Ring Fixator Bone Transport is Associated With Fewer Unplanned Major Reoperations than Masquelet in the Treatment of Segmental Bone Defects of the Tibia.

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2025-01-03 DOI:10.1097/BOT.0000000000002953

Keith G Whitlock, Dane J Brodke, Philip H Khoury, Vivian Li, Alice Bell, David Okhuereigbe, Marcus F Sciadini, Jason W Nascone, Robert V O'Toole, Nathan N O'Hara, Mark J Gage

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引用次数: 0

Abstract

Objective: To determine whether bone transport or Masquelet results in higher rates of major unplanned reoperations for the treatment of segmental tibial bone defects ≥4 cm in length.

Methods: Design: Retrospective cohort.

Setting: Level I trauma center.

Patient selection criteria: Adult patients with segmental tibial defects (OTA/AO 41,42,43) ≥4 cm who underwent surgical treatment with ring fixator bone transport or Masquelet between 2011-2022 with a minimum 1-year follow-up were included.

Outcome measures and comparisons: The primary outcome was a major unplanned reoperation after corticotomy (bone transport) or autografting (Masquelet), including below knee amputation, surgical debridement for deep infection, or surgical intervention for nonunion. Ring fixator bone transport and Masquelet were compared using multivariable logistic regression, adjusting for defect size as a potential confounder.

Results: 24 patients treated with bone transport (mean age 40yo (18-66), 100% male) and 22 patients treated with Masquelet (mean age 42yo (22-71), 91% male) were included. Defect etiology was identified as acute traumatic in 25 patients (54%) and post-infectious in 21 patients (46%) (P = 0.23). The median defect size was 7.2 cm (IQR 6.1-10.1) for transport and 5.8 cm for Masquelet (IQR 4.7-8.0) (P = 0.08). Bone transport was associated with an 85% reduction in the odds of a major unplanned reoperation compared to treatment with the Masquelet technique (OR, 0.15; 95% CI, 0.03-0.58; P = 0.01). Bone transport patients underwent a mean of 0.38 major unplanned reoperations compared to 0.91 in the Masquelet group. Reoperation for deep infection occurred significantly less in the bone transport group (21%) compared to the Masquelet group (46%) (OR, 0.18; 95% CI, 0.03-0.76; P = 0.03).

Conclusion: Bone transport was associated with a reduction in major reoperations compared to Masquelet for segmental tibial bone defects. This finding may have been driven by fewer surgeries for infection in the bone transport group.

Level of evidence: Therapeutic Level III.

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环形固定器骨运输在治疗胫骨节段性骨缺损中比面罩手术更少的意外再手术。

目的：探讨骨转运与Masquelet孰能提高长度≥4cm的胫骨节段性缺损的再手术率。方法：设计：回顾性队列。地点：一级创伤中心。患者选择标准：纳入2011-2022年间接受环固定器骨运输或Masquelet手术治疗的成年胫骨节段性缺损(OTA/AO 41,42,43)≥4 cm，随访至少1年的患者。结果测量和比较：主要结果是皮质切开术（骨运输）或自体移植（Masquelet）后的重大意外再手术，包括膝下截肢、深部感染的手术清创或不愈合的手术干预。环固定器骨运输和Masquelet使用多变量逻辑回归进行比较，调整缺陷大小作为潜在的混杂因素。结果：纳入24例骨转运患者（平均年龄40岁（18-66岁），100%为男性）和22例Masquelet患者（平均年龄42岁（22-71岁），91%为男性）。25例（54%）为急性创伤，21例（46%）为感染后（P = 0.23）。transport的中位缺陷尺寸为7.2 cm (IQR 6.1-10.1)， Masquelet的中位缺陷尺寸为5.8 cm (IQR 4.7-8.0) （P = 0.08）。与Masquelet技术相比，骨转运与重大意外再手术的几率降低85%相关(OR, 0.15；95% ci, 0.03-0.58；P = 0.01)。骨转运患者平均经历了0.38次重大意外再手术，而Masquelet组为0.91次。与Masquelet组（46%）相比，骨运输组（21%）因深度感染再次手术的发生率显著降低(OR, 0.18；95% ci, 0.03-0.76；P = 0.03)。结论：骨转运与Masquelet治疗胫骨节段性骨缺损的再手术次数减少有关。这一发现可能是由于骨运输组的感染手术较少。证据等级：治疗性III级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.