股骨干骨折术后愈合情况及影响因素分析

发布时间：2018-03-17 08:28

本文选题：股骨干骨折　切入点：不愈合　出处：《华北理工大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的通过回顾性分析我院收治并予手术治疗的股骨干骨折患者的临床病例和随访资料,探讨影响股骨干骨折愈合的影响因素,以期为临床治疗提供理论指导和试验依据。方法通过病历查阅、电话和门诊随访筛选自2004年1月至2013年12月我院收治并接受手术治疗的股骨干骨折患者,排除双侧骨折、同侧有既往骨折病史、患有严重的骨代谢疾病、术前曾长期应用糖皮质激素类药物以及随访资料不完整的病例。记录纳入病例的年龄、性别、骨折侧别、骨折类型、骨折分型、合并疾病、手术方式、术后负重时间、骨折愈合情况等指标信息。术后负重时间在12周以后的病例定义为延迟负重。术后8~12个月出现断端骨化、髓腔封闭、假关节形成等不愈合现象,需经二次手术治疗者定义为不愈合病例,对确定为延迟愈合并经二次手术治疗的患者均列入不愈合病例。采用Fisher’s确切概率法分析年龄、性别、骨折侧别、骨折类型、骨折分型、合并疾病、手术方式、术后负重时间等是否为影响骨折愈合的因素,采用多因素logistic回归对以上有统计学意义的因素进行二次分析。以P0.05表示差异具有统计学意义。结果1本组共收集167例股骨干骨折患者,男性145例,女性22例。年龄17-68岁,左侧股骨干骨折98例,右侧股骨干骨折69例。开放性骨折35例,闭合性骨折132例。简单骨折88例,楔形骨折36例,粉碎性骨折43例。髓内钉固定132例,钉板系统固定35例。2骨折愈合情况:在所有成功随访的167病例中,156例患者达到骨折一期愈合,11例发生骨折不愈合,愈合率93.4%,骨折不愈合发生率6.6%。3影响骨折愈合的单因素分析:经卡方检验筛选,骨折类型、骨折分型、术后负重时间三个变量的差异具有统计学意义(P0.05),开放性骨折、粉碎性骨折及延迟负重骨折患者骨折愈合率较低。年龄、性别、骨折侧、复合伤、合并疾病、内固定方式等因素统计结果无统计学意义。4各因素影响骨折愈合的后退逐步logistics回归分析:骨折类型(开放性骨折)、延迟负重对骨折愈合的影响具有统计学意义(P0.05)。在校正了其他因素以后,开放性骨折病例发生不愈合的风险是闭合性骨折病例的3.853倍;延迟负重病例发生不愈合的风险是早期负重病例的4.127倍。粉碎性骨折对骨折愈合的影响无统计学意义(P0.05)。结论开放性骨折及延迟负重是股骨干骨折愈合的不利因素,而粉碎性骨折是否为股骨干骨折愈合的不利因素尚有待进一步研究证实。
[Abstract]:Objective to analyze retrospectively the clinical cases and follow-up data of patients with femoral shaft fracture treated in our hospital, and to explore the influencing factors of femoral shaft fracture healing. Methods patients with femoral shaft fractures treated from January 2004 to December 2013 were selected by telephone and outpatient follow-up, and bilateral fractures were excluded, so as to provide theoretical guidance and experimental basis for clinical treatment. Patients with ipsilateral history of fracture, severe bone metabolism, long term preoperative use of glucocorticoids and incomplete follow-up data were recorded, including age, sex, fracture side, fracture type, fracture type, and type of fracture. Complicated diseases, operative methods, weight bearing time after operation, fracture healing, etc. The cases after 12 weeks of postoperative weight loading were defined as delayed load. 8 ~ 12 months after operation, the ossification of the broken end appeared, and the medullary cavity was closed. Nonunion, such as pseudoarthrosis, was defined as a case of nonunion by secondary surgical treatment. All patients who were identified as delayed union and treated by secondary surgery were included as cases of nonunion. Age and sex were analyzed by Fisher's exact probability method. Whether the fracture side, fracture type, fracture type, complicated disease, operation mode, weight bearing time after operation are the factors affecting fracture healing, Multivariate logistic regression was used to analyze the above factors. The difference was statistically significant with P0.05. Results 1 A total of 167cases of femoral shaft fractures were collected, including 145 males and 22 females, aged 17-68 years. There were 98 cases of left femoral shaft fracture, 69 cases of right femoral shaft fracture, 35 cases of open fracture, 132 cases of closed fracture, 88 cases of simple fracture, 36 cases of wedge-shaped fracture, 43 cases of comminuted fracture, 132 cases of intramedullary nail fixation. Nail plate system fixed the healing of fracture in 35 cases of .2 cases. Among 167 cases of successful follow-up, 156 cases had achieved primary healing of fracture and 11 cases had nonunion. The rate of healing was 93.4, the incidence of nonunion was 6.6.3 the univariate analysis of the influence of fracture healing: through chi-square test screening, fracture type, fracture type, weight bearing time after operation, the differences were statistically significant (P 0.05), open fracture. The fracture healing rate of comminuted fracture and delayed weight-bearing fracture was lower. Age, sex, fracture side, compound injury, complicated disease, Regression analysis of regression stepwise logistics regression analysis of factors affecting fracture healing: open fracture type (open fracture, delayed weight loading) had significant effect on fracture healing (P 0.05). After adjusting for other factors, The risk of nonunion in open fractures was 3.853 times higher than that in closed fractures. The risk of nonunion in delayed weight-bearing cases was 4.127 times higher than that in early weight-bearing cases. The effect of comminuted fractures on fracture healing was not statistically significant (P 0.05). Conclusion Open fracture and delayed weight loading are unfavorable factors for fracture healing of femoral shaft. Whether comminuted fracture is the unfavorable factor of femoral shaft fracture healing needs further study.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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