使用血管化纤维移植治疗股骨干和胫骨创伤后骨缺损后的长期效果和患者报告结果:回顾性队列和横断面调查研究

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引用次数: 0

摘要

目的 创伤后临界大小骨缺损给整形外科医生带来了整形挑战。血管化腓骨移植是一种治疗股骨和胫骨骨缺损的成熟疗法。本研究旨在评估患者报告的长期生活质量、血管化腓骨移植物下肢重建的成功率和并发症发生率。方法回顾性队列纳入了1990年至2021年期间因创伤后胫骨和股骨头缺损而接受腓骨移植物重建治疗的29例临界大小骨缺损患者。为了评估与健康相关的生活质量以及重返工作岗位的情况和满意度,研究人员使用短表-36、下肢功能量表和自制问卷(包括 DN4、满意度和主观踝关节功能)进行了横断面调查。心理成分得分与荷兰人口标准值相当,而身体功能受损得分与疼痛相关(r 0.849,p <0.001)。19 名患者中有 7 名出现了神经病理性症状,19 名患者中有 11 名恢复了正常的日常活动。所有受访者对康复的总体满意度均为正面或中性。29 名患者中有 19 人的骨愈合顺利。29 位患者中有 25 位实现了骨结合。结论血管化腓骨移植术可使胫骨和股骨创伤后节段性骨缺失患者的骨愈合率和肢体挽救率提高。患者对整体恢复情况的满意度很高,但功能结果仍然受损。
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Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study

Objectives

Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts.

Methods

A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function.

Results

The median bone defect size was 8 cm (IQR 9–7 cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, p < 0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients.

Conclusion

Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.

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来源期刊
CiteScore
3.10
自引率
11.10%
发文量
578
审稿时长
3.5 months
期刊介绍: JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.
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