Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.
Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.
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DOI：
10.1186/1749-799x-8-33
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发表时间：
2013-09-09
影响因子：
2.6
通讯作者：
Stahel PF
中科院分区：
文献类型：
--
作者：
Flierl MA;Smith WR;Mauffrey C;Irgit K;Williams AE;Ross E;Peacher G;Hak DJ;Stahel PF
新型骨替代物挑战了自体骨移植作为骨折不愈合手术治疗“金标准”的概念。本研究旨在验证自体骨移植在治疗长骨骨折不连方面与其他植骨方式相同的假设。从1998年1月1日（中心1）或2004年1月1日（中心2）至2010年12月31日，分别在美国两家一级创伤中心对两个前瞻性数据库中的骨折不愈合患者进行回顾性研究（n = 574）。其中，182例患者需要辅助植骨，并被分为以下队列：自体移植物（n = 105），同种异体移植物（n = 38），同种异体移植物和自体移植物联合（n = 16），重组人骨形态发生蛋白-2 （rhBMP-2）伴或不伴骨移植（n = 23）。主要结局参数为联合时间。次要结果参数包括并发症发生率、翻修手术率和翻修植骨率。自体移植物愈合时间（198±172-225天）比同种异体移植物愈合时间（416±290-543天）短，且与同种异体移植物/自体移植物联合愈合时间（389±159-619天）或rhBMP-2愈合时间（217±158-277天）相比，自体移植物愈合时间更早。此外，与同种异体移植（47%和32%）、同种异体移植/自体移植联合（25%和31%）或rhBMP-2（27%和17%）相比，自体移植物组的手术翻修率（17%）和骨移植翻修率（9%）最低。自体移植组术后新发感染率（12.4%）明显低于同种异体移植组（26.3%）（P < 0.05）。在长骨骨折不愈合的外科治疗中，自体骨移植似乎是安全性和有效性的最佳选择。
Novel bone substitutes have challenged the notion of autologous bone grafting as the ‘gold standard’ for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. The autograft cohort had a statistically significant shorter time to union (198 ± 172–225 days) compared to allograft (416 ± 290–543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159–619 days) or rhBMP-2 (217 ± 158–277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P < 0.05). Autologous bone grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.