NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA.
Jamaica Hospital Medical Center, Jamaica, NY, USA.
Arch Orthop Trauma Surg. 2022 Jun;142(6):961-968. doi: 10.1007/s00402-020-03735-6. Epub 2021 Jan 8.
Tibial nonunion remains a considerable burden for patients and the surgeons who treat them. In recent years, alternatives to autogenous grafts for the treatment of tibial nonunions have been sought. The purpose of this study was to evaluate the efficacy of autogenous iliac crest bone graft (ICBG) in the treatment of tibial shaft nonunions.
Sixty-nine patients were identified who underwent ICBG for repair of atrophic or oligotrophic tibial nonunion and had complete data with at least one year of follow-up (mean 27.9 months). Surgical treatments consisted of revision/supplemental fixation ± ICBG. Surgical approaches for graft placement were either posterolateral (PL), anterolateral (AL), or direct medial (DM). Healing status, time to union, postoperative pain, and functional outcomes were assessed.
Bony union was achieved by 97.1% (67/69) of patients at a mean time of 7.8 ± 3.2 months postoperatively. There was no significant difference in mean time to union between the three surgical approach groups: (PL (44.9%) = 7.3 months, AL (20.3%) = 9.2 months, DM (34.8%) = 7.6 months; p = 0.22). Intraoperative cultures obtained at the time of nonunion surgery were positive in 27.5% of patients (19/69). Positive cultures were associated with need for secondary surgery as 8/19 patients (42.1%) with positive cultures required re-operation. Two out of four patients that developed iliac donor site hematomas/infections requiring washout had positive intraoperative cultures as well. There was no difference in final SMFA among the three surgical approach groups.
Autogenous ICBG remains the gold standard in the management of persistent tibial nonunions regardless of surgical approach. There is a small risk for complication at the iliac crest donor site. Given the high union rate, autogenous iliac crest bone grafting for tibial nonunion remains the gold standard for this difficult condition.
Level III.
胫骨骨不连仍然给患者和治疗他们的医生带来了相当大的负担。近年来，人们一直在寻找替代自体移植物治疗胫骨骨不连的方法。本研究的目的是评估自体髂嵴骨移植（ICBG）治疗胫骨骨干骨不连的疗效。
共纳入 69 例接受 ICBG 修复萎缩性或寡营养性胫骨骨不连的患者，且所有患者均有完整数据并至少随访 1 年（平均 27.9 个月）。手术治疗包括翻修/补充固定+ICBG。移植骨放置的手术入路为后外侧（PL）、前外侧（AL）或直接内侧（DM）。评估愈合状态、愈合时间、术后疼痛和功能结果。
97.1%（67/69）的患者术后平均 7.8±3.2 个月达到骨性愈合。3 种手术入路组的平均愈合时间无显著差异：（PL（44.9%）=7.3 个月，AL（20.3%）=9.2 个月，DM（34.8%）=7.6 个月；p=0.22）。在非愈合手术时获得的术中培养物中，27.5%（19/69）的患者培养物呈阳性。阳性培养物与需要二次手术相关，因为 19 例阳性培养物患者中有 8 例（42.1%）需要再次手术。4 例发生髂嵴供区血肿/感染需要冲洗的患者中，有 2 例的术中培养物也呈阳性。3 种手术入路组的最终 SMFA 无差异。
无论手术入路如何，自体 ICBG 仍然是治疗持续性胫骨骨不连的金标准。髂嵴供区存在小的并发症风险。鉴于高愈合率，自体髂嵴骨移植治疗胫骨骨不连仍然是这一困难情况的金标准。
III 级。
