背景:有效治疗胫骨不愈合对骨科创伤外科医师提出了挑战。既定的金标准包括植入足够固定的自体骨移植物,但是根据所谓的钻石概念添加生物制品在治疗不结合方面变得越来越流行。以前的研究表明,综合疗法,这包括植入间充质干细胞,生物活性因子和骨传导支架,可以改善骨骼愈合。本研究旨在评估综合疗法与单一疗法治疗不同严重程度胫骨不愈合的疗效。
方法:回顾性分析2014年11月至2023年7月间连续治疗胫骨骨不连的数据。非工会评分系统(NUSS)评分术前,和胫骨骨折的影像学联合评分(RUST),在手术后1、3、6、9、12和18个月评分,被记录下来。最初,在综合疗法组和单一疗法组之间进行了比较.随后,记录接受额外手术不愈合治疗的患者,并计算这些治疗的频率,用于随后的每个治疗分析。
结果:共纳入34例患者,分为综合治疗组(n=15)和单药治疗组(n=19)。综合疗法组表现出更高的NUSS评分(44(39,52)对32(29,43),P=0.019,z=-2.347)和更高成功率的趋势(93%对68%,P=0.104)与单药治疗组相比。对于每种治疗分析,将44种治疗分为多治疗/治疗组(n=20)和单一治疗/治疗组(n=24)。每个治疗组的综合疗法表现出更高的NUSS评分(48(43,60)对38(30,50),P=0.030,z=-2.173)和更高的成功率(95%对58%,P=0.006)比单一疗法每个治疗组。在单药治疗/治疗组中,NUSS评分显示出优异的预测性能(AUC=0.9143)。将阈值设置为48,敏感性和特异性分别为100.0%和70.0%,分别。
结论:对于严重的胫骨不愈合,综合疗法比单一疗法更有效。提供更高的成功率。NUSS评分支持治疗胫骨不愈合的决策。
方法:三级。
BACKGROUND: Treating tibial non-unions efficiently presents a challenge for orthopaedic trauma surgeons. The established gold standard involves implanting autologous bone graft with adequate fixation, but the addition of biologicals according to the so-called diamond concept has become increasingly popular in the treatment of non-unions. Previous studies have indicated that polytherapy, which involves implanting mesenchymal stem cells, bioactive factors and osteoconductive scaffolds, can improve bone healing. This study aims to evaluate the efficacy of
polytherapy compared with monotherapy in treating tibial non-unions of varying severity.
METHODS: Data from consecutive tibial non-unions treated between November 2014 and July 2023 were retrospectively analysed. The Non Union Scoring System (NUSS) score before non-union surgery, and the Radiographic Union Score for Tibial fractures (RUST), scored at 1, 3, 6, 9, 12 and 18 months post-surgery, were recorded. Initially, a comparison was made between the
polytherapy and monotherapy groups. Subsequently, patients receiving additional surgical non-union treatment were documented, and the frequency of these treatments was tallied for a subsequent per-treatment analysis.
RESULTS: A total of 34 patients were included and divided into a
polytherapy group (n = 15) and a monotherapy group (n = 19). The
polytherapy group demonstrated a higher NUSS score (44 (39, 52) versus 32 (29, 43), P = 0.019, z = -2.347) and a tendency towards a higher success rate (93% versus 68%, P = 0.104) compared with the monotherapy group. For the per-treatment analysis, 44 treatments were divided into the
polytherapy per-treatment group (n = 20) and the monotherapy per-treatment group (n = 24). The polytherapy per-treatment group exhibited a higher NUSS score (48 (43, 60) versus 38 (30, 50), P = 0.030, z = -2.173) and a higher success rate (95% versus 58%, P = 0.006) than the monotherapy per-treatment group. Within the monotherapy per-treatment group, the NUSS score displayed excellent predictive performance (AUC = 0.9143). Setting the threshold value at 48, the sensitivity and specificity were 100.0% and 70.0%, respectively.
CONCLUSIONS: Polytherapy is more effective than monotherapy for severe tibial non-unions, offering a higher success ratio. The NUSS score supports decision-making in treating tibial non-unions.
METHODS: Level III.