Pieske Oliver, Wittmann Alexandra, Zaspel Johannes, Löffler Thomas, Rubenbauer Bianka, Trentzsch Heiko, Piltz Stefan
Department of Trauma Surgery, Campus Grosshadern, University Hospital of Munich, Germany.
J Trauma Manag Outcomes. 2009 Dec 15;3:11. doi: 10.1186/1752-2897-3-11.
Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG) or demineralized-bone-matrix (DBM).
From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10) or DBM-augmentation (n = 10). At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014). Mean duration of follow-up was 56.6 months (ICABG-group) and 41.2 months (DBM-group). All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20%) whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146). No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20%) (p = 0.146). Pain intensity were comparable in both groups (p = 0.326). However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031).
With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160 euro/case). Nevertheless, this study demonstrated that the application of DBM compared to ICABG led to an advanced outcome in the treatment of non-unions and simultaneously to a decreased quantity of adverse effects. Therefore we conclude that DBM should be offered as an alternative to ICABG, in particular to patients with elevated comorbidity and those with limited availability or reduced quality of autologous-bone graft material.
骨不连是骨科创伤治疗中的严重并发症，在所有骨折中发生率为10%。治疗骨不连的金标准包括切开复位内固定（ORIF）以及自体骨移植增强。然而，骨移植供区存在并发症，且一些患者的自体骨移植材料数量或质量有限。自从同种异体骨移植进入市场以来，这项对比研究旨在评估采用ORIF联合髂嵴自体骨移植（ICABG）或脱矿骨基质（DBM）治疗骨不连的愈合特征。
2000年至2006年期间，在我们的一级创伤中心连续收治的62例骨不连患者中，20例为长骨干骨不连，接受了ORIF联合ICABG（n = 10）或DBM增强（n = 10）治疗。在初次手术时，DBM组患者的合并症水平较高（美国麻醉医师协会评分：p = 0.014）。平均随访时间为56.6个月（ICABG组）和41.2个月（DBM组）。对所有患者进行了临床和影像学评估，并记录了与骨移植相关 的不良反应。结果显示，2例接受ICABG增强的骨不连未实现骨愈合（20%），而所有接受DBM移植的骨不连在初次手术后的第一年内均实现了成功愈合（p = 0.146）。两组均未记录到早期并发症，但ICABG组有2例患者在供区出现长期问题（20%）（p = 0.146）。两组的疼痛强度相当（p = 0.326）。然而，接受DBM治疗的患者对手术的满意度更高（p = 0.031）。
与ICABG相比，使用DBM增强骨不连部位的成本更高（计算差异：160欧元/例）。然而，本研究表明，与ICABG相比，应用DBM在治疗骨不连方面能带来更好的结果，同时不良反应数量减少。因此，我们得出结论，应将DBM作为ICABG的替代方案提供给患者，特别是合并症较高以及自体骨移植材料可用性有限或质量较差 的患者。
