髓内钉治疗胫骨骨折的不良预后相关因素分析

Prognostic Factors Analysis for Poor Prognosis of Intramedullary Nailing for Tibial Fracture

目的探讨髓内钉治疗胫骨骨折不良预后的相关因素。方法连续收集2010年10月至2013年4月于我院住院拟行髓内钉治疗的胫骨干骨折患者292例,使用多变量逻辑回归分析研究15个可能与不良预后有关的基线和手术因素。结果不良预后风险的发生与高能量损伤机制（OR=1.57,95%CI=1.05~2.35）、不锈钢（与钛钉相比,OR=1.52;95%CI=1.10~2.13）、骨折间隙（OR=2.40;95%CI=1.47~3.94）和手术后完全负重（OR=1.63;95%CI=1.00~2.64）有关。与使用非甾体类抗炎药、早期和后期进行手术或吸烟无关。开放性骨折患者使用钛钉治疗风险更高（OR=3.26;95%CI=2.01~5.28）,而使用非扩髓骨钉治疗则无此情况（OR=1.50;95%CI=0.92~2.47）。开放性骨折患者伤口无需额外处理或延期缝合的不良预后发生风险比需要后续更复杂组织重建的患者要低（分别为OR=0.18,95%CI=0.09~0.35和OR=0.29,95%CI=0.14~0.62）。结论本研究发现了可能增加胫骨干骨折患者发生不良预后风险的几个骨折基线因素和手术特点。外科医生应该考虑这些预测因素来确定高危患者并应给予积极治疗。

Objective To. analyses prognostic factors for poor prognosis of intramedullary nailing for tibial fracture. Methods We colleted 292 cases patient of tibial fracture in our hospital from 2010 0ct-2013 Apr. Using multivariable logistic regression analysis, we investigated 15 baseline and surgical factors for any associations with an increased risk of negative outcomes. Results There was an increased risk of negative events in patients with a high-energy mechanism of injury （ OR = 1.57 ; 95% CI = 1.05 - 2.35） , a stainless steel compared with a titanium nail （ OR = 1.52 ; 95% CI = 1.10 - 2. 13 ） , a fracture gap （ OR = 2.40 ; 95% CI = 1.47 - 3.94） , and full weight-bearing status after surgery （OR = 1.63; 95% CI = 1.00- 2.64）. There was no increased risk with the use of nonsteroidal anti-inflammatory agents, late or early time to surgery, or smoking status. Open fractures bad a higher risk of events among patients treated with reamed nailing （ OR = 3.26; 95% CI =2.01 -5.28） but not in patients treated with unreamed nailing （OR = 1.50; 95% CI =0.92 -2. 47）. Patients with open fractures who had wound management either without any additional procedures or with delayed primary closure had a decreased risk of events compared with patients who required subsequent, more complex reconstruction （ OR = 0. 18, 95% CI = 0.09 - 0.35, and 0.29, 95% CI = 0. 14-0.62, respectively）. Conclusions The research may provide identified several baseline fracture and surgical characteristics that may increase the risk of adverse events in patients with tibial shaft fractures. Surgeons should consider the predictors identified in our analysis to inform patients treated for tibial shaft fractures.