Tanner Michael C, Heller Raban Arved, Grimm Andreas, Zimmermann Stefan, Pilz Maximilian, Jurytko Louisa, Miska Matthias, Helbig Lars, Schmidmaier Gerhard, Haubruck Patrick
HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, D-69118, Germany.
Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität Zu Berlin, Berlin Institute of Health, Berlin, D-13353, Germany.
J Inflamm Res. 2021 Mar 22;14:995-1005. doi: 10.2147/JIR.S297329. eCollection 2021.
Occult infections (OI) lack typical inflammatory signs, making them challenging to diagnose. Uncertainty remains regarding OI's influence on the outcome of autologous bone grafting (ABG), and evidence-based recommendations regarding an appropriate course of action are missing. Thus, we sought to determine the incidence of an OI in patients receiving ABG, evaluate whether it influences the outcome of ABG and whether associated risk factors have a further negative influence.
This study was designed as a large size single-center case-control study investigating patients treated between 01/01/2010 and 31/12/2016 with a minimum follow-up of 12 months. Patients ≥18 years presenting with a recalcitrant non-union of the lower limb receiving surgical bone reconstruction, including bone grafting, were included. A total of 625 patients were recruited, and 509 patients included in the current study. All patients received surgical non-union therapy based on the "diamond concept" including bone reconstruction using ABG. Additionally, multiple tissue samples were harvested and microbiologically analyzed. Tissue samples were microbiologically evaluated regarding an OI. Bone healing was analyzed using clinical and radiological parameters, patient characteristics and comorbidities investigated and ultimately results correlated.
Forty-six out of 509 cases with OI resulted in an incidence of 9.04%. Overall consolidation time was increased by 15.08 weeks and radiological outcome slightly impaired (79.38% vs 71.42%), differences were at a non-significant extent. Diabetes mellitus had a significant negative influence on consolidation time (p=0.0313), while age (p=0.0339), smoking status (p=0.0337), diabetes mellitus (p=0.0400) and increased BMI (p=0.0315) showed a significant negative influence on the outcome of bone grafting.
Surgeons treating recalcitrant non-unions should be aware that an OI is common. If an OI is diagnosed subsequent to ABG the majority of patients does not need immediate revision surgery. However, special attention needs to be paid to high-risk patients.
隐匿性感染（OI）缺乏典型的炎症体征，难以诊断。OI对自体骨移植（ABG）结果的影响仍不明确，且缺乏关于适当治疗方案的循证建议。因此，我们试图确定接受ABG患者中OI的发生率，评估其是否影响ABG的结果，以及相关危险因素是否有进一步的负面影响。
本研究设计为一项大型单中心病例对照研究，调查2010年1月1日至2016年12月31日期间接受治疗且随访至少12个月的患者。纳入年龄≥18岁、下肢顽固性骨不连并接受包括植骨在内的手术骨重建的患者。共招募了625例患者，本研究纳入了509例患者。所有患者均接受基于“钻石概念”的手术治疗骨不连，包括使用ABG进行骨重建。此外，采集了多个组织样本并进行微生物学分析。对组织样本进行微生物学评估以确定是否存在OI。使用临床和放射学参数分析骨愈合情况，调查患者特征和合并症，并最终进行结果关联分析。
509例病例中有46例发生OI，发生率为9.04%。总体愈合时间延长了15.08周，放射学结果略有受损（79.38%对71.42%），差异无统计学意义。糖尿病对愈合时间有显著负面影响（p=0.0313），而年龄（p=0.0339）、吸烟状况（p=0.0337）、糖尿病（p=0.0400）和体重指数增加（p=0.0315）对骨移植结果有显著负面影响。
治疗顽固性骨不连的外科医生应意识到OI很常见。如果在ABG后诊断出OI，大多数患者不需要立即进行翻修手术。然而，需要特别关注高危患者。
