| 自体骨移植治疗四肢骨折术后骨不连失败因素分析 |
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Received:July 17, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 李凯 |
LI Kai |
浙江大学附属第二医院骨科, 浙江 杭州 310009
嘉兴学院第二附属医院骨科, 浙江 嘉兴 314000 |
Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China |
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| 叶招明 |
YE Zhao-ming |
浙江大学附属第二医院骨科, 浙江 杭州 310009 |
Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, Zhejiang, China |
yezhaomingzd@gmail.com |
| 张中伟 |
ZHANG Zhong-wei |
嘉兴学院第二附属医院骨科, 浙江 嘉兴 314000 |
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| 季康 |
JI Kang |
嘉兴学院第二附属医院骨科, 浙江 嘉兴 314000 |
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| 期刊信息：《中国骨伤》2013年26卷，第4期，第272-276页 |
| DOI：10.3969/j.issn.1003-0034.2013.04.003 |
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目的: 探讨四肢骨折骨不连经植骨治疗后未达到骨愈合的原因, 了解主要影响疗效的因素, 为提高骨不连的治疗效果提供依据。
方法: 1995年1月至2011年12月收集四肢骨折术后骨不连接受自体骨移植手术治疗患者367例, 其中男198例, 女169例;年龄12～89岁, 平均53.5岁;病程23～49个月。植骨治疗后摄X线片及CT扫描评估治疗效果, 骨折仍未愈合的32例, 其余的均后期骨愈合入院行内外固定拆除手术。通过Logistic回归分析考察年龄、性别、是否吸烟、营养状况、原发骨折类型、骨折的部位、骨不连的类型、是否更换固定方式、手术固定的类型、患者是否有影响骨折愈合的内外科疾病等因素对于患者植骨治疗成功率的影响。
结果: 纳入统计的患者为后期有再次入院记录(获得随访).手术植骨治疗后随访6～12个月, 失败率为8.72%.通过统计学分析吸烟与否、原发骨折类型、骨不连的类型、是否更换固定方式、原发内外科疾病等因素与植骨治疗后期愈合率有明确的相关。
结论: 吸烟、原发骨折类型、骨不连的类型、是否更换固定、原发疾病这些因素影响自体骨移植治疗骨不连疗效。在骨不连植骨治疗中应建议患者戒烟, 同时治疗相关疾病。手术前分析原骨折及骨不连的情况并积极的治疗感染, 制定更完善的手术方案, 以及手术中尽可能更换固定方式均可以降低植骨治疗的失败风险。 |
| [关键词]:四肢 骨折 不愈合 移植 自体 骨移植 |
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| Factor analysis of the failed treatment for limb fracture nonunion after autologous bone transplantation |
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Abstract:
Objective: To investigate the cause of failure after autogenous bone graft with limb fracture nonunion,to explore the major influencing factor of the treatment,and to research the evidence for improving the treatment of nonunion.
Methods: A retrospective analysis was done with 367 cases suffering from autogenous bone graft surgery after limb fracture nonunion between January 1995 to December 2011. Among them,there were 198 males and 169 females aged 12 to 89 years (means 53.5 years) with duration of 23 to 49 months. The treatment effect assessed with X-ray and CT after grafting in the treatment,and 32 cases were detected nonunion again,and others' fixations were dismantled by operation after fracture healing. The following correlation including factorsages,gender,smoking,nutritional status during therapy,classification of primary fracture,location of fracture,type of nonunion,changing the type of fixation,type of fixation and complicating disease were evaluated by Logistic stepwise regression to discover the influencing factors of the failure of union.
Results: The treatment failure rate was 8.72% in the patients with surgery and graft included in the statistics for the late re-admitted in 6 to 12 months followed-up. Smoking,classification of primary fracture,type of nonunion,changing the type of fixation,complicating disease had influence to incidence rate of union after autogenous bone graft.
Conclusion: Autogenous bone graft is the utility method for limb fracture nonunion. Smoking,classification of primary fracture,classification of nonunion,changing the type of fixation,complicating disease are the risk factors of nonunion after graft. Patients should be advised to stop smoking in the nonunion bone graft. And at the same time,the treatment of related diseases,analysis of the original fracture and nonunion,aggressive treatment of infection,and developing better surgical solutions before surgery,as well as changing the fixation methods can reduce the risk of failure of the graft. |
| KEYWORDS:Extremities Fractures,ununited Transplantation,autologous Bone transplantation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李凯,叶招明,张中伟,季康.自体骨移植治疗四肢骨折术后骨不连失败因素分析[J].中国骨伤,2013,26(4):272~276 |
| 英文格式: | LI Kai,YE Zhao-ming,ZHANG Zhong-wei,JI Kang.Factor analysis of the failed treatment for limb fracture nonunion after autologous bone transplantation[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(4):272~276 |
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