Department of Orthopaedic and Trauma Surgery, Sahel General Hospital, University Medical Centre, Ghoubeiry, PO Box 99/25, Beirut, Lebanon.
Int Orthop. 2022 Jun;46(6):1241-1251. doi: 10.1007/s00264-022-05379-0. Epub 2022 Mar 20.
This study was conducted to assess a stepwise surgical procedure applied to treat a continuous series of patients with aseptic atrophic nonunion of long bones.
A retrospective review was performed of the medical files of patients treated by the senior author between January 2014 and January 2021 for aseptic atrophic nonunion of long bones using a standard stepwise surgical procedure consisting of four successive surgical steps: bridge locked plating, aggressive osteoperiosteal decortication, copious autologous iliac bone grafting, and tight closure without drainage. Patients were clinically and radiographically evaluated until bone healing, then at final follow-up for the purpose of the study. The primary objective of the study was to assess completion of bone healing; secondary objectives were the time required reaching bone union, the occurrence of complications at the iliac bone graft donor site, and the achievement of bone consolidation after a second attempt of treatment when indicated following failure of the index procedure.
There were a total of 55 patients. One patient died from myocardial infarction before reaching bone healing and another one lost from early follow-up. There were remaining 53 patients with 37 years of mean age. The affected bone was the clavicle in five patients, humerus in 14, ulna in four, radius in one, femur in 13, and tibia in 16. The mean follow-up period was 3.4 years. A total of 52 patients (98.1%) achieved bone healing at a mean of 14.8 weeks from the index procedure. The only patient who did not reach bone healing after the index procedure was successfully revised using decortication-bone graft and new fixation with intra-medullary femoral nailing. Four patients (7.5%) developed local complications at the site of iliac bone harvesting.
Our stepwise surgical procedure was very effective treating aseptic atrophic nonunion of long bones. However, as this study is a retrospective review of a limited series of one surgeon's experience, prospective comparative studies with large number of patients are suitable to define the advantages and indications of the procedure herein described.
本研究旨在评估一种逐步手术程序，用于治疗连续系列的长骨无菌性萎缩性骨不连患者。
对 2014 年 1 月至 2021 年 1 月期间，由资深作者应用标准分步手术程序治疗的长骨无菌性萎缩性骨不连患者的病历进行回顾性分析。该手术程序由四个连续的手术步骤组成：桥接锁定钢板、积极的骨膜骨皮质切除术、大量自体髂骨移植和无引流的紧密闭合。患者在临床和影像学上进行评估，直至骨愈合，然后在研究的最终随访时进行评估。本研究的主要目的是评估骨愈合的完成情况；次要目标是达到骨愈合所需的时间、髂骨供区并发症的发生情况，以及在指数手术失败后需要再次治疗时获得骨整合的情况。
共纳入 55 例患者。1 例患者在达到骨愈合前因心肌梗死死亡，另 1 例患者在早期随访时失访。其余 53 例患者的平均年龄为 37 岁。病变骨为锁骨 5 例，肱骨 14 例，尺骨 4 例，桡骨 1 例，股骨 13 例，胫骨 16 例。平均随访时间为 3.4 年。52 例（98.1%）患者在指数手术后 14.8 周达到骨愈合。仅 1 例患者在指数手术后未达到骨愈合，成功采用骨皮质切除术-骨移植和新的髓内股骨钉固定进行修正。4 例（7.5%）患者在髂骨采集部位发生局部并发症。
我们的分步手术程序治疗长骨无菌性萎缩性骨不连非常有效。然而，由于本研究是对一位外科医生经验的回顾性分析，因此需要进行前瞻性的、大样本的、对比性研究，以明确该手术程序的优势和适应证。
