Garabano G, Crossa J I, Cullari M, Pérez-Alamino L, Pesciallo C A
Servicio de Ortopedia y Traumatología del Hospital Británico de Buenos Aires, Argentina.
Acta Ortop Mex. 2022 Nov-Dec;36(6):346-351.
the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures.
a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay and non-union).
96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio 0.80 increased the chance of consolidation 23.33 times (p = 0.005).
our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio 0.80) to promote bone healing.
胫骨干骨折治疗的金标准是髓内钉（IMN）。本研究旨在评估髓内钉直径对胫骨干骨折骨愈合的相关性。
进行一项回顾性研究，分析2014年1月至2020年12月期间采用扩髓锁定髓内钉治疗的42例闭合性OTA/AO胫骨骨折患者。评估的变量包括性别、年龄、合并症、使用的螺栓数量、髓腔/髓内钉指数（髓腔直径与髓内钉直径之差）、髓内钉/髓腔比（髓内钉直径与髓腔直径之比），以及与骨愈合率和失败率（延迟愈合和不愈合）相关的情况。
纳入96例患者。骨愈合率为91.7%（n = 88）。骨愈合患者的髓内钉直径显著大于未愈合患者（p = 0.0014），髓内钉直径每增加1毫米，骨愈合的几率增加5.30倍（p = 0.04）。使用直径> 10毫米的髓内钉，骨愈合的几率增加13.56倍（p = 0.018）。髓内钉/髓腔比为0.80时，骨愈合的几率增加23.33倍（p = 0.005）。
我们的研究结果表明，胫骨干骨折采用扩髓锁定髓内钉治疗时，应植入尽可能大直径的髓内钉（> 10毫米且髓内钉/髓腔比为0.80）以促进骨愈合。
