扩髓与非扩髓交锁髓内钉治疗胫骨骨干骨折的比较：初次置钉方法是否影响需要再次手术患者的结局？

Reamed compared with unreamed nailing of tibial shaft fractures: Does the initial method of nail insertion influence outcome in patients requiring reoperations?

机构信息

Division of Orthopaedic Surgery, London Health Sciences Centre and Western University, London, Ont. (Schemitsch, Sanders); Division of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Kumar); the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Heels-Ansdell, Sprague, Bhandari, Guyatt, Walter); the Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ont. (Sprague, Bhandari); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minn. (Swiontkowski); the Department of Orthopedic Surgery, Boston Medical Center, Boston, Mass. (Tornetta)

出版信息

Can J Surg. 2023 Jul 13;66(4):E384-E389. doi: 10.1503/cjs.012222. Print 2023 Jul-Aug.

DOI:10.1503/cjs.012222

PMID:37442585

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10355994/

Abstract

BACKGROUND

Patients with a tibial shaft fracture experiencing their first postoperative complication following treatment with intramedullary nails may be at greater risk of subsequent complications than the whole population. We aimed to determine whether the initial method of nail insertion influences outcome in patients with a tibial shaft fracture requiring multiple reoperations.

METHODS

Using the Study to Prospectively Evaluate Reamed Intramedullary Nails in Tibial Shaft Fractures trial data, we categorized patients as those not requiring reoperation, those requiring a single reoperation and those requiring multiple reoperations, and we compared them by nail insertion technique (reamed v. unreamed) and fracture type (open v. closed). We then determined the number of patients whose first reoperation was in response to infection, and we compared other clinical outcomes between the reamed and unreamed groups.

RESULTS

Among 1226 patients included in this analysis, 175 (14.27%) experienced a single reoperation and 44 patients (3.59%) underwent multiple reoperations. Nail insertion techniques (reamed v. unreamed) did not play a role in the need to perform multiple reoperations. Seventy-five percent of patients requiring multiple reoperations had open tibial shaft fractures. An equal number of these were reamed and unreamed insertions. The majority of patients had their course complicated by infection and almost 50% of patients whose first reoperation was for infection required more than 2 reoperations for management. The rest required multiple procedures for nonunion or bone loss.

CONCLUSION

Our findings corroborate those of other studies, in which open fracture type rather than nail insertion technique was found to be the cause of morbidity following intramedullary nailing of tibial fractures.

CLINICAL TRIAL REGISTRATION

www.

CLINICALTRIALS

gov, no. NCT00038129.

摘要

背景

接受髓内钉治疗的胫骨骨干骨折患者在术后首次出现并发症后，可能比整个人群更容易发生后续并发症。我们旨在确定胫骨骨干骨折患者在需要多次手术的情况下，初始的髓内钉插入方法是否会影响其结果。

方法

使用前瞻性评估胫骨髓内钉治疗胫骨骨干骨折的研究试验数据，我们将患者分为无需再次手术、需单次再次手术和需多次再次手术的患者，并按髓内钉插入技术（扩髓与非扩髓）和骨折类型（开放性与闭合性）对其进行比较。然后，我们确定了首次再次手术是因感染而进行的患者数量，并比较了扩髓组和非扩髓组之间的其他临床结果。

结果

在本分析中纳入的 1226 例患者中，175 例（14.27%）经历了单次再次手术，44 例（3.59%）进行了多次再次手术。髓内钉插入技术（扩髓与非扩髓）与多次再次手术的需要无关。需要多次再次手术的患者中，75%的患者为开放性胫骨骨干骨折。这些患者中有同等数量的接受了扩髓和非扩髓插入。大多数患者的病程因感染而复杂化，几乎 50%的首次因感染而再次手术的患者需要进行 2 次以上的手术来进行治疗。其余患者则需要多次手术来治疗骨不连或骨丢失。