闭合性胫骨骨折术后骨不连的非手术因素分析

Non Operative Factors of Nonunion after Closed Tibial Fracture Surgery

目的:筛选影响闭合性胫骨骨折术后骨不连的非手术因素,为临床防治提供参考。方法:选取2013年3月-2018年12月就诊于本院胫骨骨折术后骨不连者81例,设为观察组;同期于本院随机选取85例胫骨骨折术后愈合者,设为对照组。收集并分析两组患者的年龄、性别、身体质量指数、骨折分型、软组织分级、烟酒史、基础病(高血压、糖尿病、冠心病)、功能锻炼质量等非手术因素对骨折愈合的影响。结果:单因素分析显示,骨折分型、软组织分级、吸烟史、糖尿病、功能锻炼质量是闭合性胫骨骨折术后骨不连的可疑影响因素(P<0.05),而年龄、身体质量指数、性别、饮酒史、高血压、冠心病尚不能作为闭合性胫骨骨折术后骨不连的影响因素(P>0.05)。多因素分析显示,骨折分型、软组织分级、吸烟史、糖尿病、功能锻炼质量是闭合性胫骨骨折术后骨不连的独立影响因素(P<0.05)。结论:闭合性胫骨骨折术后骨不连的非手术因素中,复杂骨折、软组织损伤重、吸烟、糖尿病是危险因素,功能锻炼质量高是保护因素,临床中需加以重视。

Objective:To screen non operative factors affecting nonunion after closed tibial fracture surgery and provide reference for clinical prevention and treatment.Method:A total of 81 cases of nonunion after tibial fracture surgery in our hospital from March 2013 to December 2018 were selected as the observation group;during the same period,85 cases of tibial fracture healed after operation were randomly selected in our hospital as control group.The effects of non operative factors such as age,sex,body mass index,fracture classification,soft tissue classification,tobacco and alcohol history,basic disease(hypertension,diabetes,coronary heart disease),and the quality of functional exercise on the fracture healing of the two groups were collected and analyzed.Result:Single factor analysis showed that fracture classification,soft tissue classification,smoking history,diabetes,functional exercise quality were suspected factors of nonunion after closed tibial fracture surgery(P<0.05),but age,body mass index,sex,drinking history,hypertension,and cor pulmonale were still not as factors of nonunion after closed tibial fractures surgery(P>0.05).Multivariate analysis showed that fracture typing,soft tissue classification,smoking history,diabetes,and functional exercise quality were independent factors of bone nonunion after closed tibial fracture surgery(P<0.05).Conclusion:In the non operative factors of bone nonunion after closed tibial fracture surgery,complex fracture,heavy injury of soft tissue,smoking and diabetes are the risk factors,the high quality of functional exercise is the protective factor and should be paid attention to in clinical practice.