影响缺损型骨不连愈合的危险及保护因素的Meta分析  

A Meta analysis of risk factors affecting the healing of defective bony nonunion

作　　者：陈敬地 伍威[3] 咸春星 王陶然 高嘉锴 毕龙 Chen Jingdi;Wu Wei;Xian Chunxing;Wang Taoran;Gao Jiakai;Bi Long(Department of Orthopedics,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Department of Orthopedics,95829 Military Hospital of PLA,Wuhan 430000,China;Department of Critical Care Medicine,Renmin Hospital Affiliated to Wuhan University,Wuhan 430000,China)

机构地区：[1]空军军医大学西京医院骨科,西安710032 [2]中国人民解放军95829部队医院骨科,武汉430000 [3]武汉大学人民医院重症医学科,武汉430000

出　　处：《中华创伤骨科杂志》2024年第10期899-904,共6页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(81672189)

摘　　要：目的分析影响缺损型骨不连愈合的危险及保护因素。方法计算机检索维普论文检索系统、万方数据知识服务平台、中国知网、Web of Science、PubMed、Medline等数据库从2000年1月至2022年3月发表的影响缺损型骨不连愈合的相关文献, 采用Newcastle-Ottawa Scale(NOS)量表对纳入文献进行质量评价, 利用RevMan 5.3软件对影响缺损型骨不连愈合的一般因素、创伤及手术相关因素进行Meta分析。结果共纳入17篇文献1 236例患者, 文献NOS量表评分为5~8分。Meta分析结果显示:年龄(MD=-4.27, 95%CI: -8.29~2.91,P<0.01)、吸烟(OR=3.56, 95%CI: 2.81~6.32,P<0.01)、软组织缺损(OR=3.54, 95%CI: 2.21~5.69,P<0.01)、合并同侧腓骨骨折(OR=4.18, 95%CI: 1.24~14.03,P=0.02)、静脉血栓形成(OR=4.27, 95%CI: 1.05~17.44,P=0.04)、术后感染(OR=2.96, 95%CI: 1.97~4.47,P<0.01)是缺损型骨不连愈合的危险因素;缺损较小(SMD=-0.67, 95%CI: -1.25~-0.10,P=0.02)、由近向远骨搬运(OR=-0.42, 95%CI: 0.22~0.77,P<0.01)、外固定支架固定时间短(MD=-3.92, 95%CI: -7.10~-0.73,P=0.02)、使用自体骨移植(OR=0.39, 95%CI: 0.16~0.95,P=0.04)是影响缺损型骨不连愈合的保护因素。结论年龄(老年)、吸烟、软组织缺损、合并同侧腓骨骨折、静脉血栓形成、术后感染是缺损型骨不连愈合的危险因素, 骨缺损范围较小、由近向远骨搬运、外固定支架固定时间较短、使用自体骨移植是影响缺损型骨不连愈合的保护因素, 医生可根据以上因素早期预判缺损型骨不连患者的预后。Objective To identify the risk factors affecting the healing of defective bony nonunion.Methods The studies reporting the risk factors for healing of defective bony nonunion between January 2000 and March 2022 were retrieved by computer from the VIP,Wanfangdata,CNKI,Web of Science,PubMed,and Medline databases.The Newcastle-Ottawa Scale(NOS)was used to evaluate the quality of the included studies.the RevMan 5.3 software was used to perform a meta-analysis of the general factors,injuries and surgical-related factors affecting the healing of defective bony nonunion.Results Included in this Meta analysis were 17 studies with 1,236 patients.The NOS score of the included studies was from 5 to 8.The meta-analysis showed the following:age(MD=-4.27,95%CI:-8.29 to 2.91,P<0.01),smoking(OR=3.56,95%CI:2.81 to 6.32,P<0.01),soft tissue defect(OR=3.54,95%CI:2.21 to 5.69,P<0.01),combined ipsilateral fibular fracture(OR=4.18,95%CI:1.24 to 14.03,P=0.02),venous thrombosis(OR=4.27,95%CI:1.05 to 17.44,P=0.04),and postoperative infection(OR=2.96,95%CI:1.97 to 4.47,P<0.01)were significant risk factors for the healing of defective bone nonunion.Minor bone defect(SMD=-0.67,95%CI:-1.25 to-0.10,P=0.02),proximal to distal bone transport(OR=-0.42,95%CI:0.22 to 0.77,P<0.01),short-term external fixation(MD=-3.92,95%CI:-7.10 to-0.73,P=0.02),and autologous bone grafting(OR=0.39,95%CI:0.16 to 0.95,P=0.04)were protective factors for the healing of defective bony nonunion.Conclusions High age(senility),smoking,soft tissue defect,ipsilateral fibular fracture,venous thrombosis,and postoperative infection are risk factors affecting the healing of defective bony nonunion.Minor bone defect,proximal to distal bone transport,short-term external fixation,and autologous bone grafting are protective factors affecting the healing of defective bony nonunion.Surgeons can predict early the prognosis of patients with defective bony nonunion based on the above factors.

关 键 词：骨折 不愈合 危险因素 META分析 骨缺损 

分 类 号：R687.3[医药卫生—骨科学] R683[医药卫生—外科学]