Gaiarsa Guilherme Pelosini, Dos Reis Paulo Roberto, Kojima Kodi Edson, Silva Jorge Santos, Lima Ana Lucia Lei Munhoz
Universidade de São Paulo, Hospital das Clínicas - HCFMUSP, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Reconstruction and Lengthening Group, São Paulo, SP, Brazil.
Acta Ortop Bras. 2019 Sep-Oct;27(5):273-275. doi: 10.1590/1413-785220192705220540.
Non-union and persistence of infection at a fracture site for long periods are always described as a challenge to orthopedists, especially in cases of severe compound fractures with comminution and segmental bone loss. This is a case series of septic non-unions, using S53P4 bioactive glass for adjunctive treatment, using internal syntheses or external fixators. The objective is to retrospectively evaluate the results of the use of S53P4 bioglass for the adjunctive treatment of septic non-unions.
We reviewed 18 patients with septic non-unions. The patients were preoperatively classified using the Non-union Scoring System (NUSS) and union outcomes were assessed by the modified radiographic union scale in tibial (RUST) fractures. Of the 18 patients treated, six underwent internal osteosynthesis and 12 were treated with external fixators in combination with bioactive glass grafting.
The patients had a mean NUSS score of 56.6 (standard deviation of 7.6) and fracture union was achieved according to the RUST score in 17 of 18 cases (94.4%), with a mean value of 10.2 (standard deviation of 1.0). One patient was lost to follow-up. Reevaluation using the modified RUST score was 12.3 (SD = 1.0), maintaining union of 17/18.
The fracture union rate was high, according to the literature, as was control of infection.
骨折部位长期不愈合和感染持续存在一直被认为是骨科医生面临的挑战，尤其是在严重的粉碎性开放性骨折和节段性骨缺损病例中。这是一组关于感染性骨不连的病例系列，采用S53P4生物活性玻璃进行辅助治疗，使用内固定或外固定架。目的是回顾性评估使用S53P4生物玻璃辅助治疗感染性骨不连的结果。
我们回顾了18例感染性骨不连患者。术前使用骨不连评分系统（NUSS）对患者进行分类，并通过改良的胫骨骨折影像学骨愈合量表（RUST）评估骨愈合结果。在接受治疗的18例患者中，6例行内固定术，12例采用外固定架结合生物活性玻璃移植治疗。
患者的平均NUSS评分为56.6（标准差为7.6），根据RUST评分，18例中有17例（94.4%）实现了骨折愈合，平均值为10.2（标准差为1.0）。1例患者失访。使用改良RUST评分进行重新评估为12.3（SD = 1.0），17/18例维持愈合。
根据文献，骨折愈合率较高，感染控制情况也是如此。
