Riesgos y beneficios de la osteogénesis por distracción en pseudoartrosis infectadas en miembros inferiores según resultados funcionales
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2023
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La pseudoartrosis de fémur y tibia con gran defecto óseo segmentario representa un desafío para el cirujano ortopedista al aumentar la hospitalización, riesgo de complicaciones y gastos sanitarios, siendo su manejo difícil y complejo. Objetivo: Determinar los riesgos y beneficios de la osteogénesis por distracción en pseudoartrosis postraumáticas en miembros inferiores según los resultados óseos y funcionales mediante la clasificación de Montoya y ASAMI. Metodología: Estudio de tipo observacional, descriptivo, retrospectivo, transversal, del servicio de Traumatología y Ortopedia de la Clínica Alcívar entre diciembre de 2017 al 2020. Resultados: Se incluyeron 26 pacientes de los cuales el 80.7% presentaron fracturas expuestas. La distracción se realizó mediante un fijador externo monolateral de ORTHOFIX en un promedio de 11.4 meses. Se encontró resultados óseos y funcionales “Excelentes” y “Buenos” en 84.21% y 68.42% de la población, con un tiempo hasta la consolidación ósea menor a 6 meses en 47.36% de los pacientes con grado III y IV de consolidación radiológica, por lo tanto se demostró asociación estadísticamente significativa entre los resultados óseos, buen grado de consolidación radiológica y la aplicación de la osteogénesis por distracción (p=0,0001). Conclusión: La osteogénesis por distracción permitió regenerar complejas pérdidas óseas con buenos resultados óseos y funcionales, además aportó otros beneficios como la corrección de deformidades angulares, recuperación de longitud en miembros y control de la infección, sin embargo, se debe tomar en cuenta las principales complicaciones asociadas y sus riesgos.
Pseudarthrosis of the femur and tibia with a large segmental bone defect represents a challenge for the orthopedic surgeon since it increases hospitalization, the risk of complications and healthcare costs, so its management is difficult and complex. Objective: To determine the risks and benefits of distraction osteogenesis in post-traumatic nonunions in the lower limbs according to bone and functional results using the Montoya and ASAMI classification. Methodology: Observational, descriptive, retrospective and transversal study, in the Traumatology and Orthopedics service of the Alcívar Clinic between December 2017 and 2020. Results: 26 patients were included, of which 80.7% had open fractures. Distraction was performed using a monolateral ORTHOFIX external fixator at an average of 11.4 months. "Excellent" and "Good" bone and functional results were found in 84.21% and 68.42% of the population, with a time to bone consolidation of less than 6 months in 47.36% of patients with grade III and IV radiological consolidation. Therefore, a statistically significant association was demonstrated between bone results, a good degree of radiological consolidation and the application of distraction osteogenesis (p=0.0001). Conclusion: Distraction osteogenesis allowed to regenerate complex bone losses with good bone and functional results. It also provided other benefits such as the correction of angular deformities, limb length recovery and infection control, however, the main associated complications and their risks must be taken into account.
Pseudarthrosis of the femur and tibia with a large segmental bone defect represents a challenge for the orthopedic surgeon since it increases hospitalization, the risk of complications and healthcare costs, so its management is difficult and complex. Objective: To determine the risks and benefits of distraction osteogenesis in post-traumatic nonunions in the lower limbs according to bone and functional results using the Montoya and ASAMI classification. Methodology: Observational, descriptive, retrospective and transversal study, in the Traumatology and Orthopedics service of the Alcívar Clinic between December 2017 and 2020. Results: 26 patients were included, of which 80.7% had open fractures. Distraction was performed using a monolateral ORTHOFIX external fixator at an average of 11.4 months. "Excellent" and "Good" bone and functional results were found in 84.21% and 68.42% of the population, with a time to bone consolidation of less than 6 months in 47.36% of patients with grade III and IV radiological consolidation. Therefore, a statistically significant association was demonstrated between bone results, a good degree of radiological consolidation and the application of distraction osteogenesis (p=0.0001). Conclusion: Distraction osteogenesis allowed to regenerate complex bone losses with good bone and functional results. It also provided other benefits such as the correction of angular deformities, limb length recovery and infection control, however, the main associated complications and their risks must be taken into account.
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SEUDOARTROSIS, FACTORES DE RIESGO, EPIDEMIOLOGIA DESCRIPTIVA, HOSPITAL ALCIVAR, CANTON GUAYAQUIL, ECUADOR, FIJACION EXTERNA DE FRACTURAS, OSTEOGENESIS POR DISTRACCION, EXTREMIDAD INFERIOR, ESTUDIOS RETROSPECTIVOS