两种植骨治疗胫骨中下段骨不连的比较△

Comparison of two bone autografting techniques for middle and lower tibial shaft nonunion

摘要:

［目的］ 比较混合植骨与颗粒植骨治疗胫骨中下段骨折术后骨不连的临床疗效。［方法］ 回顾性分析 2013 年 5 月— 2020 年 5 月本院收治的胫骨中下段无菌性骨不连病例 48 例患者的临床资料。按照术前医患沟通结果，28 例采用混合植骨治疗，20 例采用颗粒植骨治疗。比较围手术期、随访与影像等相关指标。［结果］两组患者手术均顺利完成，术中均未发生重要血管、神经损伤。混合组手术时间和手术切口总长度显著长于颗粒植骨组 （P<0.05），但混合组下地行走时间显著早于颗粒组 （P<0.05）。两组术中失血量、术中透视次数、术后引流量、切口愈合程度及总住院时间的差异均无统计学意义 （P>0.05）。两组患者均获随访 （15.9±2.6） 个月，混合组术后完全负重活动时间显著早于颗粒组 （P<0.05）。随时间推移，两组的 AOFAS 评分和踝关节背伸-跖屈 ROM 显著增加 （P<0.05）。术前两组间 AOFAS 评分、踝关节背伸-跖屈 ROM 的差异均无统计学意义 （P>0.05）；术后 3 个月混合组的 AOFAS 评分及踝关节背伸-跖屈 ROM 显著优于颗粒组（P<0.05）。末次随访时，混合组的 AO- FAS 评分显著大于颗粒组 （P<0.05），但踝关节背伸-跖屈 ROM 的差异无统计学意义 （P>0.05）。末次随访时，混合组的 Joh- ner-Wruh 评分显著优于颗粒组（P<0.05）。影像学方面， 混合组骨折影像愈合时间显著早于颗粒组 （P<0.05）。［结论］两种植骨治疗方式均可有效治疗胫骨中下段骨不连，相比之下，混合植骨的临床疗效优于颗粒植骨。

Abstract:

[Objective] To compare the clinical outcomes of mixed bone autografting (MBAG) versus granular bone autografting (GBAG) in the treatment of postoperative nonunion of middle and lower tibial shaft fractures. [Methods] A retrospective study was conduct- ed on 48 patients who received bone autografting for aseptic bone nonunion of the middle and lower tibial shaft secondary to previous surgi- cal treatment in our hospital from May 2013 to May 2020. According to the results of preoperative doctor-patient communication, 28 pa- tients received MBAG, while the other 20 patients received GBAG. The documents regarding perioperative period, follow-up and imaging were compared between the two groups. [Results] All patients in both groups were operated on successfully without important vascular and nerve injuries during the operation. The MBAG group consumed significantly longer operative time with a significantly longer total incision length than the GBAG group (P＜0.05), however, the former resumed postoperative walking significantly earlier than the latter (P＜0.05). There were no significant differences in terms of intraoperative blood loss, intraoperative fluoroscopy times, postoperative drainage volume, incision healing grade and total hospital stay between the two groups (P＞0.05). All patients in both groups were followed up for (15.9±2.6) months on an average, and the MBAG group returned to full weight-bearing activity significantly earlier than the GBAG group (P＜0.05). The AOFAS score and dorsal extension-plantar flexion range of motion (ROM) increased significantly in both groups over time (P＜ 0.05), which were not significantly different before operation between the two groups (P＜0.05), whereas the MBAG group proved significantly su- perior to the GBAG group in terms of AOFAS score and ROM 3 months postoperatively (P＜0.05), and AOFAS score at the latest follow-up (P＜0.05). In addition, the MBAG group was significantly superior to the GBAG in term of Johner-Wruh criteria at the latest follow-up (P＜ 0.05). Radiographically, the MBAG group got healing of the nonunion significantly earlier than the GBAG group (P＜0.05). [Conclusion] Both bone autografting techniques do effectively treat nonunion of the middle and lower shaft of the tibia. In contrast, the clinical efficacy of mixed bone autografting is superior to granular bone autografting.