Which surgical technique may yield the best results in large, infected, segmental non-unions of the tibial shaft? A scoping review.

IF 1.9 3区 医学 Q2 EMERGENCY MEDICINE
Dena Akhoundzadeh, Frank W Bloemers, Michael H J Verhofstad, Linda J Schoonmade, Leo M G Geeraedts
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Abstract

Purpose: Infected nonunion of the tibia with a large segmental bone defect is a complex and challenging condition for the patient and surgeon. This scoping review was conducted to identify existing evidence and knowledge gaps regarding this clinical scenario. Secondly, the objective of this study was to search for a valid recommendation on the optimal treatment.

Methods: A comprehensive search was conducted in the bibliographic databases: PubMed, Embase.com, and Web of Science Core Collection. Studies reporting on bone transport techniques, the Masquelet technique, and vascularized fibular grafts in bone defects greater than 5 cm were included. Bone healing results and functional results were compared according to duration of nonunion, infection recurrence, bone consolidation, complication rate, external fixation time, and time until full weight-bearing.

Results: Of the 2753 articles retrieved, 37 studies could be included on bone transport techniques (n = 23), the Masquelet technique (n = 7), and vascularized fibular grafts (n = 7). Respective bone union percentages were 94.3%, 89.5%, and 96.5%. The percentages of infection recurrence respectively were 1.6%, 14.4% and 7.0%, followed by respectively 1.58, 0.78, and 0.73 complications per patient.

Conclusion: Bone transport was found to be the most widely studied technique in the literature. Depending on the surgeon's expertise, vascularized fibular grafts may be held as a favourable alternative. This review indicates that further high-quality research on large bone defects ( 5 cm) in patients with infected tibial nonunions is necessary to gain more insight into the potentially beneficial results of vascularized fibular grafts and the Masquelet technique.

Abstract Image

哪种手术技术可为大面积、感染性、节段性胫骨非腱鞘炎带来最佳效果?范围综述。
目的:对于患者和外科医生来说,胫骨感染性不愈合伴有大段骨缺损是一种复杂且具有挑战性的情况。本范围综述旨在确定有关这种临床情况的现有证据和知识差距。其次,本研究的目的是寻找最佳治疗方法的有效建议:方法:在文献数据库中进行了全面搜索:方法:在以下文献数据库中进行了全面搜索:PubMed、Embase.com 和 Web of Science Core Collection。方法:在PubM.Embed.com和Web Science Core Collection等文献数据库中进行了全面搜索,纳入了有关骨转运技术、Masquelet技术和血管化纤维移植治疗大于5厘米骨缺损的研究报告。根据不愈合持续时间、感染复发率、骨质巩固率、并发症发生率、外固定时间和完全负重时间对骨愈合结果和功能结果进行比较:在检索到的 2753 篇文章中,有 37 项研究涉及骨转运技术(23 项)、Masquelet 技术(7 项)和血管化纤维移植(7 项)。骨结合率分别为 94.3%、89.5% 和 96.5%。感染复发率分别为1.6%、14.4%和7.0%,每位患者的并发症分别为1.58、0.78和0.73:结论:在文献中,骨转运是研究最广泛的技术。根据外科医生的专业技能,血管化纤维移植物可能是一种有利的替代方法。这篇综述表明,有必要进一步对感染性胫骨骨不连患者的大骨缺损(≥ 5 厘米)进行高质量的研究,以便更深入地了解血管化腓骨移植物和 Masquelet 技术可能带来的益处。
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来源期刊
CiteScore
4.50
自引率
14.30%
发文量
311
审稿时长
3 months
期刊介绍: The European Journal of Trauma and Emergency Surgery aims to open an interdisciplinary forum that allows for the scientific exchange between basic and clinical science related to pathophysiology, diagnostics and treatment of traumatized patients. The journal covers all aspects of clinical management, operative treatment and related research of traumatic injuries. Clinical and experimental papers on issues relevant for the improvement of trauma care are published. Reviews, original articles, short communications and letters allow the appropriate presentation of major and minor topics.
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