非甾体抗炎药对长骨骨折不愈合和感染率的影响。
Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures.
机构信息
From the Departments of Surgery (D.J., V.S., C.L., B.E., J.P., B.D.) and Pharmacy (D.W., L.K., J.M.) and University Orthopedic Surgeons (S.S., H.K.), University of Tennessee Medical Center; Department of Statistics (P.B.), Graduate School of Medicine, University of Tennessee, Knoxville, Tennessee.
出版信息
J Trauma Acute Care Surg. 2014 Mar;76(3):779-83. doi: 10.1097/TA.0b013e3182aafe0d.
BACKGROUND
There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications.
METHODS
A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given.
RESULTS
During the 24-month period, 1,901 patients experienced LBF; 231 (12.1%) received NSAIDs; and 351 (18.4%) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2% (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95% confidence interval, 1.15-4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95% confidence interval, 1.84-5.53; p < 0.001).
CONCLUSION
LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.
LEVEL OF EVIDENCE
Epidemiologic & therapeutic study; level II.
背景
在急性创伤环境中，关于非甾体抗炎药（NSAIDs）对长骨骨折（LBF）愈合的影响，临床数据匮乏。骨科界认为，术后使用 NSAIDs 会导致愈合不良和感染并发症增加。我们假设，首先，NSAID 的使用不会增加 LBF 后的非愈合/畸形和感染率。其次，我们假设吸烟会导致这些并发症的发生率更高。
方法
对 2009 年 10 月至 2011 年 9 月在一级学术创伤中心治疗的股骨干、胫骨干和/或肱骨骨折患者进行了回顾性研究。除了非愈合/畸形和感染率外，还回顾了患者的记录，包括人口统计学数据、骨折机制、骨折类型、吸烟、损伤严重程度评分（ISS）、合并症和给予的药物。
结果
在 24 个月期间，1901 名患者发生 LBF；231 名（12.1%）接受 NSAIDs；351 名（18.4%）为吸烟者。包括非愈合/畸形和感染在内的总体并发症发生率为 3.2%（60 名患者）。对 NSAID 使用和/或吸烟导致并发症的风险进行了逻辑回归分析，我们发现，如果患者在住院术后期间接受 NSAID，他/她发生并发症的可能性显著增加（优势比，2.17；95%置信区间，1.15-4.10；p < 0.016）。同样，吸烟者发生并发症的可能性也显著增加（优势比，3.19；95%置信区间，1.84-5.53；p < 0.001）。
结论
在术后期间接受 NSAIDs 的 LBF 患者发生并发症（如非愈合/畸形或感染）的可能性是未接受 NSAIDs 的患者的两倍，而吸烟者发生并发症的可能性则是未吸烟者的三倍以上。我们建议在创伤性 LBF 中避免使用 NSAIDs。
证据水平
流行病学和治疗学研究；二级。
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