日本語AIでPubMedを検索
大規模骨欠損を有する脛骨骨折に対するOrthofix固定具を用いた二重レベル骨輸送と一重レベル骨輸送の有効性の比較
Efficacy comparison of double-level and single-level bone transport with Orthofix fixator for treatment of tibia fracture with massive bone defects.
PMID: 32114659 DOI: 10.1007/s00264-020-04503-2.
抄録
目的:
本研究の目的は，イリザロフ手技を用いた二重レベル骨輸送で管理された外傷後脛骨大欠損を有する患者の臨床的・機能的転帰を評価し，一重レベル骨輸送術と比較することであった。
PURPOSE: The aim of this study was to evaluate the clinical and functional outcomes of patients with large post-traumatic tibial bone defects managed by double-level bone transport using the Ilizarov technique and compare it with one-level bone transport technique.
方法:
2010年1月から2017年1月までの開放脛骨骨折患者26例を対象にレトロスペクティブコホート研究を実施した。症例はすべてGustilo IIIであった。骨切りの部位に応じて、患者をシングルレベル群（n=13）とダブルレベル群（n=13）に分けた。骨輸送時間、ディストラクションギャップの圧密時間、ドッキング部位の治癒時間、外固定時間、外固定指数、軟部組織欠損面積、軟部組織成長指数、手術時間、手術出血量を記録し、両群間で比較した。骨および機能的結果は、Association for the Study and Application of the Method of Ilizarov（ASAMI）基準に従って評価した。
METHODS: A retrospective cohort study was conducted on 26 patients with open tibial fracture from January 2010 to January 2017. All cases were Gustilo III. Depending on the site of osteotomy, the patients were divided into single-level (n = 13) and double-level groups (n = 13). The bone transport time, consolidation time of the distraction gap, docking site healing time, external fixation time, external fixation index, soft tissue defect area, soft tissue growth index, operating time, and surgical bleeding volume were recorded and compared between the two groups. Bone and functional results were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria.
結果:
Orthofix固定具が取り外されてからの平均追跡期間は28.5±5.8ヶ月（範囲13～38ヶ月）であり、全患者がドッキング部位の完全な結合と再生骨の統合を達成した。平均ドッキング部位治癒時間はシングルレベル群10.85±1.52months vs ダブルレベル群8.93±2.29months (P<0.05)、外枠時間はシングルレベル群18.06months (範囲15-20months) vs ダブルレベル群12.71months (範囲9.5-16.0months) (P<0.05)、外枠固定指数は2.52months/cm (範囲2.52months/cm) (P<0.05)、外枠固定指数は2.52months/cm (範囲2.52months/cm) (P<0.05)、外枠固定指数は2.52months/cm (範囲2.52months/cm) (P<0.05)であった。52months/cm（範囲2.15-2.94months/cm）対ダブルレベル群1.22months/cm（範囲0.96-1.67months/cm）（P<0.01）、軟部組織成長指数はシングルレベル群0.29months/cm（範囲0.21-0.45months/cm）対ダブルレベル群0.62months/cm（範囲0.47-0.86months/cm）（P<0.01）であった。ASAMI分類によると、臨床的・機能的にはダブルレベル群の方がシングルレベル群よりも優れていた。
RESULTS: The mean duration of follow-up was 28.5 ± 5.8 months (range 13-38 months) since the Orthofix fixator was removed, all patients achieved complete union in the docking site and consolidation in the regenerate bone; moreover, the wound was closed The mean bone defect length after debridement was 7.2 cm (range 5.8-9.0 cm) in single-level group vs. 10.7 cm (range 7.5-15.0 cm) in the double-level group (P < 0.05). The mean docking site healing time was 10.85 ± 1.52 months in the single-level group vs. 8.93 ± 2.29 months in the double-level group (P < 0.05); external frame time was 18.06 months (range 15-20 months) in single-level group vs. 12.71 months (range 9.5-16.0 months) in the double-level group (P < 0.05); external fixation index was 2.52 months/cm (range 2.15-2.94 months/cm) versus 1.22 months/cm (range 0.96-1.67 months/cm) in double-level group (P < 0.01); and soft tissue growth index was 0.29 months/cm (range 0.21-0.45 months/cm) in the single-level group versus 0.62 months/cm (range 0.47-0.86 months/cm) in the double-level group (P < 0.01). According to the ASAMI classification, the clinical and functional results in the double-level group were better than in the single-level group.
結論:
Orthofix外固定具を用いた二重レベル骨輸送のイリザロフ手技は、脛骨骨欠損とそれに伴う軟部組織欠損の修復・再建に有効であることを示した。
CONCLUSION: The Ilizarov technique of double-level bone transport with Orthofix external fixator can be used successfully to repair and reconstruct the tibial bone loss and accompanying soft tissue defect.