Najafi Arvin, Shahbazi Parmida, Azarsina Salman, Zargar Danoosh, Kahrizi Mohammad Saeed, Hadavi Dorsa, Minaei-Noshahr Reza
Department of Orthopedic Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Karaj.
Bone, Joint and Related Tissues Research Center, Shahid Beheshti University of Medical Sciences, Tehran.
Eur J Transl Myol. 2022 Oct 28;32(4):10835. doi: 10.4081/ejtm.2022.10835.
Early prediction of the union helps for timely intervention, reduction of hospitalization, treatment costs, and disability in cases of nonunion. With this in mind, we tried to find how long any cortical bridging predicts the union in femoral shaft fractures. A prospective study of 113 femoral shaft fractures treated with reamed, locked intramedullary nailing was performed. Radiographs were taken during months 2 to 4, 6, 9, and one-year follow-up. The cortical bridging (presence and number) was assessed by anterior-posterior and lateral views. The ROC curve provides the prediction of the union. The overall nonunion rate was 10.6% (12 of 113 fractures). Age and diabetes mellitus were statistically significant with nonunion (p value < 0.001). The final analysis demonstrated that any cortical bridging at four months postoperatively was the most accurate and earlier indicator (105 of 113, 92.9% accuracy), while it was 84.9% at six months in bicortical and 80.5% accuracy at nine months in tricortical bridging. Low-cost and simple radiographic imaging presents cortical bridging in any form 4 months after surgery that precisely predicts a union in femoral shaft fractures.
骨折愈合的早期预测有助于及时进行干预，减少骨折不愈合病例的住院时间、治疗费用和残疾情况。考虑到这一点，我们试图找出任何皮质骨桥接在股骨干骨折愈合预测中能提前多久发挥作用。对113例采用扩髓带锁髓内钉治疗的股骨干骨折进行了一项前瞻性研究。在术后2至4个月、6个月、9个月和1年随访时拍摄X线片。通过前后位和侧位片评估皮质骨桥接（存在情况和数量）。ROC曲线用于预测骨折愈合情况。总体不愈合率为10.6%（113例骨折中有12例）。年龄和糖尿病与骨折不愈合具有统计学意义（p值<0.001）。最终分析表明，术后4个月出现的任何皮质骨桥接是最准确且最早的指标（113例中有105例，准确率92.9%），而双皮质骨桥接在6个月时准确率为84.9%，三皮质骨桥接在9个月时准确率为80.5%。低成本且简单的影像学检查能在术后4个月呈现任何形式的皮质骨桥接，准确预测股骨干骨折的愈合情况。
