骨搬运治疗胫骨骨缺损中滑移段外固定取出后发生回缩现象的相关因素分析

目的 探讨骨搬运治疗胫骨骨缺损过程中在对合端愈合前滑移段外固定去除后发生回缩现象的相关因素。方法 回顾性研究。纳入2009年1月—2019年12月无锡市人民医院和无锡市骨科医院胫骨骨缺损应用骨搬运治疗,在对合端愈合前滑移段外固定去除或失效发生不同程度回缩的41例患者,男25例、女16例,年龄18～71(40±15)岁。用Pearson相关分析滑移段回缩距离与患者年龄、性别、受伤至手术时间、骨缺损长度、手术次数、滑移段长度、骨搬运长度、滑移段固定时间和外固定去除或松动失效前、后两次影像学检查的间隔时间等9个因素的相关性,筛选出有统计学意义的影响因素再行多元线性回归分析。结果 41例患者中,受伤至骨搬运时间7～95(40.54±25.65)d,骨缺损长度5.0～11.0(6.90±1.20)cm,手术次数1～5(1.64±0.82)次,滑移段长度4.8～12.0(9.68±2.24)cm,骨搬运长度4.5～11.0(6.76±1.64)cm,滑移段固定时间3.5～11.5 (7.47±1.94)个月,间隔时间5～21(10.16±4.07)d,滑移段回缩距离1.5～30.0(8.73±7.99)mm。Pearson相关分析显示,滑移段回缩距离与滑移段固定时间呈负相关,与骨搬运长度和滑移段长度呈正相关,差异均有统计学意义(r=-0.897、0.501、0.419, P值均＜0.05);滑移段回缩距离与年龄、性别、受伤至手术时间、骨缺损长度、手术次数和间隔时间均无相关性,差异均无统计学意义(P值均＞0.05)。多元线性回归分析显示,骨搬运长度和滑移段固定时间与滑移段发生回缩存在线性关系(t=-10.385、3.027, P值均＜0.05)。回归方程:＾Y_{回缩距离(mm)}=27.081-2.805X_{滑移段固定时间(月)}+0.447X_{骨搬运长度(cm)}(R²=0.805, F=13.256, P＜0.01)。结论 骨搬运过程回缩程度与滑移段长度、骨搬运长度、固定时间相关,其中骨搬运长度和固定时间与滑移段回缩程度存在线性关系。

Relevant factors analysis of transporting bone segment retraction after external fixation removal in the treatment of tibial defect by bone transport

Objective To investigate the relevant factors of transporting bone segment (TBS) retraction after external fixation removal before the union of the docking site in the treatment of tibial defect by bone transport.Methods A retrospective analysis was conducted on 41 cases with tibial bone defect who were treated by bone transport in our hospital and presented TBS retraction after the removal or failure of external fixation before the union of the docking site. The patients included 25 males and 16 females aged 18-71 (40±15) years. Pearson correlation was used to analyze the relationship between TBS retraction distance and nine indexes, namely, age, gender, time from injury to operation, bone defect length, number of operations, TBS size, transport distance, fixation time, and time interval between radiologic examinations before and after the removal or failure of external TBS fixation. Risk factors with significant level were further identified using multivariate linear regression.Results The time from injury to operation was 7-95 (40.54±25.65) days, the bone defect length was 5.0-11.0 (6.90±1.20) cm, the number of operations was 1-5 (1.64±0.82), the TBS size was 4.8-12.0 (9.68±2.24) cm, the transport distance was 4.5-11.0 (6.76±1.64) cm, the fixation time was 3.5-11.5 (7.47±1.94) months, the time interval was 5-21 (10.16±4.07) days, and the retraction distance was 1.5-30.0 (8.73±7.99) mm. Pearson correlation showed that fixation time was negatively correlated with retraction distance, whereas transport distance and TBS size were positively correlated with transport distance, and the differences were significant(r=-0.897, 0.501, 0.419; all P values＜0.05). Differences in age, gender, time from injury to operation, bone defect length, and number of operations were not significant (all P values＞0.05). The multivariate linear regression analysis of fixation time, transport distance, and TBS size showed that transport distance and fixation time were linear with retraction distance (t=-10.385, 3.027; both P＜0.05), and the regression equation was: ＾Y_{retraction distance(mm)}=27.081-2.805X_{fixation time(month)}+0.447X_{transport distance(cm)} (R²=0.805, F=13.256, P＜0.01).Conclusions In the process of bone transport, the retraction distance is related to TBS size, transport distance, and fixation time, and fixation time and transport distance are linear with retraction distance.