肱骨骨干骨折切开复位钢板固定术后延迟愈合的相关危险因素。
Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.
作者信息
Kuo Yuh-Ruey, Ko Po-Yen, Lee Chun-Yi, Tsai Ting-Chien, Chuang Chang-Han, Yao Shu-Hsin, Wu Po-Ting
机构信息
Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd., North Dist., Tainan City, 704, Taiwan.
Orthopedics Department, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
出版信息
J Orthop Traumatol. 2025 May 12;26(1):28. doi: 10.1186/s10195-025-00843-0.
BACKGROUND
The risk factors related to delayed union in humeral diaphyseal fractures (HDFs) following surgical osteosynthesis remain unclear. Therefore, this study aimed to evaluate radiological outcomes and the risk factors associated with delayed union in a retrospective cohort of patients who underwent open reduction and plate fixation (ORPF) for acute HDFs.
MATERIALS AND METHODS
Consecutive patients with AO/OTA 12-A and AO/OTA 12-B fractures who underwent ORPF using standard compression techniques between 2017 and 2020 were enrolled in the study. Demographic data, along with serial medical records and radiographs, were collected. The included patients were divided into two groups: the timely union (union occurring within 6 months postoperatively) and the delayed union group (union occurring between 6 and 12 months postoperatively). Differences between the groups were examined, and logistic regression was subsequently applied for risk factor analysis.
RESULTS
Sixty-five cases were included in the study, consisting of 34 males and 31 females, with a median age of 38.9 years. Among these, 45 cases (69.2%) were classified in the timely union group, while 20 cases (30.8%) were classified in the delayed union group. Overall, 30 cases (46.2%) demonstrated secondary bony union. Significant differences were observed between groups in terms of fracture pattern, immediate postoperative fracture gap, union pattern, and complication rate (p < 0.05 for all comparisons). Multivariate logistic regression analysis revealed that the use of interfragmentary screw and the presence of postoperative complications were independent predictors of delayed union, with an adjusted odds ratio of 0.14 and 5.76, respectively.
CONCLUSIONS
In ORPF for acute HSFs, 30 out of 65 cases demonstrated secondary bone union despite the use of standard compression techniques. The application of interfragmentary screws significantly reduces the risk of delayed union. Conversely, the presence of postoperative complications is associated with an increased likelihood of delayed union.
LEVEL OF EVIDENCE
3 Trial Registration All procedures were approved by the institutional review board of the authors' hospital (IRB nos. A-ER-112-395 and IRB20230089).
背景
手术接骨术后肱骨干骨折（HDFs）延迟愈合的相关危险因素尚不清楚。因此，本研究旨在评估接受切开复位钢板固定术（ORPF）治疗急性HDFs的回顾性队列患者的影像学结果及与延迟愈合相关的危险因素。
材料与方法
纳入2017年至2020年间采用标准加压技术接受ORPF治疗的AO/OTA 12 - A和AO/OTA 12 - B骨折的连续患者。收集人口统计学数据以及系列病历和X线片。纳入患者分为两组：一期愈合组（术后6个月内愈合）和延迟愈合组（术后6至12个月愈合）。检查两组间差异，随后应用逻辑回归进行危险因素分析。
结果
本研究共纳入65例患者，其中男性34例，女性31例，中位年龄38.9岁。其中，45例（69.2%）归入一期愈合组，20例（30.8%）归入延迟愈合组。总体而言，30例（46.2%）实现二期骨愈合。两组在骨折类型、术后即刻骨折间隙、愈合类型和并发症发生率方面存在显著差异（所有比较p < 0.05）。多因素逻辑回归分析显示，使用骨折块间螺钉和术后并发症的存在是延迟愈合的独立预测因素，调整后的比值比分别为0.14和5.76。
结论
在急性HSFs的ORPF中，尽管采用了标准加压技术，但65例中有30例实现了二期骨愈合。应用骨折块间螺钉可显著降低延迟愈合风险。相反，术后并发症的存在与延迟愈合可能性增加相关。
证据级别
3 试验注册 所有程序均获得作者所在医院机构审查委员会的批准（IRB编号：A - ER - 112 - 395和IRB20230089）
Zotero 插件