Orthofix单边外固定支架骨搬运治疗胫骨缺损中发生轴向偏移的危险因素分析  

Risk factors for axial deviation in treatment of tibial bone defects by bone transport with Orthofix unilateral external fixator

作　　者：冯东伟 张雅欣 刘彦士 罗雪峰[1] 程二林 贾麒钰 陈东生 郭建 马创[1] Feng Dongwei;Zhang Yaxin;Liu Yanshi;Luo Xuefeng;Cheng Erlin;Jia Qiyu;Chen Dongsheng;Guo Jian;Ma Chuang(Department of Microrepair and Reconstruction,The First Hospital Affiliated to Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054

出　　处：《中华创伤骨科杂志》2022年第6期471-477,共7页Chinese Journal of Orthopaedic Trauma

基　　金：新疆维吾尔自治区天山青年计划-优秀青年科技人才项目(2019Q041)。

摘　　要：目的探讨Orthofix单边外固定支架骨搬运治疗胫骨缺损中发生轴向偏移的危险因素。方法回顾性分析2012年5月至2019年6月期间新疆医科大学第一附属医院骨科中心显微修复外科采用Orthofix单边外固定支架治疗的90例胫骨缺损患者资料。男77例,女13例;年龄为17~63岁,平均41.2岁。骨缺损长度为4~13 cm。根据Paley关于轴向偏移的标准将患者分成两组:未发生偏移或偏移角度≤5°的患者为无轴向偏移组,偏移角度>5°的患者为轴向偏移组。比较两组患者的年龄、既往手术次数、骨缺损长度、Schanz钉置入角度、戴架时间、外固定指数及末次随访时Schanz钉弯曲角度等。再将P<0.05的因素进行多因素logistic回归分析,分析轴向偏移的危险因素。结果90例患者术后获平均23个月(12~40个月)随访。本组患者轴向偏移的发生率为36.7%(33/90)。轴向偏移组患者的既往手术次数[5(3,6)次]显著多于无轴向偏移组患者[3(2,3)次],骨缺损长度[8(8,9)cm]和戴架时间[400.0(341.8,426.3)d]显著长于无轴向偏移组患者[6(5,8)cm、340.8(226.5,422.8)d],末次随访时Schanz钉弯曲角度[1.2°(0.4°,3.5°)]显著大于无轴向偏移组患者[0.8°(0.2°,3.7°)],差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示:既往手术次数多(OR=2.581,95%CI:1.496~4.450,P=0.001)和骨缺损长度长(OR=5.310,95%CI:1.952~14.442,P=0.001)是发生轴向偏移的危险因素。结论在单边外固定支架胫骨近端截骨骨搬运治疗胫骨缺损中,既往手术次数越多、骨缺损长度越长,越容易发生轴向偏移。Objective To investigate the risk factors for axial deviation in the treatment of tibial defect susing Orthofix unilateral external fixator and proximal tibial osteotomy for bone transport.Methods A retrospective study was performed to analyze the clinical data of 90 patients who had been treated for tibial bone defects by the Orthofix unilateral external fixator at Department of Microrepair and Reconstruction,The First Hospital Affiliated to Xinjiang Medical University from May 2012 to June 2019.There were 77 males and 13 females with a mean age of 41.2 years(from 17 to 63 years).The bone defects ranged from 4 to 13 cm in length.According to the Paley criteria for axial deviation,the 90 patients were divided into 2 groups:a deviation-free group with no axial deviation or an axial deviation≤5°and a deviation group with an axial deviation>5°.The 2 groups were compared in terms of age,number of prior surgery,defect length,placement angle of Schanz screws,external fixation time,external fixation index and bending degree of Schanz screws at the last follow-up.The factors with P<0.05 were analyzed by multivariate logistic regression to find the risk factors for coronal axial deviation.Results The 90 patients were followed up for an average of 23 months(from 12 to 40 months).The incidence of axial deviation in this cohort was 36.7%(33/90).The deviation group had a significantly larger number of prior surgery[5(3,6)times],a significantly longer defect length[8(8,9)cm],a significantly longer external fixation time[400.0(341.8,426.3)d],and a significantly greater bending degree of Schanz screws at the last follow-up[1.2°(0.4°,3.5°)]than the deviation-free group[3(2,3)times,6(5,8)cm,340.8(226.5,422.8)d,and 0.8°(0.2°,3.7°)](all P<0.05).Multivariate logistic regression analysis showed that the number of prior surgery(OR=2.581,95%CI:1.496-4.450,P=0.001)and the defect length(OR=5.310,95%CI:1.952-14.442,P=0.001)were the risk factors for the axial deviation.Conclusion In the treatment of tibial defect susing Orthofix u

关 键 词：胫骨 骨缺损 外固定器 伊利扎罗夫技术 轴向偏移 危险因素 

分 类 号：R687.3[医药卫生—骨科学]