四肢骨折不同内固定物治疗后发生骨不连的局部因素

Local factors of nonunion of fractures after fixation using different internal fixators in limbs

背景:尽管切开复位内或外固定可以减少骨折并发症,但是仍然有5%-10%发生骨不连。骨不连原因有全身因素、局部因素和药物因素,其中,局部因素是最主要原因。目的:探讨四肢骨折不同内固定方式治疗后发生骨不连的具体局部原因。方法:回顾性分析2005年1月至2011年6月由局部因素造成四肢骨折不同内固定物固定后骨不患者87例,分析判断局部因素的具体原因。医源性局部因素包括:未达有效固定,忽视断端血运保护,忽略植骨,复位不良,内固定后感染,缺乏正确康复指导;患者因素包括:损伤严重,特殊部位,活动过早与过多。结果与结论:医源性因素占73.0%,患者因素占27.0%。在医源性因素中,由高到低依次为:忽略植骨占26.1%,缺乏正确康复指导占23.9%,未达有效固定占21.7%,未达必要复位占15.2%,忽视断端血运保护占8.7%,术后感染占4.3%。在患者因素中,由高到低依次为:活动过早过多占50.0%,损伤严重占32.4%,特殊部位占17.6%。在总因素中,客观因素占13.5%,人为因素占86.5%。减少医源性因素是减少骨折内固定治疗后骨不连发生的重要环节。

BACKGROUND： Although open reduction and internal or external fixation can reduce complications of fractures, however, there are still 5%-10% nonunions occurred. The causes of nonunion are composed of systemic factor, local factor and medication factor, among them, the local factor is the main reason. OBJECTIVE： To investigate the local factors of nonunion of fractures after fixation using different fixators in limbs. METHODS： Eighty-seven cases of nonunion of fractures after fixation with different fixators in limbs between January 2005 and June 2011 were analyzed retrospectively. Analyzing and judging the specific local factor and calculating its proportion. The iatrogenic local factors included： invalid fixation, ignoring protecting the blood supply, ignoring bone graft, fracture reduction below the standard, postoperative infection and lacking proper rehabilitation guidance; patient-related factors included： severe injury, special location and early excessive activity. RESULTS AND CONCLUSION： The iatrogenic factors accounted for 73.0%, the patient-related factors accounted for 27.0%. In the iatrogenic factors from high to low were： ignoring bone graft 26.1%, lacking proper rehabilitation guidance 23.9%, invalid fixation 21.7%, fracture reduction below the standard 15.2%, ignoring protecting the blood supply 8.7%, postoperative infection 4.3%. In the patient-related factors from high to low were： early excessive activity 50.0%, severe injury 32.4%, special location 17.6%.Among the general factors, the objective factors accounted for 13.5% and the subjective factors accounted for 86.5%. Reducing the iatrogenic factors is an important part of reducing the nonunion of fractures after internal fixation treatment.