Liang Cecilia, Jacoby Johann, Reumann Marie, Braun Benedikt, Ehnert Sabrina, Nikolaou Konstantin, Springer Fabian, Almansour Haidara
Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
Acad Radiol. 2023 Nov;30(11):2625-2635. doi: 10.1016/j.acra.2023.01.041. Epub 2023 Mar 14.
Blood supply is vital for sound callus formation. The tibial nutrient artery (TNA) is the main diaphyseal artery nurturing the tibial shaft. The objective is to investigate the impact of TNA canal (TNAC) injury on the development of atrophic, oligotrophic, and hypertrophic nonunion in patients with tibial shaft fractures.
Between January 2010 and December 2020, patients with a nonunion of a tibial shaft fracture were retrospectively included. Two readers independently evaluated the integrity of the TNAC and classified nonunion type. A multinomial regression model was utilized to evaluate if a TNAC injury has an impact on the type of nonunion.
From an initial set of 385 patients with the diagnosis of a nonunion of the lower leg, a total of 60 patients could be finally included in the study. Most patients were males (78%), diabetic (95%), smokers (73%), and had an American Society of Anesthesiologists (ASA) score of 2 (72%). TNAC injury was noted in 24 patients (40%): an iatrogenic TNAC injury was observed in 13 (22%) patients, a traumatic TNAC injury in 11 (18%) patients. Most patients had a hypertrophic nonunion (29 patients (48%)), followed by an oligotrophic nonunion (24 patients (40%)) and lastly an atrophic nonunion (seven patients (11%)). The multinomial regression model showed that there was no impact of TNAC injury on the development of a specific type of non-union (p = 0.798 for oligotrophic vs. atrophic nonunion; p = 0.943 for hypertrophic vs. atrophic nonunion). Furthermore, patients were about four times more likely to develop an oligotrophic/hypertrophic nonunion rather than atrophic one (odds ratio 3.75 and 4.25, respectively), regardless of the presence of a TNAC injury.
In the evaluated patient cohort with tibial shaft fractures, we could not find a statistically significant association between TNAC injury and type of nonunion. However, patients were almost four times more likely to develop oligotrophic or hypertrophic nonunion rather than an atrophic one although common risk factors for impaired (micro)vascular blood supply were highly prevalent in the study group. Multicenter studies with a larger number of atrophic nonunions are warranted to further evaluate this result.
血供对于良好的骨痂形成至关重要。胫营养动脉（TNA）是滋养胫骨干的主要骨干动脉。目的是研究胫营养动脉管（TNAC）损伤对胫骨干骨折患者萎缩性、营养缺乏性和肥大性骨不连发生发展的影响。
回顾性纳入2010年1月至2020年12月期间胫骨干骨折骨不连患者。两名阅片者独立评估TNAC的完整性并对骨不连类型进行分类。采用多项回归模型评估TNAC损伤是否对骨不连类型有影响。
最初诊断为小腿骨不连的385例患者中，最终共有60例患者纳入研究。大多数患者为男性（78%）、糖尿病患者（95%）、吸烟者（73%），美国麻醉医师协会（ASA）评分为2分的患者占72%。24例患者（40%）存在TNAC损伤：13例（22%）患者为医源性TNAC损伤，11例（18%）患者为创伤性TNAC损伤。大多数患者为肥大性骨不连（29例患者（48%）），其次为营养缺乏性骨不连（24例患者（40%）），最后是萎缩性骨不连（7例患者（11%））。多项回归模型显示，TNAC损伤对特定类型骨不连的发生发展没有影响（营养缺乏性与萎缩性骨不连相比，p = 0.798；肥大性与萎缩性骨不连相比，p = 0.943）。此外，无论是否存在TNAC损伤，患者发生营养缺乏性/肥大性骨不连的可能性是萎缩性骨不连的四倍左右（比值比分别为3.75和4.25）。
在评估的胫骨干骨折患者队列中，我们未发现TNAC损伤与骨不连类型之间存在统计学上的显著关联。然而，尽管研究组中（微）血管血供受损的常见危险因素非常普遍，但患者发生营养缺乏性或肥大性骨不连的可能性几乎是萎缩性骨不连的四倍。有必要进行多中心研究，纳入更多萎缩性骨不连患者以进一步评估该结果。
