From the Department of Orthopaedics, University of North Carolina, Chapel Hill, NC (Shapiro, Stillwagon, Lin, and Ostrum), the Department of Orthopaedic Surgery, Boston University, Boston, MA (Tornett and Seaver), the Department of Orthopaedic Surgery, Duke University, Durham, NC (Gage, O'Donnell, and Whitlock), the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Yarboro), the Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC (Jeray), the Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN (Obremskey and Rodriguez-Buitrago), and the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY (Matuszewski).
J Am Acad Orthop Surg. 2022 Sep 15;30(18):e1179-e1187. doi: 10.5435/JAAOS-D-21-00366. Epub 2022 Jun 7.
This multicenter cohort study investigated the association of serology and comorbid conditions with septic and aseptic nonunion.
From January 1, 2011, to December 31, 2017, consecutive individuals surgically treated for nonunion were identified from seven centers. Nonunion-type, comorbid conditions and serology were assessed.
A total of 640 individuals were included. 57% were male with a mean age of 49 years. Nonunion sites included tibia (35.2%), femur (25.6%), humerus (20.3%), and other less frequent bones (18.9%). The type of nonunion included septic (17.7%) and aseptic (82.3%). Within aseptic, nonvascular (86.5%) and vascular (13.5%) nonunion were seen. Rates of smoking, alcohol abuse, and diabetes mellitus were higher in our nonunion cohort compared with population norms. Coronary artery disease and tobacco use were associated with septic nonunion (P < 0.05). Diphosphonates were associated with vascular nonunion (P < 0.05). Serologically, increased erythrocyte sedimentation rate, C-reactive protein, parathyroid hormone, red cell distribution width, mean platelet volume (MPV), and platelets and decreased absolute lymphocyte count, hemoglobin, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and albumin were associated with septic nonunion while lower calcium was associated with nonvascular nonunion (P < 0.05). The presence of four or more of increased erythrocyte sedimentation rate, C-reactive protein, or red cell distribution width; decreased albumin; and age younger than 65 years carried an 89% positive predictive value for infection. Hypovitaminosis D was seen less frequently than reported in the general population, whereas anemia was more common. However, aside from hematologic and inflammatory indices, no other serology was abnormal more than 25% of the time.
Abnormal serology and comorbid conditions, including smoking, alcohol abuse, and diabetes mellitus, are seen in nonunion; however, serologic abnormalities may be less common than previously thought. Septic nonunion is associated with inflammation, younger age, and malnourishment. Based on the observed frequency of abnormality, routine laboratory work is not recommended for nonunion assessment; however, specific focused serology may help determine the presence of septic nonunion.
这项多中心队列研究调查了血清学和合并症与脓毒症和无菌性非愈合的关系。
从 2011 年 1 月 1 日至 2017 年 12 月 31 日，从七个中心确定了接受手术治疗非愈合的连续个体。评估了非愈合类型、合并症和血清学。
共纳入 640 人，其中 57%为男性，平均年龄为 49 岁。非愈合部位包括胫骨（35.2%）、股骨（25.6%）、肱骨（20.3%）和其他较少见的骨骼（18.9%）。非愈合类型包括脓毒症（17.7%）和无菌性（82.3%）。在无菌性中，可见非血管性（86.5%）和血管性（13.5%）非愈合。与人群正常值相比，我们的非愈合队列中吸烟、酗酒和糖尿病的发生率更高。冠状动脉疾病和烟草使用与脓毒症非愈合相关（P < 0.05）。二膦酸盐与血管性非愈合相关（P < 0.05）。血清学方面，红细胞沉降率、C 反应蛋白、甲状旁腺激素、红细胞分布宽度、平均血小板体积（MPV）和血小板升高，以及绝对淋巴细胞计数、血红蛋白、平均红细胞血红蛋白、平均红细胞血红蛋白浓度和白蛋白降低与脓毒症非愈合相关，而血钙降低与非血管性非愈合相关（P < 0.05）。红细胞沉降率、C 反应蛋白或红细胞分布宽度升高 4 项或以上、白蛋白降低、年龄小于 65 岁时，感染的阳性预测值为 89%。维生素 D 缺乏症的发生率低于一般人群，而贫血更为常见。然而，除了血液学和炎症指标外，没有其他血清学异常超过 25%的时间。
非愈合中存在异常的血清学和合并症，包括吸烟、酗酒和糖尿病；然而，血清学异常可能比以前认为的要少。脓毒症非愈合与炎症、年龄较小和营养不良有关。基于观察到的异常频率，不建议常规进行实验室检查来评估非愈合；然而，特定的针对性血清学检查可能有助于确定是否存在脓毒症非愈合。
