Gortler Hilary, Rusyn Jessyca, Godbout Charles, Chahal Jas, Schemitsch Emil H, Nauth Aaron
Division of Orthopaedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Canada.
Toronto Western Hospital, University of Toronto Orthopaedic Sports Medicine, Canada.
Injury. 2018 Feb;49(2):177-183. doi: 10.1016/j.injury.2017.11.006. Epub 2017 Nov 20.
The purpose of this study was to review the rates of adverse healing outcomes following surgical fixation of lower extremity fractures in diabetic patients and matched controls.
Searches of PubMed, MEDLINE, CINAHL and Embase were performed for studies published between the date of database inception and July 6, 2015. Patient characteristics and the incidence of adverse healing outcomes (nonunion, malunion, delayed union, infection and reoperation) were extracted from each study. The occurrence of each fracture healing complication was pooled and analyzed for comparisons between diabetic and non-diabetic patients. An odds ratio with a 95% confidence interval for each healing outcome was calculated between the diabetic and non-diabetic groups.
Diabetes was found to significantly increase rates of malunion, infection and reoperation in patients with surgically treated lower extremity fractures. In addition, when only peripheral lower extremity fractures (i.e. below the knee) were examined, diabetes significantly increased the rates of nonunion.
Diabetes substantially alters bone metabolism and soft tissue healing, posing a risk of adverse fracture healing and other complications. This systematic review provides evidence that the presence of diabetes significantly increases the risks of infection, malunion, nonunion and re-operation across a wide variety of surgically treated lower extremity fractures. This study provides prognostic information for clinicians and may aid in guiding treatment for this population.
本研究旨在回顾糖尿病患者与匹配对照组下肢骨折手术固定后不良愈合结局的发生率。
检索了PubMed、MEDLINE、CINAHL和Embase数据库，纳入自建库至2015年7月6日发表的研究。从每项研究中提取患者特征及不良愈合结局（骨不连、畸形愈合、延迟愈合、感染和再次手术）的发生率。汇总并分析每种骨折愈合并发症的发生情况，以比较糖尿病患者与非糖尿病患者。计算糖尿病组与非糖尿病组每种愈合结局的比值比及95%置信区间。
研究发现，糖尿病显著增加了接受手术治疗的下肢骨折患者发生畸形愈合、感染和再次手术的几率。此外，仅检查下肢周围骨折（即膝关节以下）时，糖尿病显著增加了骨不连的发生率。
糖尿病会显著改变骨代谢和软组织愈合，带来骨折愈合不良及其他并发症的风险。本系统评价提供的证据表明，糖尿病的存在显著增加了各种手术治疗的下肢骨折发生感染、畸形愈合、骨不连和再次手术的风险。本研究为临床医生提供了预后信息，可能有助于指导该人群的治疗。
