Houben I B, Raaben M, Van Basten Batenburg M, Blokhuis T J
Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
Eur J Orthop Surg Traumatol. 2018 Oct;28(7):1429-1436. doi: 10.1007/s00590-018-2190-2. Epub 2018 Apr 9.
The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture.
Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression.
Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p < 0.001). Correlation analysis yielded four possible confounders: infection requiring surgical intervention, fracture type, fasciotomy and open fractures. Logistic regression identified IWB as an independent predictor for impaired healing with an odds ratio of 1.13 per week delay (95% CI 1.03-1.25).
Delay in initial weight bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation.
3b.
骨折后负重时机与愈合结果之间的关系尚未明确，这限制了对患者可能有益效应的应用。本研究旨在确定手术治疗胫骨干骨折后负重时机的影响。
对2007年至2015年期间手术治疗的胫骨干骨折进行回顾性研究。将首次负重（IWB）时机作为多因素回归中愈合受损的预测因素进行分析。
共纳入166例胫骨干骨折，86例愈合受损，80例愈合正常。平均年龄为38.7岁（范围16 - 89岁）。正常骨折愈合组至IWB的平均时间显著更短（2.6周对7.4周，p < 0.001）。相关性分析得出四个可能的混杂因素：需要手术干预的感染、骨折类型、筋膜切开术和开放性骨折。逻辑回归确定IWB是愈合受损的独立预测因素，每周延迟的优势比为1.13（95%CI 1.03 - 1.25）。
手术治疗的胫骨干骨折中，首次负重延迟与骨折愈合受损独立相关。与骨折类型或软组织状况等其他因素不同，早期恢复负重可受治疗医生影响，因此该因素具有直接临床相关性。本研究表明早期恢复负重应是骨折固定的治疗目标。
3b。
