Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; and.
Southern California Orthopedic Institute, Van Nuys, CA.
J Orthop Trauma. 2021 Dec 1;35(12):619-625. doi: 10.1097/BOT.0000000000002276.
The goals of the study were (1) to document the healing rates of femoral nonunions stratified by those that healed as intended, healed after a subsequent intervention, and those that did not heal; (2) to report the prevalence of recalcitrant femoral nonunions and (3) to identify specific demographic, injury, and treatment-related risk factors for the development of a recalcitrant nonunion.
Longitudinal observational cohort study.
Academic Level 1 trauma center.
PATIENTS/PARTICIPANTS: One hundred twenty-two femoral nonunions treated with either a plate or intramedullary nail by a single surgeon between 1991 and 2018.
Bivariate and multivariate regression analysis were performed to identify specific demographic, injury, and treatment factors in patients who developed a recalcitrant nonunion.
Although 83.6% of the femoral nonunions eventually healed, only 66% "healed as intended" with 17.2% requiring 1 or more additional procedures to consolidate and 16.4% of nonunions failing to unite. There were no statistically significant differences in the recalcitrance rate when we compared treatment with conventional versus locked plates or primary versus exchange nailing. Risk factors for developing a recalcitrant nonunion were deep infection, current smokers, metabolic bone disease, and patients who had undergone 3 or more prior surgical procedures.
The use of both intramedullary nails and modern plates were associated with a high rate of recalcitrance. Infection, current smokers, metabolic bone disease, and 3 or more prior surgical procedures were predictors for the development of a recalcitrant nonunion.
Therapeutic Leve IV. See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是：(1)记录股骨骨不连的愈合率，根据预期愈合、后续干预后愈合和未愈合的情况进行分层；(2)报告难治性股骨骨不连的患病率；(3)确定特定的人口统计学、损伤和与治疗相关的风险因素，以了解难治性骨不连的发生。
纵向观察队列研究。
学术一级创伤中心。
患者/参与者：1991 年至 2018 年间，由一位外科医生采用钢板或髓内钉治疗的 122 例股骨骨不连患者。
对发生难治性骨不连的患者进行双变量和多变量回归分析，以确定特定的人口统计学、损伤和治疗因素。
尽管 83.6%的股骨骨不连最终愈合，但只有 66%“按预期愈合”，17.2%需要 1 次或多次额外手术来固定，16.4%的骨不连未能愈合。在比较传统钢板与锁定钢板、初次与交锁髓内钉治疗的难治性率时，没有统计学上的显著差异。发生难治性骨不连的危险因素包括深部感染、现吸烟者、代谢性骨病以及接受过 3 次或更多手术的患者。
髓内钉和现代钢板的使用都与难治性骨不连的高发生率有关。感染、现吸烟者、代谢性骨病和 3 次或更多手术是难治性骨不连发生的预测因素。
治疗级别 IV。有关证据水平的完整描述，请参见作者指南。
