Findeisen Sebastian, Böpple Jessica, Tanner Michael, Bewersdorf Tim, Schamberger Christian, Ferbert Thomas, Grossner Tobias, Schmidmaier Gerhard, Miska Matthias
Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Paraplegiology, University Hospital Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
Sci Rep. 2025 May 7;15(1):15887. doi: 10.1038/s41598-025-00318-6.
Compared to other long bones, non-unions of the tibia after fractures are more likely. Due to surgical debridement, the residual bone stock in the distal part of the bone may be insufficient for adequate fixation of an implant. Thus, treatment with a retrograde nail with the additional performance of an arthrodesis of the hindfoot may be an alternative. The aim of this study was to examine the consolidation and reinfection rates of non-unions of the distal tibia treated with a retrograde arthrodesis nail. A total of 27 patients between 2010 and 2018 were included according to our inclusion criteria. The modified Lane Sandhu Score was used for the radiographic evaluation. The osseous consolidation was validated after 1 year as well as after 2 years. Furthermore, we investigated differences in surgical treatment and treatment-associated complications. One year after the initial therapy 48% of the patients showed osseous consolidation, 75% showed consolidation after two years. 14% underwent amputation later. The majority of the patients (77%) received the ETN PROtect (Expert Tibia Nail PROtect) retrogradely, while the rest were obtained with the HAN (Hindfoot Arthrodesis Nail). Major revision surgeries were required in 26% of patients, while minor revisions were necessary in 15% of patients. In conclusion, treatment with a retrograde nail is a safe treatment option for distal tibia non-unions with a satisfactory overall fusion rate. Therefore, it can be an effective option especially in cases, where the fixation of the implant is difficult, in order to prevent amputation.
与其他长骨相比，胫骨骨折后不愈合的可能性更大。由于手术清创，骨远端的剩余骨量可能不足以对植入物进行充分固定。因此，采用逆行髓内钉并附加后足关节融合术可能是一种选择。本研究的目的是检查采用逆行关节融合髓内钉治疗的胫骨远端不愈合的骨愈合率和再感染率。根据我们的纳入标准，共纳入了2010年至2018年间的27例患者。采用改良的Lane Sandhu评分进行影像学评估。分别在1年和2年后验证骨愈合情况。此外，我们还调查了手术治疗的差异以及与治疗相关的并发症。初始治疗1年后，48%的患者显示骨愈合，2年后75%的患者显示骨愈合。14%的患者后来接受了截肢手术。大多数患者（77%）接受了ETN PROtect（专家胫骨钉PROtect）逆行植入，其余患者使用的是HAN（后足关节融合钉）。26%的患者需要进行大的翻修手术，15%的患者需要进行小的翻修手术。总之，对于胫骨远端不愈合，逆行髓内钉治疗是一种安全的治疗选择，总体融合率令人满意。因此，特别是在植入物固定困难的情况下，它可能是一种有效的选择，可以防止截肢。
