Heck V, Glombitza M, Weichert V, Schöllmann H, Dudda M, Steinhausen E
Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Essen, Essen, Deutschland.
Unfallchirurgie (Heidelb). 2024 Nov;127(11):796-804. doi: 10.1007/s00113-024-01489-z. Epub 2024 Oct 9.
In surgery for sepsis it is a well-established principle that no internal osteosynthetic material should be implanted in cases of chronic osteomyelitis. Therefore, the surgical treatment with intramedullary nails is so far used only rarely in cases of chronic osteomyelitis.
This study analyzed whether the implantation of tibial intramedullary nails is an effective treatment for chronic osteomyelitis and how high is the rate of reinfection.
A retrospective analysis of patients with an infected pseudarthrosis of the tibia in whom a gentamycin-coated nail (ETN) or an uncoated tibial intramedullary nail (UCN) was implanted between December 2011 and December 2019 was carried out. The preoperative, perioperative and postoperative results were evaluated.
During the study period 29 patients received a UCN and 27 patients received an ETN. Of the patients 95% (n = 53) had been previously unsuccessfully treated with external fixation. Postoperative complications occurred in 45% of the patients and more often in the ETN group (48% vs. 41%). Reexacerbation of the infection occurred in 20 patients and more frequently in the UCN group (38% vs. 33%). The nonunion already showed a bony consolidation at the time of the exacerbation in 10 patients (50%). At the end of the follow-up a consolidation was present in 48 patients (86%), more frequently in the UCN group (90% vs. 78%). Of the patients 50 (89%) reached full weight bearing without any differences between the groups.
Despite a relatively high a rate of postoperative complications the risk of reinfection was acceptable with good functional and radiological results. The main general advantages of nailing are without doubt the high primary stability, the implantation with preservation of the soft tissue and the improved wearing comfort for patients.
在脓毒症手术中，一个公认的原则是，在慢性骨髓炎病例中不应植入任何内部骨合成材料。因此，迄今为止，髓内钉手术治疗在慢性骨髓炎病例中很少使用。
本研究分析了胫骨髓内钉植入术是否是治疗慢性骨髓炎的有效方法，以及再感染率有多高。
对2011年12月至2019年12月期间植入庆大霉素涂层钉（ETN）或未涂层胫骨髓内钉（UCN）的胫骨感染性假关节患者进行回顾性分析。评估术前、围手术期和术后结果。
在研究期间，29例患者接受了UCN，27例患者接受了ETN。95%（n = 53）的患者此前外固定治疗失败。45%的患者出现术后并发症，且在ETN组中更常见（48%对41%）。20例患者感染复发，且在UCN组中更频繁（38%对33%）。在复发时，10例患者（50%）的骨不连已显示出骨愈合。随访结束时，48例患者（86%）实现了骨愈合，在UCN组中更常见（90%对78%）。89%（50例）的患者实现了完全负重，两组之间无差异。
尽管术后并发症发生率相对较高，但再感染风险是可以接受的，功能和影像学结果良好。毫无疑问，髓内钉固定的主要总体优势是初始稳定性高、植入时保留软组织以及提高患者的佩戴舒适度。
