Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Germany.
Department of Traumatology and Orthopedic Surgery, Klinikum Esslingen, Hirschlandstraße 97, 73730, Esslingen a.N., Germany.
Arch Orthop Trauma Surg. 2020 Mar;140(3):303-311. doi: 10.1007/s00402-019-03217-4. Epub 2019 Jul 17.
Corrective osteotomies of the lower limb are standard procedures in orthopedic surgery. Still, there is only limited research on factors affecting bone healing after osteotomies. We hypothesize that especially the location of the osteotomy, smoking status and BMI affect bone healing.
The healing process of 547 patients who underwent osteotomies of the lower limb (259 female, 288 male; average 40.6 years, range 14-77) was evaluated. To assess bone healing, participants were divided into three groups by bone healing duration ( < 5/5-8/ > 8 months). Differences in healing duration related to the anatomic level of the osteotomy (diaphysis vs. metaphysis), age, gender, smoking status, BMI, and modus of the osteotomy (open vs. closed wedge) were tested for significance using an ordinal regression analysis.
A significant correlation between bone healing and the anatomical level of the osteotomy on femur and tibia and the patients' smoking status was found. The odds of the diaphysis considering bone healing was 0.187 (95% CI, 0.08-0.44) times that of the metaphysis (Wald χ(1) = 14.597, p < 0.000). The odds ratio of smokers considering bone healing was 0.192 (95% CI, 0.11-0.33) times that of non-smokers (Wald χ(1) = 35.420, p < 0.000). All other analyzed factors did not show a significant correlation with bone healing.
Smoking status and the localization of the osteotomy on femur and tibia (diaphysis vs. metaphysis) are significantly correlated with bone healing duration. In line with current literature emphasizing the detrimental effect of smoking on bone healing, our findings should encourage surgeons to think twice about the indication to perform osteotomies on smokers. Furthermore, if applicable, osteotomies should be performed in the metaphyseal areas of femur and tibia.
下肢矫正性截骨术是矫形外科的标准程序。然而，对于影响截骨术后骨愈合的因素，仅有有限的研究。我们假设，截骨的位置、吸烟状况和 BMI 尤其会影响骨愈合。
对 547 例行下肢截骨术（女性 259 例，男性 288 例；平均年龄 40.6 岁，范围 14-77 岁）的患者的愈合过程进行评估。为了评估骨愈合情况，将患者根据骨愈合时间分为三组（<5/5-8/ >8 个月）。使用有序回归分析测试了与截骨部位（骨干 vs. 干骺端）、年龄、性别、吸烟状况、BMI 和截骨方式（开放式 vs. 闭合楔形）相关的愈合时间差异的显著性。
在股骨和胫骨的截骨部位的解剖水平以及患者的吸烟状况与骨愈合之间发现了显著的相关性。骨干考虑骨愈合的可能性是干骺端的 0.187 倍（95%CI，0.08-0.44）（Wald χ(1) = 14.597，p < 0.000）。吸烟者考虑骨愈合的可能性是非吸烟者的 0.192 倍（95%CI，0.11-0.33）（Wald χ(1) = 35.420，p < 0.000）。所有其他分析因素与骨愈合均无显著相关性。
吸烟状况和股骨与胫骨截骨部位（骨干 vs. 干骺端）与骨愈合时间显著相关。与强调吸烟对骨愈合的有害影响的现有文献一致，我们的研究结果应鼓励外科医生在考虑对吸烟者进行截骨术时三思而后行。此外，如果适用，截骨应在股骨和胫骨的干骺端进行。
