文献类型：期刊文献

英文题名：A systematic review and meta-analysis:comparing the efficacy of the Ilizarov technique alone with lengthening over a nail for lower extremity bone defects

作者：Tan, Fei[1,2];Yang, Cuixian[3];Zeng, Jiankang[1,2];Li, Jiahuan[1,2];Li, Peijie[1,2];Qiao, Yongjie[1];Wang, Jing[1,2];Zhang, Jiangming[1,2];Xie, Dong[1,2];Ye, Shuo[1];Zhou, Shenghu[1]

第一作者：Tan, Fei

通信作者：Zhou, SH[1]

机构：[1]940 Hosp Joint Logist Support Force Chinese People, Dept Joint Surg, Lanzhou, Gansu, Peoples R China;[2]Gansu Univ Chinese Med, Lanzhou, Gansu, Peoples R China;[3]Zhengzhou Univ, Zhengzhou, Henan, Peoples R China

第一机构：940 Hosp Joint Logist Support Force Chinese People, Dept Joint Surg, Lanzhou, Gansu, Peoples R China

通信机构：[1]corresponding author), 940 Hosp Joint Logist Support Force Chinese People, Dept Joint Surg, Lanzhou, Gansu, Peoples R China.

年份：2024

卷号：25

期号：1

外文期刊名：BMC MUSCULOSKELETAL DISORDERS

收录：;Scopus(收录号：2-s2.0-85202928458);WOS:【SCI-EXPANDED(收录号:WOS:001304087900008)】；

基金：This study was funded by Tutor Project of Gansu University of Traditional Chinese Medicine (2023YXKY015), Lanzhou Science and Technology Plan (2023-2-11), Gansu province Science and Technology Plan (22JR5RA009), and Lanzhou Science and Technology Plan (2023-ZD-170).

语种：英文

外文关键词：Ilizarov; Lengthening over a nail; Lower extremity lengthening; Meta analysis

摘要：Purpose The task faced by surgeons becomes significantly more challenging when they encounter lower extremity bone defects due to a variety of causes requiring lengthening. The most discussed and successful approach is the Illizarov technique, or lengthening over a nail (LON):distraction osteogenesis is also widely performed with monoliteral external fixators and intramedullary lengthening nails have increasingly been used in the last decade. Methods The data were collected from PubMed, Cochrane Library, Embase, and the Web of Science for all available studies comparing the outcomes of Ilizarov technique alone and LON technique (from January 1, 1997, to November 30, 2023). The outcomes of interest encompassed the external fixation index (EFI) (month/cm), mean duration of follow-up (MFT) (month), length gained (LG) (cm), consolidation index (CIx) (month/cm), and bone healing index (BHI) (month/cm).Complications include pin tract infection rate (PTI), axial deviation rate (AD), occurrence of intramedullary infection (II), delayed consolidation rate (DC), as well as data categorized into three levels of problems, obstacles, and sequelae based on the severity of complications. Two reviewers independently assessed each study for quality and extracted data. The case-control or respective cohort studies were evaluated using the Newcastle-Ottawa scale (NOS) to determine their techniqueological rigor. The Cochrane Collaboration's risk assessment tool was employed to perform quality evaluations for randomized controlled trials. Results This review included thirteen studies comprising a total of 629 patients. The external fixation index (month/cm) was significantly smaller in the LON technique compared to the Ilizarov technique alone [Mean Difference(MD) = -29.59, 95% CI -39.68--19.49, P < 0.00001].In terms of the mean follow-up time(month) (MD = -0.92, 95% CI -3.49-1.65, P = 0.57), length gained (cm) (MD = -0.87, 95%CI -2.80-1.07, P = 0.38), consolidation index (month/cm) (MD = 0.66, 95% CI -3.44-4.77, P = 0.75), and bone healing index (month/cm) (MD = -3.33, 95% CI -13.07-6.41, P = 0.5), there were no significant differences observed. The LON technique exhibited a lower incidence of axial deviation [Odds Ratio(OR) = 0.06, 95%CI 0.03-0.16, P < 0.00001] and pin tract infection (OR = 0.30, 95%CI 0.18-0.50, P < 0.00001) compared to the Ilizarov technique alone. The remaining complications, such as intramedullary infection rate (OR = 0.93, 95%CI 0.42-2.06, P = 0.85) and delayed consolidation rate(OR = 0.61, 95%CI 0.20-1.86, P = 0.38), did not exhibit statistically significant differences. Our findings demonstrated that the LON technique results in lower incidences of problems (38.5%vs.58.6%) and sequelae (16.6% vs.30.9%) when compared to the Ilizarov technique alone. However, the rates of obstacles (32.4% vs.32.3%) were comparable between the two methods. Conclusions Our findings indicate that patients treated with the LON technique experienced significantly shorter external fixation durations and a lower incidence of complications (e.g., pin tract infections and axial deviation) compared to those treated with the Ilizarov technique alone. Other outcome metrics showed no significant differences between the two techniques. However, the LON technique offers substantial benefits, including reduced external fixation times and increased comfort, which enhance patient compliance. In conclusion, the LON technique is a safe, reliable, and effective method for treating tibial and femoral defects.