者建议采用环形外架固定。如果选择单边外架,预期延长长度长、固定时间久的建议采用羟基磷灰石涂层螺钉固定,严密监测踝关节活动,防止足下垂畸形。

Objective:To compare treatment effect of monolateral and circular external fixator in infectious tibial nonunion and to explore external fixation structure with better osteogenic ability and fewer complications.Methods:A retrospective analysis was performed on 150 patients with infectious tibial nonunion admitted from January 2010 to December 2014.Patients who met the inclusion and exclusion criteria were divided into monolateral fixator group and circular fixator group according to the type of external fixation.Demographic and perioperative data of the two groups were collected.New bone quality was assessed by pixels ratio,treatment effect was assessed by complications.Notes for treatment was explored by case analysis.Results:A total of 64 patients with infectious mid-tibial nonunion were included,26 in monolateral fixator group and 38 in circular fixator group.There was no difference in demographic data between two groups.The pixel ratio of new bone between two groups was from 0.91 to 0.97 with an average of(0.94±0.03),and from 0.93 to 0.97 with an average of(0.95±0.02),respectively,with no statistical significance(P>0.05).The external fixation index was from 34.1 to 50.6 with an average of(42.3±8.3)days/cm in monolateral fixator group and from 44.5 to 56.1 with an average of(45.8±10.3)days/cm in the circular fixator group,and the difference was not statistically significant(P>0.05).There were 7 cases(26.9%)of complications in monolateral fixator group and 5 cases(13.2%)in circular fixator group,the difference was not statistically significant(P>0.05),but 5 cases of foot ptosis in monolateral fixator group and none in circular fixator group.The time of weight bearing in monolateral fixator group was later than that in circular fixator group,and the difference was statistically significant(P<0.05).Conclusion:Monolateral and circular fixators can achieve equivalent bone formation in the treatment of infected tibial nonunion.Circular fixator is recommended for patients with severe osteoporosis or concomitant medical diseases requiring early weight bearing.Hydroxyapatite coated screws are recommended if a monolateral external fixator is selected when the expected enlarged length is long and the fixation time is long and close monitoring of the ankle movement is required to avoid foot droop.