骨搬移治疗创伤性胫骨慢性骨髓炎并发对合端未愈合的危险因素分析

Analysis of the risk factors of the nonhealing of the docking site in the treatment of traumatic chronic osteomyelitis of the tibia with bone transfer

目的分析骨搬移治疗创伤性胫骨慢性骨髓炎并发对合端未愈合的危险因素。方法选取2017年9月至2019年9月于本院接受治疗的70例创伤性胫骨慢性骨髓炎患者作为研究对象,均给予病灶清除联合骨搬移治疗,采用单因素及Logistic回归系数分析对合端未愈合的危险因素。结果70例患者中,对合端愈合45例,对合端未愈合25例。对合端愈合与对合端未愈合患者性别、文化程度、受伤因素、创伤类型、受伤至骨搬移时间、发病部位、既往手术频次、初次手术固定方式、搬移架类型比较差异无统计学意义;对合端未愈合患者年龄>41~62岁、软组织条件差、骨搬移距离>7 cm、搬移方向由远至近、吸烟占比均高于对合端愈合患者,差异有统计学意义(P<0.05)。年龄>41~62岁、软组织条件差、吸烟、骨搬移距离>7 cm和搬移方向由远至近是骨搬移治疗创伤性胫骨慢性骨髓炎并发对合端未愈合的危险因素(P<0.05)。结论年龄大、吸烟、骨块搬移距离>7 cm、局部软组织条件差和搬移方向由远至近是影响创伤性胫骨慢性骨髓炎并发对合端未愈合的危险因素,临床需针对上述因素给予患者预防性干预措施,以促进对合端愈合。

Objective To analyze the influencing factors of nonhealing of the docking site in the treatment of traumatic chronic osteomyelitis of the tibia with bone transfer.Methods 70 patients with traumatic chronic osteomyelitis of the tibia who received treatment in our hospital from September 2017 to September 2019 were selected as the study subjects,and all of them were treated with focus removal combined with bone transfer treatment,and the risk factors of the nonhealing of the docking site were analyzed by univariate and Logistic regression coefficients were used to analyze.Results Among the 70 patients,45 had docking site healing and 25 had docking site nonhealing.There were no statistically significant differences in gender,educational level,injury factors,trauma type,time from injury to bone transfer,site of onset,frequency of previous surgeries,initial surgical fixation method,and type of transfer frame between patients with docking site healing and docking site nonhealing;aged>41-62 years old,with poor soft tissue conditions,bone movement distance>7 cm,movement direction from far to near,and smoking in patients with docking site nonhealing were all higher than those patients with docking site healing,the differences were statistically significant(P<0.05).Age>41-62 years old,poor soft tissue condition,smoking,bone moving distance>7 cm,and moving direction from far to near were the risk factors of docking site nonhealing in the treatment of traumatic chronic osteomyelitis of the tibial with bone transport(P<0.05).Conclusion Older age,smoking,bone block moving distance>7 cm,poor local soft tissue conditions and moving direction from far to near are the risk factors of nonhealing of the docking site in the treatment of traumatic chronic osteomyelitis of the tibial with bone transport,preventive interventions should be given to patients according to the above factors to promote contralateral healing.