The dynamic changes of postoperative symptoms in lower limb Ilizarov bone transport patients: a longitudinal cross-lagged panel network analysis

BACKGROUND: Patients undergoing lower limb Ilizarov bone transport often experience a multidimensional symptom burden postoperatively, including physical, psychological, and social domains, which interact with each other. These symptoms collectively hinder postoperative recovery, yet their dynamic interactions over time remain unclear. OBJECTIVE: To construct a longitudinal symptom network for postoperative lower limb bone transport patients, identify core symptoms that persistently drive changes in other symptoms throughout rehabilitation, and reveal the dynamic evolution of symptom network structures over the treatment course. METHODS: This prospective study recruited 260 patients undergoing first-time Ilizarov bone transport surgery from two hospitals in Guangzhou, China, between September 2024 and October 2025. Data were collected at three time points: within one week post-surgery (T1), one month post-surgery (T2), and three months post-surgery (T3). Fourteen core symptoms were assessed using the PROMIS-29 and Ilizarov-specific symptom inventory. Cross-lagged panel network analysis (CLPN) was employed to construct longitudinal symptom networks. RESULTS: Complex interactions were identified among postoperative symptoms in patients with lower limb bone transport. The ability to participate in social roles and activities emerged as the core driving node within the entire longitudinal network. Fatigue acted as a susceptibility node in the symptom network from one week to one month post-surgery, while both fatigue and muscular discomfort functioned as susceptibility nodes from one to three months postoperatively. Furthermore, the early-stage symptom network was primarily driven by a single key symptom; however, as rehabilitation progressed, the symptom system became increasingly complex, exhibiting dynamic characteristics driven by the combined action of multiple nodes. CONCLUSION: Restricted social role participation can be used as a priority target for clinical intervention, while fatigue and muscular discomfort serve as early warning indicators of symptom deterioration. A staged systemic intervention should be implemented for patients: focusing on social function reconstruction within the first month post-surgery, and adopting multi-target collaborative intervention strategies from one to three months postoperatively, in order to break the vicious cycle of symptoms and improve patient prognosis and quality of life.