Ferbert Thomas, Münch Christina, Findeisen Sebastian, Pauly William, Miska Matthias, Grossner Tobias, Tanner Michael C, Schmidmaier Gerhard, Helbig Lars
Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, D-69118, Germany.
Ther Clin Risk Manag. 2023 May 12;19:395-404. doi: 10.2147/TCRM.S409119. eCollection 2023.
A central aspect of the treatment of non-unions is the filling of bone defects. The quantity of available autologous bone for this purpose is limited. Alternatively, or additionally, bone substitutes may be used. The aim of this retrospective, single-center study including 404 non-unions in 393 patients is to investigate the effect of tricalcium phosphate (TCP) on the healing of non-unions. Furthermore, the influence of gender, age, smoking status, comorbidities, type of surgical procedure, presence of infection, and length of treatment was investigated.
We evaluated three groups of patients. Group 1 received TCP + BG, group 2 received BG alone and group 3 received no augmentation. Bone stability was assessed 1 and 2 years after non-union revision surgery through analysis of radiographs using the Lane Sandhu Score. Scores ≥3 were rated as stable Other influencing factors were collected from the electronic medical record.
In 224 non-unions, bone defects were filled with autologous bone and TCP (TCP+BG). In 137 non-unions, bone defects were filled with autologous bone (BG), and in 43 non-unions presenting non-relevant defects, neither autologous bone nor TCP were used (NBG). After 2 years, 72.7% of the TCP+BG patients, 90.1% of the BG patients and 84.4% of the NBG patients achieved a consolidation score ≥3. Advanced age, presence of comorbidities and longer treatment period had a significantly negative effect on consolidation 1 year after surgery. Longer treatment periods also showed a negative significant effect after 2 years. It is notable that larger defects, mainly treated with the combination of autologous bone and TCP, showed similar healing rates to that of smaller defects after 2 years.
The combination of TCP and autologous bone-grafts shows good results in the reconstruction of complicated bone-defects, but patience is required since the healing period exceeds 1 year in most patients.
骨不连治疗的一个核心方面是填充骨缺损。用于此目的的自体骨数量有限。可以选择使用骨替代物，或者额外使用骨替代物。这项回顾性单中心研究纳入了393例患者的404处骨不连，旨在研究磷酸三钙（TCP）对骨不连愈合的影响。此外，还研究了性别、年龄、吸烟状况、合并症、手术方式、感染情况和治疗时长的影响。
我们评估了三组患者。第1组接受TCP + BG，第2组仅接受BG，第3组未进行增强治疗。在骨不连翻修手术后1年和2年，通过使用Lane Sandhu评分分析X线片来评估骨稳定性。评分≥3被评为稳定。其他影响因素从电子病历中收集。
在224处骨不连中，骨缺损用自体骨和TCP填充（TCP + BG）。在137处骨不连中，骨缺损用自体骨填充（BG），在43处无相关缺损的骨不连中，既未使用自体骨也未使用TCP（NBG）。2年后，72.7%的TCP + BG患者、90.1%的BG患者和84.4%的NBG患者达到了巩固评分≥3。高龄、合并症的存在和较长的治疗期对术后1年的巩固有显著负面影响。较长的治疗期在2年后也显示出显著的负面影响。值得注意的是，主要用自体骨和TCP联合治疗的较大缺损，2年后的愈合率与较小缺损相似。
TCP与自体骨移植相结合在复杂骨缺损的重建中显示出良好的效果，但由于大多数患者的愈合期超过1年，需要有耐心。
