股骨干髓内钉术后骨不连初次翻修后发生再骨不连的危险因素分析

Analysis on risk factors of re-nonunion after primary revision for femoral shaft nonunion subsequent to failed intramedullary nailing

目的 探讨股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连的危险因素.方法 回顾性分析2008年6月至2014年6月收治的61例股骨干髓内钉术后骨不连患者行初次翻修术后的临床资料,根据骨再不连诊断标准将纳入患者分为再骨不连组（22例）和非再骨不连组（39例）.对股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连可能的14项危险因素,包括年龄、性别、体质量指数、吸烟、酗酒、致伤原因、骨折类型、髓内钉类型、髓内钉锁钉技术、骨不连部位、骨不连时间、骨不连病理类型、初次翻修方法及自体骨植骨与否,进行单因素分析和多因素非条件Logistic回归分析.结果 单因素分析显示,吸烟（χ2=6.564,P=0.036）、体质量指数（χ2=6.783,P=0.021）、骨不连部位（χ2=7.316,P=0.011）、初次翻修方法（χ2=8.069,P=0.003）和自体骨植骨与否（χ2=6.668,P=0.027）均为股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连的相关危险因素.多因素非条件Logistic回归分析显示,初次翻修方法（OR=1.027,95% CI 0.028~0.463,P〈0.05）和自体骨植骨与否（OR=1.024,95% CI 0.006~0.363,P〈0.05）是股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连的独立危险因素.结论 初次翻修方法和自体骨植骨与否是股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连的独立危险因素,通过严格掌握手术指征和联合自体骨植骨可能会有效减少股骨干髓内钉术后骨不连患者初次翻修后发生再骨不连的发生.

Objective To analyze the related risk factors of re-nonunion after primary revision for femoral shaft nonunion subsequent to failed intramedullary nailing. Methods A retrospective study was performed in 61 patients with femoral shaft nonunion subsequent to failed intramedullary nailing from June 2008 to June.All patients were divided into re-nonunion group（22 cases）and non-re-nonunion group （39 cases） according to diagnostic criteria of bone re-nonunion. Univariate analysis was used to analyze 14 factors that may lead to the occurrence of re-nonunion after revision for femoral shaft nonunion subsequent to failed intramedullary nailing including age, gender, body mass index （BMI）, smoking, alcohol abuse, injury reason, fracture types, intramedullary nail types, locking screws technology for intramedullary nail, bone nonunion sites, bone nonunion time, pathological types of bone nonunion, primary revision methods and autologous bone graft or not, and multi-factor logistic regression analysis was performed on the factors showing a significant difference. Results Univariate analysis showed significant difference in smoking （χ2= 6.564, P = 0.036）, BMI （χ2= 6.783, P = 0.021）, bone nonunion sites（χ2=7.316,P=0.011）,primary revision methods（χ2=8.069,P=0.003）and autologous bone graft or not（χ 2=6.668,P=0.027）.Logistic regression analysis showed that primary revision methods（OR=1.027,95% CI 0.028-0.463,P〈0.05）and autologous bone graft or not（OR=1.024,95% CI 0.006-0.363, P 〈 0.05） were independent risk factors for re-nonunion after revision of femoral shaft nonunion subsequent to failed intramedullary nailing. Conclusions Primary revision methods and autologous bone graft or not are independent risk factors for re-nonunion after revision of femoral shaft nonunion subsequent to failed intramedullary nailing.By strictly controlling the surgical indications and combining with autogenous bone grafting,it is possible to reduce the occurrence of nonunion after primary revision of the femoral shaft nonunion subsequent to failed intramedullary nailing.