Quan Kun, Xu Qiang, Zhu Meisong, Liu Xuqiang, Dai Min
Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, China.
Front Surg. 2021 Dec 14;8:754150. doi: 10.3389/fsurg.2021.754150. eCollection 2021.
The purpose of this study was to analyze the risk factors for limb fracture non-union in order to improve non-union prevention and early detection. A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing after surgery for limb fractures who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analyzed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union. After comparison between two groups by univariate analysis and multivariate logistic regression, we found some risk factors associated that osteoporosis (odds ratio [OR] = 3.16, 95% confidence interval [CI]: 2.05-4.89, < 0.001), open fracture (OR = 2.71, 95%CI: 1.72-4.27, < 0.001), NSAIDs use (OR = 2.04, 95%CI: 1.24-3.37, = 0.005), delayed weight bearing (OR = 1.72, 95%CI: 1.08-2.74, = 0.023), failed internal fixation (OR = 5.93, 95%CI: 2.85-12.36, < 0.001), and infection (OR = 6.77, 95%CI: 2.92-15.69, < 0.001) were independent risk factors for non-union after surgery for limb fractures. Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.
本研究旨在分析四肢骨折不愈合的危险因素，以改善不愈合的预防和早期检测。2005年1月至2017年6月在我院接受四肢骨折手术后出现不愈合的223例患者被纳入病例组，同时通过计算机生成随机列表，选取同期接受四肢骨折手术后骨愈合成功的446例患者作为对照组，从而实现1:2的比例。对这些患者的病历进行回顾性分析。分析并比较两组患者的年龄、性别、体重指数、肥胖、吸烟、饮酒、糖尿病、高血压、骨质疏松、骨折类型、多发骨折、非甾体抗炎药（NSAIDs）使用情况、负重延迟、内固定失败及感染数据。构建多因素logistic回归模型以确定与不愈合相关的因素。经单因素分析和多因素logistic回归比较两组后，我们发现骨质疏松（比值比[OR]=3.16，95%置信区间[CI]：2.05 - 4.89，<0.001）、开放性骨折（OR = 2.71，95%CI：1.72 - 4.27，<0.001）、NSAIDs使用（OR = 2.04，95%CI：1.24 - 3.37，=0.005）、负重延迟（OR = 1.72，95%CI：1.08 - 2.74，=0.023）、内固定失败（OR = 5.93，95%CI：2.85 - 12.36，<0.001）及感染（OR = 6.77，95%CI：2.92 - 15.69，<0.001）是四肢骨折手术后不愈合的独立危险因素。骨质疏松、开放性骨折类型、NSAIDs使用、负重延迟、内固定失败及感染被发现是骨不愈合的主要原因；因此，临床医生应采取针对性措施对高危人群进行早期干预。
