CAJ | 학술논문

目的：探讨髓内钉治疗胫骨骨折不良预后的相关因素。方法连续收集2010年10月至2013年4月于我院住院拟行髓内钉治疗的胫骨干骨折患者292例，使用多变量逻辑回归分析研究15个可能与不良预后有关的基线和手术因素。结果不良预后风险的发生与高能量损伤机制（OR＝1．57，95％CI＝1．05～2．35）、不锈钢（与钛钉相比，OR＝1．52；95％CI＝1．10～2．13）、骨折间隙（OR＝2．40；95％CI＝1．47～3．94）和手术后完全负重（OR＝1．63；95％CI＝1．00～2．64）有关。与使用非甾体类抗炎药、早期和后期进行手术或吸烟无关。开放性骨折患者使用钛钉治疗风险更高（ OR＝3．26；95％CI＝2．01～5．28），而使用非扩髓骨钉治疗则无此情况（ OR＝1．50；95％CI＝0．92～2．47）。开放性骨折患者伤口无需额外处理或延期缝合的不良预后发生风险比需要后续更复杂组织重建的患者要低（分别为OR＝0．18，95％CI＝0．09～0．35和OR＝0．29，95％CI＝0．14～0．62）。结论本研究发现了可能增加胫骨干骨折患者发生不良预后风险的几个骨折基线因素和手术特点。外科医生应该考虑这些预测因素来确定高危患者并应给予积极治疗。
목적：탐토수내정치료경골골절불량예후적상관인소。방법련속수집2010년10월지2013년4월우아원주원의행수내정치료적경골간골절환자292례，사용다변량라집회귀분석연구15개가능여불량예후유관적기선화수술인소。결과불량예후풍험적발생여고능량손상궤제（OR＝1．57，95％CI＝1．05～2．35）、불수강（여태정상비，OR＝1．52；95％CI＝1．10～2．13）、골절간극（OR＝2．40；95％CI＝1．47～3．94）화수술후완전부중（OR＝1．63；95％CI＝1．00～2．64）유관。여사용비치체류항염약、조기화후기진행수술혹흡연무관。개방성골절환자사용태정치료풍험경고（ OR＝3．26；95％CI＝2．01～5．28），이사용비확수골정치료칙무차정황（ OR＝1．50；95％CI＝0．92～2．47）。개방성골절환자상구무수액외처리혹연기봉합적불량예후발생풍험비수요후속경복잡조직중건적환자요저（분별위OR＝0．18，95％CI＝0．09～0．35화OR＝0．29，95％CI＝0．14～0．62）。결론본연구발현료가능증가경골간골절환자발생불량예후풍험적궤개골절기선인소화수술특점。외과의생응해고필저사예측인소래학정고위환자병응급여적겁치료。
Objective To.analyses prognostic factors for poor prognosis of intramedullary nailing for tibial fracture.Methods We colleted 292 cases patient of tibial fracture in our hospital from 2010 Oct-2013 Apr.Using multivariable logistic regression analysis, we investigated 15 baseline and surgical factors for any associations with an increased risk of negative outcomes.Results There was an increased risk of negative events in patients with a high-energy mechanism of injury (OR=1.57;95%CI=1.05-2.35), a stainless steel compared with a titanium nail (OR=1.52;95%CI=1.10-2.13), a fracture gap (OR=2.40;95% CI=1.47 -3.94), and full weight-bearing status after surgery (OR=1.63;95%CI=1.00-2.64).There was no increased risk with the use of nonsteroidal anti-inflammatory agents, late or early time to surgery, or smoking status.Open fractures had a higher risk of events among patients treated with reamed nailing ( OR=3.26;95%CI=2.01-5.28) but not in patients treated with unreamed nailing (OR=1.50;95%CI=0.92-2.47).Patients with open fractures who had wound management either without any additional procedures or with delayed primary closure had a decreased risk of events compared with patients who required subsequent, more complex reconstruction (OR=0.18, 95%CI=0.09-0.35, and 0.29, 95%CI=0.14-0.62, respectively).Conclusions The research may provide identified several baseline fracture and surgical characteristics that may increase the risk of adverse events in patients with tibial shaft fractures.Surgeons should consider the predictors identified in our analysis to inform patients treated for tibial shaft fractures.