Klinik für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwig - Guttmann - Str. 13, 67071 Ludwigshafen, Germany.
Injury. 2011 Dec;42(12):1435-42. doi: 10.1016/j.injury.2011.05.011. Epub 2011 Jun 12.
Tibial shaft fracture is one of the most common types of bone fracture in young patients. In this prospective clinical cohort study, we investigated the effects of cigarette smoking on the clinical, functional, psychosocial and occupational outcomes after isolated lower-leg fracture. We examined 85 patients, including 61 men and 24 women, with a collective mean age of 46 years (range: 18-84 years). Thirty-nine patients had never smoked (G1) and 45 patients were current or previous smokers (G2). The G2 group displayed a significantly increased risk for delayed union or nonunion (G1=3 patients, G2=18 patients; P=0.0007) and increased time required for fracture healing (mean times: G1=11.9 weeks, G2=17.4 weeks; p=0.003) and a markedly increased time out of work (mean times: G1=16.1 weeks, G2=21.5 weeks; p=0.1177 (not significant)). The 18 negatively affected patients in G2 displayed a significant increase in the time required for fracture healing and time out of work (26 weeks (p=0.02) and 31 weeks (p=0.03), respectively). G2 group members had a 3- to 18-fold higher risk of impaired bone healing. The mean Short Form 36 (SF-36) was similar in both groups. The physical-function scores were G1=49.6 and G2=48.6; the mental scores were G1=52.7 and G2=52.8. These findings indicate that smoking significantly increases the risk of impaired fracture healing, which has clinical and occupational consequences for the affected patients. Based on our data, we developed a score to estimate the individual risk of impaired fracture healing. These types of patients must be informed and closely monitored to determine the need for timely re-intervention with additional therapy, such as BMP s or ultrasound.
胫骨骨干骨折是年轻患者中最常见的骨折类型之一。在这项前瞻性临床队列研究中，我们研究了吸烟对小腿骨折后临床、功能、心理社会和职业结果的影响。我们检查了 85 名患者，包括 61 名男性和 24 名女性，平均年龄为 46 岁（范围：18-84 岁）。39 名患者从不吸烟（G1），45 名患者为当前或既往吸烟者（G2）。G2 组的延迟愈合或不愈合（G1=3 例，G2=18 例；P=0.0007）和骨折愈合所需时间（平均时间：G1=11.9 周，G2=17.4 周；p=0.003）显著增加，旷工时间明显延长（平均时间：G1=16.1 周，G2=21.5 周；p=0.1177（无统计学意义）。G2 组中 18 名受影响的患者骨折愈合和旷工时间明显增加（分别为 26 周（p=0.02）和 31 周（p=0.03）。G2 组骨折愈合不良的风险增加 3 至 18 倍。两组的简明健康状况调查问卷（SF-36）平均得分相似。G1 的生理功能评分为 49.6，G2 为 48.6；G1 的心理评分为 52.7，G2 为 52.8。这些发现表明吸烟显著增加了骨折愈合不良的风险，这对受影响的患者的临床和职业结果产生了影响。基于我们的数据，我们开发了一种评分来估计骨折愈合不良的个体风险。这些类型的患者必须得到告知，并进行密切监测，以确定是否需要及时进行额外的治疗，如 BMP 或超声。
