Gönder Nevzat, Demir İbrahim Halil, Öğümsöğütlü Erman, Kılınçoğlu Volkan
Department of Orthopaedics and Traumatology, T.C. Ministry of Health Islahiye State Hospital, 27800 Gaziantep, Turkey.
Department of Orthopaedics and Traumatology, Gaziantep University Faculty of Medicine, 27310 Gaziantep, Turkey.
Indian J Orthop. 2021 Oct 19;56(3):412-420. doi: 10.1007/s43465-021-00545-9. eCollection 2022 Mar.
Our aim in this study was to evaluate the effect of exchange intramedullary nailing in femoral shaft atrophic nonunions and the use of collagen/nano-hydroxyapatite composite scaffold applied in addition to the cancellous iliac crest autograft on the union, return to work, and quality of life.
Fifty-four patients with an atrophic nonunion in the isthmic region of the femoral shaft were included in the study. The patients were divided into two groups. Group A consisted of 24 patients who underwent collagen/nano-hydroxyapatite composite scaffold in addition to exchange intramedullary nailing and iliac autograft, while group B consisted of 30 patients without scaffold. Short Form-36 (SF-36) questionnaire scores, union rates, time to union, return to work were complications were compared.
Mean age of patients was 47.5 ± 14.1. The mean follow-up period was 3.56 ± 1.88 years. There was no statistically significant difference between Group A and B in terms of age, gender, smoking and alcohol use, and trauma mechanism. Time to union and return to work were statistically significantly shorter in Group A than in Group B ( = 0.004, = 0.001). All of the SF-36 survey scores at month six were better in Group A. In the first year, mental health and general health perception were still statistically better in group A ( = 0.009, = 0.008).
In the treatment of atrophic nonunions of the femoral shaft isthmic region, the use of collagen/nano-hydroxyapatite composite scaffolds together with exchange intramedullary nailing affects the union positively. This positive effect also brings about earlier return to work and better quality of life.
本研究的目的是评估交锁髓内钉治疗股骨干萎缩性骨不连的效果，以及除了髂骨松质骨自体移植外，使用胶原/纳米羟基磷灰石复合支架对骨愈合、恢复工作和生活质量的影响。
本研究纳入了54例股骨干峡部萎缩性骨不连患者。患者被分为两组。A组由24例患者组成，他们接受了交锁髓内钉、髂骨自体移植以及胶原/纳米羟基磷灰石复合支架治疗；而B组由30例未使用支架的患者组成。比较了两组患者的简明健康状况调查量表（SF-36）评分、骨愈合率、骨愈合时间、恢复工作情况及并发症。
患者的平均年龄为47.5±14.1岁。平均随访时间为3.56±1.88年。A组和B组在年龄、性别、吸烟和饮酒情况以及创伤机制方面无统计学显著差异。A组的骨愈合时间和恢复工作时间在统计学上显著短于B组（P = 0.004，P = 0.001）。在术后6个月时，A组的所有SF-36调查评分均更好。在第一年，A组的心理健康和总体健康感知在统计学上仍更好（P = 0.009，P = 0.008）。
在治疗股骨干峡部萎缩性骨不连时，交锁髓内钉联合使用胶原/纳米羟基磷灰石复合支架对骨愈合有积极影响。这种积极影响还能使患者更早恢复工作并拥有更好的生活质量。
