儿童四肢长骨干骨折术后骨折延迟愈合的影响因素分析  

Analysis of factors influencing postoperative delayed fracture healing in children with long stem fractures of the extremities

作　　者：朱豪伟 郭占豪 孙克明 ZHU Haowei;GUO Zhanhao;SUN Keming(Department of Orthopaedics,The Children's Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan450000,China)

机构地区：[1]郑州大学附属儿童医院骨科,河南郑州450000

出　　处：《淮海医药》2024年第3期254-258,共5页Journal of Huaihai Medicine

摘　　要：目的:探讨儿童四肢长骨干骨折术后骨折延迟愈合的影响因素。方法:回顾性分析2021年3月—2022年4月某院手术治疗的120例四肢长骨干骨折患儿的基本资料。根据骨折延迟愈合的诊断标准将患儿分为延迟愈合组(n=26)和正常愈合组(n=94),术后检测血清25-OH-VD和骨代谢指标[甲状旁腺素(PTH)、总1型胶原氨基酸延长肽(PINP)、β-胶原特殊序列(β-CTX)]水平并进行比较,采用骨质疏松症自我效能量表(OSES)评估患儿的锻炼自我效能水平和骨量减少程度。采用单因素和多因素Logistic分析法明确影响四肢长骨干骨折患儿术后延迟愈合的独立因素,绘制ROC曲线分析诊断效能。结果:2组在性别、年龄、体重、居住地、骨折原因、部位、类型、固定方式方面比较差异无统计学意义(P>0.05),但2组在锻炼自我效能是否良好、是否合并骨质疏松、术后血清25-OH-VD、PTH、PINP、β-CTX水平方面比较差异有统计学意义(P<0.05);多因素Logistic回归分析显示,锻炼自我效能是否良好(OR=2.032,95%CI=1.077~3.835)、合并骨质疏松(OR=5.114,95%CI=1.860~14.060)、术后血清25-OH-VD(OR=1.125,95%CI=1.040~1.217)、PTH(OR=1.132,95%CI=1.061~1.208)、PINP(OR=1.215,95%CI=1.027~1.438)、β-CTX(OR=5.966,95%CI=1.598~22.267)水平是四肢长骨干骨折患儿术后延迟愈合的独立影响因素(P均<0.05);经构建风险评估模型ROC曲线显示,以上因素联合检测AUC值为0.991,灵敏度、特异度分别为96.55%、89.65%。结论:四肢长骨干骨折患儿术后血清25-OH-VD、PTH、PINP、β-CTX水平和锻炼自我效能是否良好、是否合并骨质疏松是其术后延迟愈合的独立影响因素。在临床上应对相关因素予以有效控制,施以有针对性的防治措施降低骨折延迟愈合的发生风险。Objective:To explore the influencing factors of postoperative delayed healing of fractures of the long diaphysis of the extremities in children.Methods:Basic data of 120 children with long diaphysis fractures of the extremities admitted to a hospital from March 2021 to April 2022 were retrospectively analysed.The 120 children were divided into a delayed healing group(n=26)and a normal healing group(n=94)according to the diagnostic criteria of delayed fracture healing,and the levels of 25-OH-VD and bone metabolic indexes(PTH,PINP,β-CTX)were detected in the postoperative period and were compared.The basic data of the children were collected(gender,age,weight,place of residence,cause of fracture,site and type,etc.),and the Osteoporosis Self-Efficacy Scale(OSES)and the Osteoporotic Fracture Diagnostic Guidelines were applied to assess the level of exercise self-efficacy and the degree of bone loss in the children.Univariate and logistic regression models were used to identify the independent factors affecting postoperative delayed healing in children with long trunk fractures of the extremities,and the diagnostic efficacy was analysed by plotting ROC curves.Results:There were no statistically significant differences between the two groups in terms of gender,age,weight,place of residence,cause,site and type of fracture(P>0.05),but the differences between the two groups in terms of whether the exercise self-efficacy was good or not,whether there was a combination of osteoporosis or not,postoperative infections,and the levels of serum 25-OH-VD,PTH,PINP,andβ-CTX in postoperative period were statistically significant(P<0.05).Mulitiple factor Logistic regression analysis indicated that exercise self-efficacy(P=0.029,OR=2.032),comorbid osteoporosis(P=0.001,OR=5.114),postoperative infection(P=0.035,OR=1.445),postoperative serum 25-OH-VD(P=0.003,OR=1.125),PTH(P=0.000,OR=1.132),PINP(P=0.023,OR=1.215),andβ-CTX(P=0.008,OR=5.966)levels were independent influencing factors for postoperative delayed healing in children with long

关 键 词：四肢长骨干骨折 儿童 延迟愈合 影响因素 血清25-羟基维生素D 骨代谢 

分 类 号：R683.4[医药卫生—骨科学]