摘要
目的探讨四肢骨折固定术后发生骨不连的各种原因及比重。方法回顾性分析自2001-01—2011-12符合纳入标准的214例四肢骨折固定术后骨不连患者,统计导致骨不连发生的原因的比重。结果在患者总数中,有全身性因素者占5.6%,有药物性因素者占2.8%,有局部因素者占91.6%;在总因素中,全身因素占4.0%、局部因素占94.0%、药物因素占2.0%;在局部因素中,医源性因素占70.7%,患者自身因素占29.3%。在医源性因素中,未达有效固定占24.5%,忽视断端血运保护占8.0%,忽略植骨占25.5%,未达良好以上复位占17.5%,术后感染占4.0%,缺乏正确康复指导占20.5%。在患者自身因素中,术后活动过早过多占32.5%,损伤严重占43.4%,特殊部位占24.1%。结论四肢骨折固定术后骨不连与多种因素有关,但医源性因素是术后骨不连发生的主要原因;术者应严格选择手术适应证和遵循AO固定技术的基本原则和术后正确康复指导,才能减少术后骨不连的发生。
Objective To explore the causes and its proportion of nonunion after internal fLxation operation for fractures of limbs. Methods Between January 2001 and December 2011, 214 cases of nonunion after internal fixation operation for fractures of limbs were retrospectively analyzed to evaluate the causes of nonunion and its proportion. Results In the total number of patients, systemic factor accounted for 5.6%, pharmaceutical factor 2.8%, local factor 91.6%. In the general factors, local factor accounted for 94%, systemic factor 4%, pharmaceutical factors 2%. In the local factors, iatrogenic factor accounted for 70.7%, patient derived factor 29.3%. In the iatrogenic factors, no reaching effective fixation accounted for 24.5%, ignoring protection of blood supply 8.0%, ignoring bone grafting 25.5%, below the standard of fine reduction of fracture 17.5%, postoperative infection 4%, lacking proper rehabilitation instruction 20.5%. In the patient derived local factors, postoperative excessive activity accounted for 32.5%, serious injury 43.4%, special location 24.1%. Conclusion Many factors may cause nonunion after internal fixation operation for fractures of limbs, but iatrogenic factor is the main factor. Surgeon should strictly select indicated patients and follow the basic principles of AO fixation techniques and give correct postoperative rehabilitation instruction, which will help to reduce the incidence of nonunion.
出处
《中国骨与关节损伤杂志》
2013年第10期938-940,共3页
Chinese Journal of Bone and Joint Injury
基金
无锡市科技计划项目(CSE01N1123)
关键词
四肢骨折
内固定
外固定
骨不连
Fracture of limbs
Internal fixation
External fixation
Nonunion
