Hierholzer Christian, Friederichs Jan, Glowalla Claudio, Woltmann Alexander, Bühren Volker, von Rüden Christian
Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Trauma Surgery, Trauma Center Murnau, Professor Küntscher Str. 8, 82418 Murnau, Germany.
Int Orthop. 2017 Aug;41(8):1647-1653. doi: 10.1007/s00264-016-3317-x. Epub 2016 Oct 28.
The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome.
This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome.
Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result.
Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.
本研究旨在评估一种关于二次骨愈合率、并发症及功能结局的标准化治疗方案。
本研究于2003年至2012年在一家一级创伤中心作为前瞻性研究开展。研究组由188例诊断为无菌性胫骨干骨不连的患者组成。按照标准化手术方案进行交锁髓内钉更换术。对骨愈合率和功能结局进行长期随访分析。
188例患者中有182例（97%）实现了骨愈合。188例患者中有165例（88%）在单次交锁髓内钉更换术后及时且顺利地观察到骨愈合。32例患者（17%）需要采用开放手术入路。23例患者（12%）需要额外治疗，如体外冲击波治疗。7例患者（4%）出现术后并发症。几乎所有患者在12个月内实现骨愈合，大多数骨愈合发生在6个月内。188例患者中有20例（11%）观察到胫骨骨折出现明显短缩。在中位随访23个月（范围12 - 45个月）后，使用Friedman/Wyman评估系统对结局进行评估。总体而言，188例患者中有154例（82%）获得了良好的长期功能结果。
扩髓髓内交锁钉更换术，包括对线矫正，是治疗无菌性胫骨干骨不连的一种安全有效的方法，骨愈合率高，且具有良好的放射学和长期功能结局。
