Ding Zi-Chuan, Zeng Wei-Nan, Rong Xiao, Liang Zhi-Min, Zhou Zong-Ke
Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
Clinic Research Management Department, West China Hospital, Sichuan University, Chengdu, China.
ANZ J Surg. 2020 Jul;90(7-8):1259-1264. doi: 10.1111/ans.15878. Epub 2020 Apr 7.
The majority of the existing evidence showing an association between diabetes and impaired fracture healing comes from basic scientific research. This systematic review and meta-analysis aimed to summarize the current clinical literature that investigates fracture healing in patients with diabetes.
The outcome of interest was impaired fracture healing including non-union, delayed union and malunion. Studies that compared fracture healing outcomes between patients with and without diabetes were included in this study. Subgroup analyses regarding different fracture sites, types of fracture and classifications of diabetes were performed.
A total of 14 studies involving 695 patients with diabetes and 4937 controls fulfilled the inclusion criteria. Diabetes was associated with an increased risk of impaired fracture healing (odds ratio (OR): 2.11, 95% confidence interval (CI) 1.33-3.37, P = 0.002). Subgroup analyses showed that diabetes was associated with a significantly higher incidence of impaired fracture healing in lower extremity fractures (OR 2.63, 95% CI 1.30-5.30, P = 0.007), short bone fractures (OR 2.64, 95% CI 1.35-5.20, P = 0.005), long bone fractures (OR 2.13, 95% CI 1.23-3.70, P = 0.007) and osteoporosis-unrelated fractures (OR 2.39, 95% CI 1.19-4.80, P = 0.01). Both insulin-dependent diabetes (OR 4.04, 95% CI 1.05-15.56, P = 0.04) and non-insulin-dependent diabetes (OR 5.83, 95% CI 1.73-19.58, P = 0.004) were associated with significantly higher risks of impaired fracture healing.
Patients with diabetes have an increased risk of impaired fracture healing when compared to patients without diabetes. Fracture healing in the lower extremities, short bones and osteoporosis-unrelated fractures is affected more severely by diabetes.
现有的大多数表明糖尿病与骨折愈合受损之间存在关联的证据来自基础科学研究。本系统评价和荟萃分析旨在总结当前调查糖尿病患者骨折愈合情况的临床文献。
感兴趣的结局是骨折愈合受损，包括骨不连、延迟愈合和畸形愈合。本研究纳入了比较糖尿病患者和非糖尿病患者骨折愈合结局的研究。对不同骨折部位、骨折类型和糖尿病分类进行了亚组分析。
共有14项研究涉及695例糖尿病患者和4937例对照，符合纳入标准。糖尿病与骨折愈合受损风险增加相关（比值比（OR）：2.11，95%置信区间（CI）1.33 - 3.37，P = 0.002）。亚组分析表明，糖尿病与下肢骨折（OR 2.63，95% CI 1.30 - 5.30，P = 0.007）、短骨骨折（OR 2.64，95% CI 1.35 - 5.20，P = 0.005）、长骨骨折（OR 2.13，95% CI 1.23 - 3.70，P = 0.007）和与骨质疏松无关的骨折（OR 2.39，95% CI 1.19 - 4.80，P = 0.01）的骨折愈合受损发生率显著较高相关。胰岛素依赖型糖尿病（OR 4.04，95% CI 1.05 - 15.56，P = 0.04）和非胰岛素依赖型糖尿病（OR 5.83，95% CI 1.73 - 19.58，P = 0.004）均与骨折愈合受损风险显著较高相关。
与非糖尿病患者相比，糖尿病患者骨折愈合受损的风险增加。糖尿病对下肢、短骨和与骨质疏松无关的骨折的愈合影响更为严重。
