尺骨切除长度：尺骨缩短截骨术骨不连的危险因素。
Ulnar Resection Length: A Risk Factor for Nonunion in Ulnar Shortening Osteotomy.
机构信息
Duke University School of Medicine, Durham, NC, USA.
出版信息
Hand (N Y). 2024 Jan;19(1):74-81. doi: 10.1177/15589447221122827. Epub 2022 Sep 6.
BACKGROUND
Nonunion rates following ulnar shortening osteotomy (USO) are reported up to 18% with few known risk factors. While resection length is variable in practice, little is known about the prognostic implications on healing. The purpose of this study was to evaluate whether longer resection lengths increased the odds of nonunion.
METHODS
A retrospective review was performed on patients who underwent an elective USO at a single institution over a 6-year period. Demographic, social, comorbidity, and surgical data were reviewed. Ulnar resection length was obtained from operative notes and dichotomized into smaller (<5.5 mm) and larger (≥5.5 mm) groups. The primary outcome was the rate of nonunion. Univariate analyses and a multivariable logistic regression model were used to assess for significant predictors of nonunion.
RESULTS
A total of 87 patients were included with a mean age of 45 years. Patient comorbidities included 12.6% with diabetes, 29.9% with an American Society of Anesthesiologists score of ≥ 3, 5.8% reporting current tobacco use, and 29.9% reporting former tobacco use. There were 55 patients (63.2%) with resection lengths < 5.5 mm and 32 patients (36.8%) with ≥ 5.5 mm resections. Multivariable analysis identified longer resection length (≥5.5 mm) and current tobacco use as independent risk factors for nonunion. Patients with a resection length of ≥ 5.5 mm had 20.2 times greater odds of nonunion compared with patients with smaller resections, and current smokers had 72.2 times greater odds of nonunion compared with nonsmokers.
CONCLUSION
Longer ulnar resection length (≥5.5 mm) significantly increases the risk of nonunion following USO.
背景
尺骨缩短截骨术（USO）后不愈合的发生率高达 18%，且其危险因素知之甚少。虽然实际操作中的切除长度是可变的，但对于愈合的预后意义知之甚少。本研究旨在评估较长的切除长度是否会增加不愈合的几率。
方法
对一家机构在 6 年内进行的选择性 USO 患者进行回顾性分析。回顾了人口统计学、社会、合并症和手术数据。从手术记录中获得尺骨切除长度，并将其分为较小（<5.5mm）和较大（≥5.5mm）两组。主要结局是不愈合的发生率。使用单变量分析和多变量逻辑回归模型来评估不愈合的显著预测因素。
结果
共纳入 87 例患者，平均年龄 45 岁。患者合并症包括：糖尿病 12.6%，美国麻醉医师协会评分≥3 者 29.9%，当前吸烟者 5.8%，前吸烟者 29.9%。有 55 例（63.2%）患者的切除长度<5.5mm，32 例（36.8%）患者的切除长度≥5.5mm。多变量分析确定较长的切除长度（≥5.5mm）和当前吸烟是不愈合的独立危险因素。与切除长度较小的患者相比，切除长度≥5.5mm 的患者发生不愈合的几率高 20.2 倍，与不吸烟者相比，当前吸烟者发生不愈合的几率高 72.2 倍。
结论
尺骨缩短截骨术后较长的切除长度（≥5.5mm）显著增加了不愈合的风险。
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