四肢骨折内固定术后延迟愈合的原因分析及处理

Cause analysis and treatment of delayed healing after internal fixation of limb fracture

目的：分析四肢骨折内固定术后延迟愈合的因素及预防处理措施。方法回顾性分析220例四肢骨折患者内固定手术的临床资料，比较术后延迟愈合患者（观察组110例）与未延迟愈合患者（对照组110例）相关因素的差异。结果观察组年龄（62．6±10．2）岁、合并内科疾病者43．6％、内固定不牢固者比例25．5％、外固定不当者比例30．9％、功能锻炼不正确者比例56.4％，高于对照组的（50．5±9．4）岁、11.8％、1．8％、7．3％、8．2％（t＝9．1491，χ^2＝27．786、26．091、58．416、19．893，均P＜0．05），而手术切口长度、性别构成、骨折部位等差异均无统计学意义（t＝1．8259，χ^2＝0．308、0.073、0．073，均P＞0．05）。结论四肢骨折内固定术后延迟愈合因素较多，其中患者年龄大、合并内科疾病者、内固定不牢固、功能锻炼不正确、外固定管理不当是导致四肢骨折术后延迟愈合的主要因素，应及时的采取术前评估、术中牢固固定及正规的术后指导功能锻炼等措施，避免术后延迟愈合及不愈合的发生。

Objective To analyze the reasons of the delayed healing factors after internal fixation of limb fracture and the prevention and treatment measures.Methods 220 cases who were treated with internal fixation of fracture cases were retrospectively analyzed,compared difference with patients with postoperative （observation group of 1 10 cases）and non delay healing patients （1 10 cases in the control group）related factors.Results In the obser-vation group,age （62.6 ±10.2）years old,43.6% with diseases in department of internal medicine,the loose of internal fixation ratio was 25.5%,external fixation improper proportion was 30.9%,functional exercise did not correct rate was 56.4%,higher than those of the control group （50.5 ±9.4）years old,11.8%,1.8%,7.3%,8.2%%（t=9.149 1,χ^2 =27.786,26.091,58.416,19.893,all P〈0.05）,but there was no statistically significance in operation incision length,gender composition,the fracture site （t =1.825 9,χ^2 =0.308,0.073,0.073,all P 〉0.05 ）. Conclusion There are many factors in delayed healing after internal fixation of limb fracture,the patients age,associ-ated with diseases in department of internal medicine,the loose of internal fixation,external fixation and functional exercise is not correct are the main factor of the limbs fracture postoperative delayed healing,and should take meas-ures timely to guide firmly fixed and regular postoperative preoperative exercise and avoid postoperative delayed union and nonunion.