骨不连的危险因素及风险预警模型研究进展

张伟; 刘昊扬; 唐佩福

doi:10.3969/j.issn.2095-5227.2023.06.022

骨不连的危险因素及风险预警模型研究进展

doi: 10.3969/j.issn.2095-5227.2023.06.022

张伟^1,,
刘昊扬¹,
唐佩福^{2, 3, ,}

1.
北京体育大学体育工程学院，北京　100084
2.
解放军总医院骨科医学部，北京　100048
3.
国家骨科与运动康复临床医学研究中心，北京　100048

基金项目: 科技创新2030-重大项目(2021ZD0140410)

详细信息

作者简介:
张伟，男，博士，副主任医师，运动人体科学博士后。研究方向：创伤骨科，运动人体科学，数字医疗。Email: 2022980001@bsu.edu.cn

通讯作者:
唐佩福，男，博士，主任医师，教授。Email: pftang301@163.com

中图分类号: R687.3
计量
- 文章访问数: 95
- HTML全文浏览量: 35
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-11
- 网络出版日期: 2023-04-17
- 刊出日期: 2023-06-28

Research advances in risk factor and early warning of nonunion

ZHANG Wei^1
,,
LIU Haoyang¹,
TANG Peifu^{2, 3
, ,}

1.
School of Sports Engineering, Beijing Sport University, Beijing 100084, China
2.
Orthopedics Department, Chinese PLA General Hospital, Beijing 100048, China
3.
National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100048, China

More Information

Corresponding author: TANG Peifu. Email: pftang301@163.com

摘要

摘要: 骨不连是骨折最常见的严重并发症之一，发病率为4% ~ 10%，严重影响患者的身体功能和生活质量，并带来沉重的社会负担。对骨不连做出科学合理的临床诊断是构建风险预警机制的基础，其中以时间诊断标准最为重要。研究显示，来源于患者个体情况、外伤和医疗干预的众多暴露因素可以导致骨不连的发生。探索这些危险因素和骨不连发生的内在相关性，开发风险预警模型，是早期识别骨不连的重要手段。
- 骨折 /
- 骨不连 /
- 危险因素 /
- 早期预警 /
- 预测模型
Abstract: Nonunion is one of the most common serious complications of fracture, with an incidence of approximately 4%-10%, which seriously affects patients' function, quality of life, and brings heavy social burden. Scientific and reasonable clinical diagnosis of nonunion is the basis for building the risk stratification and early warning mechanism, in which time diagnostic criteria are particularly important. Numerous exposure factors derived from the individual patient's circumstances, trauma, and medical interventions have been shown to contribute to the development of nonunion. Exploring these risk factors and the intrinsic correlation of nonunion, and developing a prediction model, are important means of early identification of nonunion.
- fracture /
- nonunion /
- risk factor /
- early warning /
- prediction model

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参考文献(50)

[1]	Zura R,Xiong Z,Einhorn T,et al. Epidemiology of fracture nonunion in 18 human bones[J]. JAMA Surg,2016,151(11): e162775. doi: 10.1001/jamasurg.2016.2775
[2]	Padilla-Eguiluz NG,Gómez-Barrena E. Epidemiology of long bone non-unions in Spain[J]. Injury,2021,52(Suppl 4): S3-S7.
[3]	Marti RK, Kloen P. Navicular nonunion［M］//Concepts and Cases in Nonunion Treatment. Stuttgart: Georg Thieme Verlag, 2011.
[4]	Brinker MR,Trivedi A,OʼConnor DP. Debilitating effects of femoral nonunion on health-related quality of life[J]. J Orthop Trauma,2017,31(2): e37-e42. doi: 10.1097/BOT.0000000000000736
[5]	Brinker MR,Hanus BD,Sen ML,et al. The devastating effects of tibial nonunion on health-related quality of life[J]. J Bone Joint Surg Am,2013,95(24): 2170-2176. doi: 10.2106/JBJS.L.00803
[6]	Tay WH,de Steiger R,Richardson M,et al. Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures[J]. Injury,2014,45(10): 1653-1658. doi: 10.1016/j.injury.2014.06.025
[7]	Ekegren CL,Edwards ER,de Steiger R,et al. Incidence,costs and predictors of non-union,delayed union and mal-union following long bone fracture[J]. Int J Environ Res Public Health,2018,15(12): 2845. doi: 10.3390/ijerph15122845
[8]	Kanakaris NK,Giannoudis PV. The health economics of the treatment of long-bone non-unions[J]. Injury,2007,38(Suppl 2): S77-S84.
[9]	Antonova E,Le TK,Burge R,et al. Tibia shaft fractures:costly burden of nonunions[J]. BMC Musculoskelet Disord,2013,14: 42. doi: 10.1186/1471-2474-14-42
[10]	Li M,Meng YT,Li Y,et al. Multidirectional percutaneous drilling and autologous bone marrow injection for the treatment of femoral diaphyseal nonunions:a prospective interventional study[J]. Ther Clin Risk Manag,2019,15: 1003-1011. doi: 10.2147/TCRM.S209393
[11]	Willems A,van der Jagt OP,Meuffels DE. Extracorporeal shock wave treatment for delayed union and nonunion fractures:a systematic review[J]. J Orthop Trauma,2019,33(2): 97-103. doi: 10.1097/BOT.0000000000001361
[12]	Wildemann B,Ignatius A,Leung F,et al. Non-union bone fractures[J]. Nat Rev Dis Primers,2021,7(1): 57. doi: 10.1038/s41572-021-00289-8
[13]	Buckley RE, Moran CG, Apivatthakakul T. 骨折治疗的AO原则［M］. 危杰, 刘璠, 吴新宝, 等译. 3版. 上海: 上海科学技术出版社, 2019: 471-544.
[14]	Ricci WM. Principles of Nonunion and Bone Defect Treatment［M］//Tornetta III P, Ricci WM, Ostrum RF, et al. Rockwood and Green's Fractures in Adults. 9th Ed. Philadelphia: Wolters Kluwer, 2019: 2140-2262.
[15]	Goudie EB,Robinson CM. Prediction of nonunion after nonoperative treatment of a proximal humeral fracture[J]. J Bone Joint Surg Am,2021,103(8): 668-680. doi: 10.2106/JBJS.20.01139
[16]	Nicholson JA,Clement ND,Clelland AD,et al. Displaced midshaft clavicle fracture union can be accurately predicted with a delayed assessment at 6 weeks following injury:a prospective cohort study[J]. J Bone Joint Surg Am,2020,102(7): 557-566. doi: 10.2106/JBJS.19.00955
[17]	Brinker MR, O’Connor DP. Nonunion: evaluation and treatment［M］//Browner BD, Jupiter JB, Kretteck C, et al. Skeletal trauma: basic science, management, and reconstruction. 6th Ed. Philadelphia: W. B. Saunders, 2020: 743–834.
[18]	Tang PF, Chen H. Orthopaedic Trauma Surgery, Volume 3: Axial Skeleton Fractures and Nonunion［M］. Singapore: Springer Singapore, 2022.
[19]	Zura R,Braid-Forbes MJ,Jeray K,et al. Bone fracture nonunion rate decreases with increasing age:a prospective inception cohort study[J]. Bone,2017,95: 26-32. doi: 10.1016/j.bone.2016.11.006
[20]	Mills LA,Simpson AH. The relative incidence of fracture non-union in the Scottish population (5.17 million):a 5-year epidemiological study[J]. BMJ Open,2013,3(2): e002276. doi: 10.1136/bmjopen-2012-002276
[21]	雷明星,张里程,林峰,等. 骨不连风险因素的最新研究进展[J]. 中国骨与关节杂志,2018,7(7): 514-518. doi: 10.3969/j.issn.2095-252X.2018.07.009
[22]	Rodriguez EK,Boulton C,Weaver MJ,et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating:a retrospective multicenter case-control study of 283 fractures[J]. Injury,2014,45(3): 554-559. doi: 10.1016/j.injury.2013.10.042
[23]	Nicholson JA,Makaram N,Simpson A,et al. Fracture nonunion in long bones:a literature review of risk factors and surgical management[J]. Injury,2021,52(Suppl 2): S3-S11.
[24]	Butler AJ,Eismont FJ. Effects of anticoagulant medication on bone-healing[J]. JBJS Rev,2021,9(5): e20.00194. doi: 10.2106/JBJS.RVW.20.00194
[25]	George MD,Baker JF,Leonard CE,et al. Risk of nonunion with nonselective NSAIDs,COX-2 inhibitors,and opioids[J]. J Bone Joint Surg Am,2020,102(14): 1230-1238. doi: 10.2106/JBJS.19.01415
[26]	全宸良,娄盛涵,刘勃,等. 股骨骨折术后骨不连相关危险因素分析[J]. 解放军医学院学报,2017,38(5): 430-432. doi: 10.3969/j.issn.2095-5227.2017.05.012
[27]	Toogood P,Miclau T. Critical-sized bone defects:sequence and planning[J]. J Orthop Trauma,2017,31(Suppl 5): S23-S26.
[28]	O'Halloran K,Coale M,Costales T,et al. Will my tibial fracture heal?predicting nonunion at the time of definitive fixation based on commonly available variables[J]. Clin Orthop Relat Res,2016,474(6): 1385-1395. doi: 10.1007/s11999-016-4821-4
[29]	张伟,陈华,李建涛,等. 股骨近端三角形结构力学重建治疗股骨转子间骨折术后失败的疗效[J]. 中华创伤杂志,2021,37(4): 339-346. doi: 10.3760/cma.j.cn501098-20201030-00655
[30]	张伟,朱正国,常祖豪,等. 经股直肌旁入路治疗股骨干无菌性骨不连的临床疗效[J]. 解放军医学院学报,2018,39(1): 31-35. doi: 10.3969/j.issn.2095-5227.2018.01.009
[31]	Manon J,Detrembleur C,van de Veyver S,et al. Predictors of mechanical complications after intramedullary nailing of tibial fractures[J]. Orthop Traumatol Surg Res,2019,105(3): 523-527. doi: 10.1016/j.otsr.2019.01.015
[32]	张伟,陈华,刘浩,等. 无菌性和感染性股骨骨不连患者的临床对照研究[J]. 中华骨与关节外科杂志,2018,11(2): 118-123. doi: 10.3969/j.issn.2095-9958.2018.02.008
[33]	Taitsman LA,Lynch JR,Agel J,et al. Risk factors for femoral nonunion after femoral shaft fracture[J]. J Trauma,2009,67(6): 1389-1392.
[34]	Qvist AH,Væsel MT,Jensen CM,et al. Minimal pain decrease between 2 and 4 weeks after nonoperative management of a displaced midshaft clavicle fracture is associated with a high risk of symptomatic nonunion[J]. Clin Orthop Relat Res,2021,479(1): 129-138. doi: 10.1097/CORR.0000000000001411
[35]	Santolini E,West RM,Giannoudis PV. Leeds-Genoa Non-Union Index:a clinical tool for asessing the need for early intervention after long bone fracture fixation[J]. Int Orthop,2020,44(1): 161-172. doi: 10.1007/s00264-019-04376-0
[36]	Massari L, Benazzo F, Falez F, et al. Can clinical and surgical parameters be combined to predict how long it will take a Tibia fracture to heal?A prospective multicentre observational study: the FRACTING study［J/OL］. https://doi.org/10.1155/2018/1809091.
[37]	Jang Y,Gaski G,Natoli R,et al. Tibial fracture healing score:a novel tool to predict tibial nonunion[J]. Orthopedics,2020,43(4): e323-e328.
[38]	Collins GS,Reitsma JB,Altman DG,et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD):the TRIPOD Statement[J]. Br J Surg,2015,102(3): 148-158. doi: 10.1002/bjs.9736
[39]	Moons KGM,Wolff RF,Riley RD,et al. PROBAST:a tool to assess risk of bias and applicability of prediction model studies:explanation and elaboration[J]. Ann Intern Med,2019,170(1): W1-W33. doi: 10.7326/M18-1377
[40]	O'Hara NN,Slobogean GP,O'Halloran K,et al. Predicting tibia shaft nonunions at initial fixation:an external validation of the Nonunion Risk Determination (NURD) score in the SPRINT trial data[J]. Injury,2020,51(10): 2302-2308. doi: 10.1016/j.injury.2020.06.050
[41]	Chloros GD,Kanakaris NK,Vun JSH,et al. Scoring systems for early prediction of tibial fracture non-union:an update[J]. Int Orthop,2021,45(8): 2081-2091. doi: 10.1007/s00264-021-05088-0
[42]	Wiss DA,Garlich JM. Healing the index humeral shaft nonunion:risk factors for development of a recalcitrant nonunion in 125 patients[J]. J Bone Joint Surg Am,2020,102(5): 375-380. doi: 10.2106/JBJS.19.01115
[43]	Wiss DA,Garlich J,Hashmi S,et al. Risk factors for development of a recalcitrant femoral nonunion:a single surgeon experience in 122 patients[J]. J Orthop Trauma,2021,35(12): 619-625. doi: 10.1097/BOT.0000000000002276
[44]	Wiss DA,Garlich J,Sherman R. Healing the index tibial nonunion:risk factors for development of a recalcitrant nonunion in 222 patients[J]. J Orthop Trauma,2021,35(9): e316-e321. doi: 10.1097/BOT.0000000000002060
[45]	Zhang JY,Tornetta P 3rd,Dale KM,et al. The fate of patients after a staged nonunion procedure for known infection[J]. J Orthop Trauma,2021,35(4): 211-216. doi: 10.1097/BOT.0000000000001953
[46]	Arsoy D,Donders JCE,Kleeblad LJ,et al. Outcomes of presumed aseptic long-bone nonunions with positive intraoperative cultures through a single-stage surgical protocol[J]. J Orthop Trauma,2018,32(Suppl 1): S35-S39.
[47]	Konda SR,Carlock KD,Hildebrandt KR,et al. Predicting functional outcomes following fracture nonunion repair-development and validation of a risk profiling tool[J]. J Orthop Trauma,2020,34(6): e214-e220. doi: 10.1097/BOT.0000000000001718
[48]	Topol EJ. High-performance medicine:the convergence of human and artificial intelligence[J]. Nat Med,2019,25(1): 44-56. doi: 10.1038/s41591-018-0300-7
[49]	Myers TG,Ramkumar PN,Ricciardi BF,et al. Artificial intelligence and orthopaedics:an introduction for clinicians[J]. J Bone Joint Surg Am,2020,102(9): 830-840. doi: 10.2106/JBJS.19.01128
[50]	Loftus TJ,Tighe PJ,Filiberto AC,et al. Artificial intelligence and surgical decision-making[J]. JAMA Surg,2020,155(2): 148-158. doi: 10.1001/jamasurg.2019.4917