儿童前臂骨干骨折弹性髓内钉固定术后再骨折危险因素分析  

Assessment of Risk Factors for Refracture of Pediatric Forearm Diaphysis Following Elastic Stable Intramedullary Nailing Treatment

作　　者：高志鹏 路真 郭海滨 杨港 Gao Zhipeng;Lu Zhen;Guo Haibin;Yang Gang(Department of Orthopaedics,Changzhou Children’s Hospital,Nantong University,Changzhou 213018,China)

机构地区：[1]南通大学附属常州儿童医院骨科,江苏常州213018

出　　处：《实用骨科杂志》2024年第9期788-792,共5页Journal of Practical Orthopaedics

基　　金：常州市卫健委科技项目(青年项目)(QN202333)。

摘　　要：目的探讨弹性髓内钉(elastic stable intramedullary nail,ESIN)治疗儿童前臂骨干骨折后再骨折的危险因素,以期提高儿童前臂骨干骨折的治疗效果。方法回顾性分析2015年1月至2022年12月南通大学附属常州儿童医院经ESIN治疗的127例前臂骨干骨折患者资料,根据术后是否发生再骨折分为再骨折组和非再骨折组。再骨折组10例,男9例,女1例;年龄5~14岁,平均(8.35±2.65)岁。非再骨折组117例,男66例,女51例;年龄5~12岁,平均(9.58±2.43)岁。比较两组患者年龄、性别、身体质量指数、伤侧、石膏拆除时间、血液25羟-维生素D含量、骨折部位、骨折数量、骨折类型及内固定移除时间。通过Logistic回归模型进行多因素分析,分析儿童前臂骨干再骨折的危险因素。结果患者术后随访7~40个月,平均(11.26±3.93)个月。单因素分析显示:两组患者性别、骨折部位和内固定移除时间比较差异有统计学差异(P<0.05)。Logistic回归模型显示:内固定移除时间短于6个月(P=0.032,OR=10.846)及中段1/3骨折(P=0.013,OR=15.374)是前臂骨干再骨折的独立危险因素。结论ESIN治疗儿童前臂骨干骨折后再骨折较少见,中段1/3骨折及内固定移除时间短于6个月患者需警惕再骨折。Objective To investigate the risk factors for refracture in children undergoing elastic stable intramedullary nailing(ESIN)for forearm diaphysis fractures,aiming to enhance the therapeutic efficacy of this treatment.Methods We conducted a retrospective analysis of clinical data from 127 patients with forearm diaphysis fractures treated with ESIN at Changzhou Children’s Hospital affiliated to Nantong University between January 2015 and December 2022.The patients were divided into two groups based on the occurrence of postoperative refracture:the refracture group(n=10)and the non-refracture group(n=117).The refracture group consisted of 9 males and 1 female,with a mean age of(8.35±2.65)years(range:5~14 years),while the non-refracture group included 66 males and 51 females,with a mean age of(9.58±2.43)years(range:5~12 years).Variables such as age,gender,body mass index(BMI),injured side,immobilization time,blood 25(OH)D levels,fracture location,number of fractures,fracture classification,and ESIN retention time were compared between the two groups.Logistic regression analysis was used to identify potential risk factors for pediatric forearm refracture.Results The patients were followed up for 7~40 months,with an average of(11.26±3.93)months.Univariate analysis revealed significant associations between gender,fracture location,and ESIN retention time with refracture(P<0.05).Multivariate Logistic regression analysis further confirmed that ESIN retention time less than 6 months(P=0.032,OR=10.846)and middle third fracture location(P=0.013,OR=15.374)were independent risk factors for forearm diaphysis refracture.Conclusion Refracture after ESIN for forearm diaphysis fractures in children is uncommon.Clinicians should be vigilant about cases with middle third fracture location and ESIN retention time less than 6 months,as these factors pose an increased risk of refracture.

关 键 词：再骨折 前臂 儿童 弹性髓内钉 

分 类 号：R683.41[医药卫生—骨科学]