Davulcu Cumhur Deniz, Saruhan Sertac, Bilgin Emre, Zengin Eyup Cagatay
Department of Orthopaedics and Traumatology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye.
Department of Orthopaedics and Traumatology, Bozyaka Training and Research Hospital, Izmir, Turkiye.
North Clin Istanb. 2024 Jul 31;11(4):322-327. doi: 10.14744/nci.2023.43410. eCollection 2024.
This study aims to investigate the effect of bone grafting on the bone union in exchange nailing (EN) for the treatment of femoral shaft nonunions.
A total of 26 patients (16 male) were included in this study. The mean age of the patients was 36.1±9.3. Bone grafts were used in 8 patients (bone graft group), and EN was performed without bone grafting (no bone graft group) in 18 patients. Etiology, fracture type, location, and classification of the fractures at the time of initial injury were evaluated. The reduction type (open or closed) and locking status of the nails were also noted. Nonunion types were recorded. In the bone grafting group, iliac bone autografts were used in seven patients and a synthetic bone graft was used in one patient. Following EN, the presence and duration of bone union, and the increase in the nails' diameter were analyzed for each group and compared.
Union rates were 100% and 94.4% in bone grafting and no bone grafting groups, respectively. The mean union period was not significant between the groups (22.5 and 16.5 months, respectively). The mean increase in the nail diameter was 1.88 mm in the bone graft group and 2.00 mm in the no bone graft group (p>0.05).
This study demonstrated that high union rates can be achieved with EN by means of using larger diameter nails with or without bone grafting in the management of femoral shaft nonunions, and bone grafting had no significant effect on union rates and periods.
本研究旨在探讨植骨对交锁髓内钉（EN）治疗股骨干骨不连时骨愈合的影响。
本研究共纳入26例患者（16例男性）。患者的平均年龄为36.1±9.3岁。8例患者使用了骨移植（骨移植组），18例患者在未进行骨移植的情况下进行了EN（非骨移植组）。对初次受伤时骨折的病因、类型、部位及骨折分类进行了评估。还记录了复位类型（开放或闭合）及髓内钉的锁定状态。记录骨不连类型。在骨移植组中，7例患者使用了自体髂骨移植，1例患者使用了人工骨移植。EN术后，分析每组骨愈合的情况及持续时间，以及髓内钉直径的增加情况，并进行比较。
骨移植组和非骨移植组的愈合率分别为100%和94.4%。两组间平均愈合时间无显著差异（分别为22.5个月和16.5个月）。骨移植组髓内钉直径的平均增加量为1.88 mm，非骨移植组为2.00 mm（p>0.05）。
本研究表明，在股骨干骨不连的治疗中，使用较大直径的髓内钉，无论是否进行骨移植，EN均可获得较高的愈合率，且骨移植对愈合率和愈合时间无显著影响。
