Liu W, Xiao J, Ji F, Xie Y, Hao Y
Department of orthopedics, Huai'an First People's Hospital, Nanjing Medical University, 6, Beijing Road West, Huai'an, Jiangsu 223300, PR China.
Department of orthopedics, The 101st Hospital of Chinese PLA, No. 101 North Xingyuan Road, Wuxi, Jiangsu 214044, PR China.
Orthop Traumatol Surg Res. 2015 Apr;101(2):197-200. doi: 10.1016/j.otsr.2014.11.018. Epub 2015 Feb 18.
The optimal treatment of midshaft clavicle fractures remains controversial. Nonunion is usually considered to be an uncommon complication following a nonoperatively treated clavicle fracture.
Not every midshaft clavicular fractures shares the same risk of developing nonunion after nonoperative treatment. The present study was performed to identify the intrinsic and extrinsic independent factors that are independently predictive of nonunion in patients with midshaft clavicular fractures after nonoperative treatment.
We performed a retrospective study of a series of 804 patients (391 men and 413 women with a median age of 51.3 years) with a radiographically confirmed midshaft clavicle fracture, which was treated nonoperatively. There were 96 patients who underwent nonunion. Putative intrinsic (patient-related) and extrinsic (injured-related) risk factors associated with nonunion were determined with the use of bivariate and multivariate statistical analyses.
By bivariate analysis, the risk of nonunion was significantly increased by several intrinsic risk factors including age, sex, and smoking and extrinsic risk factors including displacement of the fracture and the presence of comminution (P<0.05 for all). On multivariate analysis, smoking (OR=4.16, 95% CI: 1.01-14.16), fracture displacement (OR=7.81, 95% CI: 2.27-25.38) and comminution of fracture (OR=3.86, 95% CI: 1.16-13.46) were identified as independent predictive factors.
The risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures are multifactorial. Smoking, fracture displacement and comminution of fracture are independent predictors for an individual likelihood of nonunion. Further studies are still required to evaluate these factors in the future.
Level III, case-control study.
锁骨中段骨折的最佳治疗方法仍存在争议。骨不连通常被认为是锁骨骨折非手术治疗后一种不常见的并发症。
并非每例锁骨中段骨折在非手术治疗后发生骨不连的风险都相同。本研究旨在确定非手术治疗后锁骨中段骨折患者发生骨不连的内在和外在独立预测因素。
我们对804例经影像学证实为锁骨中段骨折且接受非手术治疗的患者（391例男性和413例女性，中位年龄51.3岁）进行了回顾性研究。其中96例发生骨不连。通过双变量和多变量统计分析确定与骨不连相关的假定内在（患者相关）和外在（损伤相关）风险因素。
双变量分析显示，包括年龄、性别和吸烟在内的几个内在风险因素以及包括骨折移位和粉碎性骨折在内的外在风险因素均显著增加了骨不连的风险（所有P<0.05）。多变量分析确定吸烟（OR=4.16，95%CI：1.01-14.16）、骨折移位（OR=7.81，95%CI：2.27-25.38）和骨折粉碎（OR=3.86，95%CI：1.16-13.46）为独立预测因素。
锁骨中段骨折非手术治疗后发生骨不连的风险因素是多因素的。吸烟、骨折移位和骨折粉碎是个体发生骨不连可能性的独立预测因素。未来仍需进一步研究来评估这些因素。
Ⅲ级，病例对照研究。
