髓内磁性延长钉的截骨部位通气可增强股骨骨质固结

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Roy Gigi, Yehuda Weil, Eyal Amar, Amit Sigal, Dror Ovadia, John E Herzenberg, Eitan Segev
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引用次数: 0

摘要

背景:在股骨头延长术中,磁性髓内加长钉比外固定装置更有优势。这些优势包括避免不舒适的外固定和相关的钉部位感染、疤痕以及肌肉或关节功能抑制。尽管如此,在生物增强骨再生领域却没有什么变化。扩孔前在截骨部位对股骨髓内管进行通气,可在扩孔时为骨髓创造出口。从通气孔中挤出的铰孔可作为牵引间隙处的预置植骨。问题/目的:(1)通过排气孔挤出的骨髓铰孔是否能提高骨再生的质量并改善愈合指数和巩固时间?(2)与不通气相比,通气是否与更高比例的并发症相关?我们对一家医院在2012年12月至2022年2月期间使用磁性髓内加长钉进行的股骨加长术进行了回顾性研究,在扩孔前在截骨部位进行了或未进行扩孔。这是一个大致连续的系列,研究组的分组情况如下:2012年7月至2016年8月期间进行通风,2021年11月以后再次进行通风。在2016年10月至2021年10月期间,由于资深作者选择在扩孔术后钻孔,以避免在完成扩孔术前致力于截骨水平,因此采用了不扩孔术。结果根据骨愈合时间、达到完全负重的时间和并发症进行评估。共研究了61例股骨延长手术(33例男性患者和28例女性患者),其中2例患者因植入物破损而被排除在外。平均年龄为 17±5 岁。通气组的平均延长量为 55 ± 13 毫米,非通气组为 48 ± 16 毫米(平均差异为 7 ± 21 [95% CI 2 至 12];P = 0.07)。愈合指数被定义为三个骨皮质桥接新骨形成所需的时间(天数)除以临床方案中延长的长度(厘米)。该指数表示在方案的特定条件下达到的骨形成率。三面再生间隙弥合后,允许完全负重。巩固时间是指从延长阶段结束到实现充分骨结合(三个皮质全部愈合)并允许完全负重的总天数。这一时间范围代表了延长术完成后的整个愈合过程除以达到的延长量(厘米)。我院对患者进行了细致的随访,并遵守精确的时间表,在牵引阶段每两周随访一次,在巩固阶段每四周随访一次。随访过程中没有出现失访的情况。每位患者都顺利完成了治疗,达到了规定的负重里程碑,并实现了三个皮质的骨桥:通气组的平均愈合指数时间快于不通气组(21 ± 6 天/厘米对 31 ± 22 天/厘米,平均差异为 10 ± 23 [95% CI 4 至 16];P = 0.02)。通气组的平均巩固时间快于不通气组(10 ± 6 天/厘米对 20 ± 22 天/厘米;平均差 10 ± 23 [95% CI 4 至 15];P = 0.02)。未出现深静脉血栓、脂肪栓塞或肺栓塞等医疗并发症。有两名患者的再生结合出现了长时间的延迟,这两名患者都属于非通气组(愈合指数分别为74天和62天/厘米;巩固时间分别为52天和40天/厘米):结论:使用磁性髓内加长钉进行股骨加长术,术前通气比不通气愈合更快,而且可以更早完全负重,不会出现任何重大相关并发症。未来的研究应评估通气孔的数量与愈合指数和巩固时间的改善之间是否存在相关性:证据等级:三级,治疗性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Osteotomy Site Venting Enhances Femoral Bone Consolidation With Magnetic Intramedullary Lengthening Nails.

Background: Magnetic intramedullary lengthening nailing has demonstrated benefits over external fixation devices for femoral bone lengthening. These include avoiding uncomfortable external fixation and associated pin site infections, scarring, and inhibition of muscle or joint function. Despite this, little has changed in the field of biologically enhanced bone regeneration. Venting the femoral intramedullary canal at the osteotomy site before reaming creates egress for bone marrow during reaming. The reamings that are extruded from vent holes may function as a prepositioned bone graft at the distraction gap. The relationship between venting and the consolidation of regenerating bone remains unclear.

Questions/purposes: (1) Do bone marrow reamings extruded through venting holes enhance the quality of bone regeneration and improve healing indices and consolidation times? (2) Is venting associated with a higher proportion of complications than nonventing?

Methods: We performed a retrospective study of femoral lengthening performed at one hospital from December 2012 to February 2022 using a magnetic intramedullary lengthening nail with or without venting at the osteotomy site before reaming. This was a generally sequential series, in which the study groups were assembled as follows: Venting was performed between July 2012 and August 2016 and again from November 2021 onward. Nonventing was used between October 2016 and October 2021 because the senior author opted to create drill holes after the reaming procedure to avoid commitment to the osteotomy level before completing the reaming procedure. Outcomes were evaluated based on bone healing time, time to achieve full weightbearing, and complications. Sixty-one femoral lengthening procedures were studied (in 33 male and 28 female patients); two patients were excluded because of implant breakage. The mean age was 17 ± 5 years. The mean amount of lengthening was 55 ± 13 mm in the venting group and 48 ± 16 mm in the nonventing group (mean difference 7 ± 21 [95% CI 2 to 12]; p = 0.07). The healing index was defined as the time (in days) required for three cortices to bridge with new bone formation divided by the length (in cm) lengthened during the clinical protocol. This index signifies the bone formation rate achieved under the specific conditions of the protocol. Full weightbearing was allowed upon bridging the regenerated gap on three sides. Consolidation time was defined as the total number of days from the completion of the lengthening phase until adequate bone union (all three cortices healed) was achieved and full weightbearing was permitted. This time frame represents the entire healing process after the lengthening is complete divided by the amount of lengthening achieved (in cm). Patient follow-up was conducted meticulously at our institution, and we adhered to a precise schedule, occurring every 2 weeks during the distraction phase and every 4 weeks during the consolidation phase. There were no instances of loss to follow-up. Every patient completed the treatment successfully, reaching the specified milestones of weightbearing and achieving three cortexes of bone bridging.

Results: The mean healing index time in the venting group was faster than that in the nonventing group (21 ± 6 days/cm versus 31 ± 22 days/cm, mean difference 10 ± 23 [95% CI 4 to 16]; p = 0.02). The mean consolidation time was faster in the venting group than the nonventing group (10 ± 6 days/cm versus 20 ± 22 days/cm; mean difference 10 ± 23 [95% CI 4 to 15]; p = 0.02). No medical complications such as deep vein thrombosis or fat or pulmonary embolism were seen. Two patients had lengthy delays in regenerate union, both of whom were in the nonventing group (healing indexes were 74 and 62 days/cm; consolidation time was 52 and 40 days/cm).

Conclusion: Femoral lengthening with a magnetic intramedullary lengthening nail healed more quickly with prereaming venting than with nonventing, and it allowed earlier full weightbearing without any major associated complications. Future studies should evaluate whether there is a correlation between the number of venting holes and improvement in the healing index and consolidation time.

Level of evidence: Level III, therapeutic study.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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