Brighton C T, Shaman P, Heppenstall R B, Esterhai J L, Pollack S R, Friedenberg Z B
Department of Orthopaedic Surgery, School of Medicine, Wharton School, Philadelphia, PA, USA.
Clin Orthop Relat Res. 1995 Dec(321):223-34.
Two hundred seventy-one tibial nonunions of average duration of 23.5 months (range, 9-69 months) were treated with direct current (167 patients), capacitive coupled electrical stimulation (56 patients), or bone graft surgery (48 patients). Logistic regression analysis was used to compare heal rates among the 3 treatment methods, to identify risk factors adversely affecting the heal rate, and to predict the probability of successful healing of a nonunion of any given risk profile treated with each of the 3 forms of therapy. Seven risk factors were identified: duration of nonunion, prior bone graft surgery, prior electrical treatment, open fracture, osteomyelitis, comminuted or oblique fracture, and atrophic nonunion. When no risk factors were present, there were no significant differences among the 3 treatment methods. As progressively more risk factors were present, the predicted heal rates decreased significantly regardless of the treatment method. Some differences among the treatment groups did appear in the heal rates: bone graft surgery yielded a worse heal rate when there was a previous bone graft failure, and capacitive coupling had a worse heal rate in the presence of an atrophic nonunion.
271例平均病程为23.5个月(范围9 - 69个月)的胫骨骨不连患者,分别接受直流电治疗(167例)、电容耦合电刺激治疗(56例)或骨移植手术治疗(48例)。采用逻辑回归分析比较三种治疗方法的愈合率,确定对愈合率有不利影响的危险因素,并预测采用这三种治疗方法之一治疗的具有任何给定风险特征的骨不连成功愈合的概率。确定了七个危险因素:骨不连病程、既往骨移植手术、既往电治疗、开放性骨折、骨髓炎、粉碎性或斜形骨折以及萎缩性骨不连。当不存在危险因素时,三种治疗方法之间无显著差异。随着存在的危险因素逐渐增多,无论治疗方法如何,预测的愈合率均显著降低。治疗组之间在愈合率上确实出现了一些差异:当既往骨移植失败时,骨移植手术的愈合率较差,而在存在萎缩性骨不连的情况下,电容耦合的愈合率较差。