Stavrou Petros Z, Ciriello Vincenzo, Theocharakis Stylianos, Gudipati Suribabu, Tosounidis Theodoros H, Kanakaris Nikolaos K, Giannoudis Peter V
Academic department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, UK.
Academic department of Trauma and Orthopaedics, Leeds Teaching Hospitals, School of Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
Injury. 2016 Dec;47 Suppl 7:S49-S52. doi: 10.1016/S0020-1383(16)30855-5.
This study aimed to identify the prevalence and the risk factors for re-interventions following reamed intramedullary nailing (IMN) of tibial shaft fractures.
We retrospectively analysed a prospectively populated data of adult patients that underwent reamed intramedullary nailing for stabilization of tibial shaft fractures over a period of three years. Exclusion criteria were immature patients, pathological and periarticular fractures. Data collected included patient demographics, mechanism of injury, open or closed injury pattern, ISS, perioperative complications, reintervention characteristics (time, cause, number), smoking habits, medical co-morbidities and progress to radiological fracture union. Fractures were classified according to AO/OTA system. The cohort of these patients was divided in two groups: Group 1 included the patients who healed uneventfully and Group 2 included the patients who underwent a re-intervention for the healing of the fracture. A logistic regression analysis model was used to assess the odds ratio (OR) of identified risk factors predicting the necessity of re-interventions.
181 (129 male) patients with a mean age of 37 (range 16-87) met the inclusion criteria. 30 patients were excluded due to inadequate follow up, leaving 151 patients for the study group. 119 patients were included in Group 1. 32 (21.2%) patients who had at least one re-intervention (range 1-3) were included in Group 2. The most common causes for re-intervention were aseptic non-union (31.3%) and removal of implants due to soft tissue irritation/anterior knee pain (31.3%), followed by early metalwork failure (12.5%), infected non-union (9.4%), correction of rotational deformities (9.4%) and canal intramedullary sepsis with evident fracture healing (6.3%). 29 (25.8%) from the study cohort patients sustained an open fracture and 8 of them underwent a re-intervention (20.5% of interventions). Incidence of fracture pattern 42-B, C was statistically significant greater in the reintervention (40.6%) compared to the non-re-intervention group (23.53%) (p = 0.026). Risk factors predicting the need for re-interventions included the type of fracture B, C (p = 0.026 OR: 2.528, range: 1.117-5.721) and increased alcohol consumption (p = 0.027/OR: 2.618, range: 1.116-6.141).
Fracture pattern and alcohol abuse were highly predictive for re-interventions following reamed IM nailing for stabilization of acute tibial shaft fractures.
本研究旨在确定胫骨干骨折扩髓髓内钉固定术后再次干预的发生率及危险因素。
我们回顾性分析了三年内接受扩髓髓内钉固定胫骨干骨折的成年患者的前瞻性数据。排除标准为未成熟患者、病理性骨折和关节周围骨折。收集的数据包括患者人口统计学资料、损伤机制、开放性或闭合性损伤类型、损伤严重程度评分（ISS）、围手术期并发症、再次干预特征（时间、原因、次数）、吸烟习惯、合并疾病以及骨折影像学愈合情况。骨折根据AO/OTA系统进行分类。这些患者被分为两组：第1组包括骨折顺利愈合的患者，第2组包括因骨折愈合而接受再次干预的患者。采用逻辑回归分析模型评估已确定的危险因素预测再次干预必要性的比值比（OR）。
181例（129例男性）平均年龄为37岁（范围16 - 87岁）的患者符合纳入标准。30例患者因随访不充分被排除，研究组剩余151例患者。第1组纳入119例患者。第2组纳入32例（21.2%）至少接受过一次再次干预（范围1 - 3次）的患者。再次干预最常见的原因是无菌性骨不连（31.3%）和因软组织刺激/前膝疼痛取出植入物（31.3%），其次是早期内固定失败（12.5%）、感染性骨不连（9.4%）、旋转畸形矫正（9.4%）以及髓内感染伴明显骨折愈合（6.3%）。研究队列中的29例（25.8%）患者为开放性骨折，其中8例接受了再次干预（占干预患者的20.5%）。再次干预组骨折类型42 - B、C的发生率（40.6%）与未再次干预组（23.53%）相比，差异有统计学意义（p = 0.026）。预测需要再次干预的危险因素包括骨折类型B、C（p = 0.026，OR：2.528，范围：1.117 - 5.721）和饮酒量增加（p = 0.027，OR：2.618，范围：1.116 - 6.141）。
骨折类型和酗酒对急性胫骨干骨折扩髓髓内钉固定术后的再次干预具有高度预测性。
