Pereira Sebastian, Garabano Germán, Alamino Leonel Perez, Bidolegui Fernando, Angel Pesciallo Cesar
Orthopaedic and Trauma Surgery Department, Hospital Sirio Libanes, Campana 4658, C1419, Buenos Aires, Argentina.
Department of Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Buenos Aires Argentina, Perdriel 74, C1280 AEB, Buenos Aires, Argentina.
J Clin Orthop Trauma. 2024 Nov 7;59:102802. doi: 10.1016/j.jcot.2024.102802. eCollection 2024 Dec.
Although the intramedullary nail represents the treatment for most tibia diaphyseal fractures, there is no agreement on the configuration of the distal locking screws. Therefore, this study aimed to investigate the impact of the configuration of distal locking bolts on the healing of a tibial shaft fracture.
We retrospectively analyzed 170 closed fractures of the tibia diaphyseal operated consecutively between 2018 and 2021. Patients with postoperative unacceptable reduction (>5° in any plane or gap >4 mm), nail-canal ratio <0.78, and less than 12 months of follow-up were excluded. Using a univariate and multivariate analysis, we analyzed comorbidities (smoking, Body mass index >30, diabetes), fracture type (OTA/AO), the number (one, two, three distal locking screws), and configuration (uniplanar, biplanar, triplanar) of distal locking screws between patients with and without a bone union.
One hundred and forty-two fractures were available for analysis. The bone union and non-union rates were 89.4 % (n = 127) and 10.6 % (n = 15), respectively. The multivariate analysis showed that type A fractures (OR 6.67, p = 0.010) and using two distal locking screws with a biplanar configuration (OR 3.63, p = 0.036) were independent variables related to bone union. In contrast, smoking habit (OR 0.12, p = 0.041), fractures type B (OR 0.22, p = 0.013), and uniplanar fixation (OR 0.51, p = 0.003) were related to non-union.
The findings of this study suggest that using two distal locking screws (anteroposterior + mediolateral) in the nailing of closed tibial diaphyseal fracture represents the optimal configuration, offering a higher likelihood of healing compared to other locking options.
虽然髓内钉是大多数胫骨干骨折的治疗方法，但对于远端锁定螺钉的构型尚无统一意见。因此，本研究旨在探讨远端锁定螺栓的构型对胫骨干骨折愈合的影响。
我们回顾性分析了2018年至2021年间连续接受手术的170例闭合性胫骨干骨折患者。排除术后复位不佳（任何平面>5°或间隙>4 mm）、钉道比<0.78以及随访时间少于12个月的患者。通过单因素和多因素分析，我们分析了合并症（吸烟、体重指数>30、糖尿病）、骨折类型（OTA/AO）、远端锁定螺钉的数量（一枚、两枚、三枚）以及构型（单平面、双平面、三平面）在骨折愈合和未愈合患者之间的差异。
142例骨折可供分析。骨折愈合率和不愈合率分别为89.4%（n = 127）和10.6%（n = 15）。多因素分析表明，A型骨折（OR 6.67，p = 0.010）和使用两枚具有双平面构型的远端锁定螺钉（OR 3.63，p = 0.036）是与骨折愈合相关的独立变量。相反，吸烟习惯（OR 0.12，p = 0.041）、B型骨折（OR 0.22，p = 0.013）和单平面固定（OR 0.51，p = 0.003）与骨折不愈合相关。
本研究结果表明，在闭合性胫骨干骨折的髓内钉固定中，使用两枚远端锁定螺钉（前后位 + 内外侧位）是最佳构型，与其他锁定方式相比，愈合的可能性更高。
