Shibuya Naohiro, Humphers Jon M, Fluhman Benjamin L, Jupiter Daniel C
Department of Surgery, Texas A&M Health and Science Center College of Medicine, Temple, TX, USA.
J Foot Ankle Surg. 2013 Mar-Apr;52(2):207-11. doi: 10.1053/j.jfas.2012.11.012. Epub 2013 Jan 11.
The incidence of bone healing complications in diabetic patients is believed to be high after foot and ankle surgery. Although the association of hyperglycemia with bone healing complications has been well documented, little clinical information is available to show which diabetes-related comorbidities directly affect bone healing. Our goal was to better understand the risk factors associated with poor bone healing in the diabetic population through an exploratory, observational, retrospective, cohort study. To this end, 165 diabetic patients who had undergone arthrodesis, osteotomy, or fracture reduction were enrolled in the study to assess the risk factors associated with nonunion, delayed union, and malunion after elective and nonelective foot and/or ankle surgery. Bivariate analyses showed that a history of foot ulcer, peripheral neuropathy, and surgery duration were statistically significantly associated with bone healing complications. After adjusting for other covariates, only peripheral neuropathy, surgery duration, and hemoglobin A1c levels >7% were significantly associated statistically with bone healing complications. Of the risk factors we considered, peripheral neuropathy had the strongest association with bone healing complications.
糖尿病患者在足踝手术后骨愈合并发症的发生率据信很高。尽管高血糖与骨愈合并发症之间的关联已有充分记录，但几乎没有临床信息表明哪些糖尿病相关合并症会直接影响骨愈合。我们的目标是通过一项探索性、观察性、回顾性队列研究，更好地了解糖尿病患者骨愈合不良的相关危险因素。为此，本研究纳入了165例行关节融合术、截骨术或骨折复位术的糖尿病患者，以评估择期和非择期足和/或踝关节手术后骨不连、延迟愈合和畸形愈合的相关危险因素。双变量分析显示，足部溃疡病史、周围神经病变和手术持续时间与骨愈合并发症在统计学上显著相关。在对其他协变量进行调整后，只有周围神经病变、手术持续时间和糖化血红蛋白水平>7%与骨愈合并发症在统计学上显著相关。在我们考虑的危险因素中，周围神经病变与骨愈合并发症的关联最为密切。
