Vascularized fibular grafts for the treatment of long bone defects: pros and cons. A systematic review and meta-analysis

被引:28
作者
Feltri, Pietro [1 ]
Solaro, Luca [2 ]
Errani, Costantino [3 ]
Schiavon, Guglielmo [1 ]
Candrian, Christian [1 ,5 ]
Filardo, Giuseppe [4 ,5 ]
机构
[1] Osped Reg Lugano, Orthopaed & Traumatol Unit, EOC, CH-6900 Lugano, Switzerland
[2] IRCCS Ist Ortoped Rizzoli, Clin Ortoped & Traumatol 2, Via Pupilli 1-10, I-40136 Bologna, Italy
[3] IRCCS Ist Ortoped Rizzoli, Orthopaed Serv, Musculoskeletal Oncol Dept, I-40136 Bologna, Italy
[4] IRCCS Ist Ortoped Rizzoli, Appl & Translat Res Ctr, I-40136 Bologna, Italy
[5] Univ Svizzera Italiana, Fac Sci Biomed, Via Buffi 13, CH-6900 Lugano, Switzerland
关键词
Vascularized fibular grafts; VFG; Long-bone defects; Pedicled; Free graft; Bone implant; LARGE SKELETAL DEFECTS; INTERCALARY RECONSTRUCTION; TIBIAL DEFECTS; LOWER-LIMB; CONGENITAL PSEUDOARTHROSIS; EPIPHYSEAL TRANSFER; SARCOMA RESECTION; MASSIVE ALLOGRAFT; CAPANNA TECHNIQUE; TUMOR;
D O I
10.1007/s00402-021-03962-5
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose To quantify union rate, complication rate, reintervention rate, as well as functional outcome after vascularized fibular bone grafts (VFGs) for the treatment of long-bone defects. Methods A comprehensive search was performed in the PubMed, Web of Science, and Cochrane databases up to August 18, 2020. Randomized controlled trials, comparative studies, and case series describing the various techniques available involving VFGs for the reconstruction of segmental long-bone defects were included. A meta-analysis was performed on union results, complications, and reinterventions. Assessment of risk of bias and quality of evidence was performed with the Downs and Black's "Checklist for Measuring Quality". Results After full-text assessment, 110 articles on 2226 patients were included. Among the retrieved studies, 4 were classified as poor, 83 as fair, and 23 as good. Overall, good functional results were documented and a union rate of 80.1% (CI 74.1-86.2%) was found, with a 39.4% (CI 34.4-44.4%) complication rate, the most common being fractures, non-unions and delayed unions, infections, and thrombosis. Donor site morbidity represented 10.7% of the total complications. A 24.6% reintervention rate was documented (CI 21.0-28.1%), and 2.8% of the patients underwent amputation. Conclusions This systematic review and meta-analysis documented good long-term outcomes both in the upper and lower limb. However, VFG is a complex and demanding technique; this complexity means an average high number of complications, especially fractures, non-unions, and vascular problems. Both potential and limitations of VFG should be considered when choosing the most suitable approach for the treatment of long-bone defects.
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页码:29 / 48
页数:20
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