开放性胫骨骨干骨折患者在有或没有软组织覆盖手术治疗后骨不连的结局。

Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.

Department of Orthopedic Surgery, Medisys Health Network, Jamaica Hospital Medical Center, Queens, NY; and.

J Orthop Trauma. 2021 Aug 1;35(8):e271-e276. doi: 10.1097/BOT.0000000000002031.

OBJECTIVES

To evaluate the outcomes of patients who underwent soft tissue flap coverage during treatment of a tibia fracture nonunion.

DESIGN

Retrospective analysis on prospectively collected data.

SETTING

Academic medical center.

PATIENTS/PARTICIPANTS: One hundred fifty-seven patients were treated for a fracture nonunion after a tibia fracture over a 15-year period. Sixty-six patients had sustained an open tibial fracture initially and 25 of these patients underwent soft tissue flaps for their open tibia fracture nonunion.

INTERVENTION

Manipulation of soft tissue flaps, either placement or elevation for graft placement in ununited previously open tibial fractures.

MAIN OUTCOME MEASUREMENTS

Bony healing, time to union, ultimate soft tissue status, postoperative complications, and functional outcome scores using the Short Musculoskeletal Functional Assessment (SMFA). This group was compared with a group of open tibial fracture nonunions that did not undergo soft tissue transfer.

RESULTS

Bony healing was achieved in 24 of 25 patients (96.0%) who received flaps at a mean time to union of 8.7 ± 3.3 months compared with 39 of 41 patients (95.1%) at a mean 7.5 ± 3.2 months (P > 0.05) in the noncoverage group. Healing rate and time to union did not differ between groups. At latest follow-up, the flap coverage group reported a mean SMFA index of 17.1 compared with an SMFA index of 27.7 for the noncoverage group (P = 0.037).

CONCLUSIONS

Utilization of soft tissue flaps in the setting of open tibia shaft nonunion repair surgery are associated with a high union rate (>90%). Coverage with or manipulation of soft tissue flaps did not result in improved bony healing rate or time to union compared with those who did not require flaps. However, soft tissue flap coverage was associated with higher functional scores at long-term follow-up.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

目的

评估在治疗胫骨骨折不愈合时进行软组织瓣覆盖的患者的结局。

设计

前瞻性收集数据的回顾性分析。

地点

学术医疗中心。

患者/参与者：在 15 年的时间里，157 例胫骨骨折患者因骨折不愈合接受治疗。66 例患者最初发生开放性胫骨骨折，其中 25 例患者因开放性胫骨骨折不愈合而行软组织瓣转移。

干预

软组织瓣的处理，包括放置或抬高以用于先前开放性胫骨骨折不愈合处植骨。

主要观察指标

骨愈合、愈合时间、最终软组织状态、术后并发症以及使用短节段肌肉骨骼功能评估（Short Musculoskeletal Functional Assessment，SMFA）的功能结局评分。将该组与未行软组织转移的开放性胫骨骨折不愈合组进行比较。

结果

25 例接受皮瓣转移的患者中有 24 例（96.0%）达到骨性愈合，平均愈合时间为 8.7 ± 3.3 个月，而未行皮瓣覆盖的 41 例患者中有 39 例（95.1%）达到平均 7.5 ± 3.2 个月（P > 0.05）。两组愈合率和愈合时间无差异。在末次随访时，皮瓣覆盖组的 SMFA 指数平均为 17.1，而非皮瓣覆盖组的 SMFA 指数为 27.7（P = 0.037）。