股骨干骨不连——更换髓内钉后造成不良后果的危险因素

Femoral shaft nonunions——Risk factors for poor outcome following exchange nailing

年龄、性别、骨折类型、锁钉技术及植骨术对骨折愈合、平均愈合时间或是否需要二次手术影响不大。吸烟是否能作为一项预后因素，目前仍有争议。在某研究中，经同样手术操作非吸烟者比吸烟者更容易愈合。然而，在其他两个研究中，非吸烟者在平均愈合时间及是否需要二次手术方面未显示出优势。相关研究可能很难有效鉴别出各种预后因素的效应。从方法学上看，严格的多中心预后研究能提供更大的样本量，在治疗股骨干骨不连更换髓内钉时有助于分析影响其结果的因素。

Summary Age, and bone gender, fracture type, nail locking technique, grafting did not appear to affect union, mean time to union, or need for additional procedures. Evidence on smoking as a prognostic factor was con icting. Nonsmokers were more likely to achieve union after one procedure compared with smokers in one study. However, the mean time to union and need for additional procedures were not decreased in nonsmokers in two other studies. Studies may have had insuf cient power to detect the effects of various prognostic factors. A method-ologically rigorous multi-center prognostic study may provide a larger sample size, and help delineate factors affecting outcome in exchange nailing for the treatment of femoral shaft nonunion.