| Objective:Although a large number of clinical and animal experiment studies have explored many factors that could affect fracture healing,there is a lack of systematic research currently.Fracture nonunion still cannot be completely avoided in the case of excluding these factors,thus there may be other risk factors for fracture nonunion.While looking into a large amount of literature,I found that many studies have not explored the factors from the aspect of laboratory tests.Therefore,on the basis of the above studies and plus blood-related data,the paper is to further explore the risk factors for fracture nonunion by retrospectively analyzing the medical records of patients with fracture nonunion and patients who recovered from fractures and discharged from the hospital.Methods:A total of 729 patients who had undergone concurrent surgical treatment in our hospital from January 2005 to June 2017 due to fracture or nonunion of fractures were retrospectively collected.According to the site of the original fracture,all patients were divided into two groups of four types.The two groups were fracture nonunion group and fracture healing group.The four types were femur,Tibia & Fibula,Humerus and Ulnar & Radius.There were a total of 223 patients with fracture nonunion and 506 patients recovered from fractures.The collected data includes basic demographic information of the two groups of patients(name,gender,age,BMI,smoking and drinking history,etc.);relevant clinical data including whether it is an open fracture,whether it is hyperarticular fixation,whether the last operation was performed functional exercise and the functional exercise time,smoking history,drinking history,whether there is hypertension,diabetes or hepatitis,whether anti-cardiovascular drugs,hypoglycemic agents,anti-osteoporosis drugs or diuretics have been taken,whether there is a history of blood transfusion or drug allergy;Patients' laboratory test parameters were collected,including blood tests(white blood cell count,hemoglobin count,platelet count,neutrophil count and the percentage,monocyte count and the percentage,eosinophil count and the percentage,basophilic cell count and the percentage),blood biochemical tests(alanine aminotransferase,aspartate aminotransferase,conjugated bilirubin,total protein,globulin,alkaline phosphatase,creatinine,urea nitrogen,uric acid,glucose when admitted into the hospital,glycated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein),coagulation function(PT,APTT,fibrinogen),blood type and other indicators.(1)To find out whether there is statistical difference in the appeal index between the fracture nonunion group and the healing group,classify the indicators,and use the multi-factor Logistics regression equation to analyze the relevant risk factors of all types of fracture patients in the event of fracture nonunion.(2)To divide the above patients into four types according to the original fracture site,compare the indicators of the nonunion group and the fracture healing group,and use single logistic regression equation to analyze the related risk factors of fracture nonunion in all types of fracture patients.Results:A total of 729 subjects were enrolled,including 223 patients in the fracture nonunion group and 506 patients in the fracture healing group;253 patients of Femur type(78 in the nonunion group,175 in the fracture healing group)and 274 of tibia & Fibula type(87 in the nonunion group,187 in the fracture healing group),95 of Humerus type(24 in the nonunion group,71 in the fracture healing group),113 of Ulnar & Radiu type(34 in the nonunion group,and 79 in the fracture healing group)The age of bone nonunion group(39.78±14.694)was higher than that of bone healing group(37.02±16.183),the difference was statistically significant(P<0.05);height,weight,BMI,gender,smoking history,drinking history,hypertension history,history of diabetes,history of hepatitis of the healing group and the nonunion group was not statistically significant;The bone nonunion group(34.1%)was higher than that of the bone healing group(11.1%)in the case of open fractures,and the difference was statistically significant(P<0.05);the nonunion group(25.11%)was higher than bone healing group(4.9%)in the setting of hyperarthrosis,and the difference was statistically significant(P <0.05);the nonunion group(30.9%)was higher than the bone healing group(13.2%)in non-premature functional exercise,and the difference was statistically significant(P<0.05);the nonunion group(20.6%)was higher than that in the bone healing group(4.0%)in the aspect whether there is a history of blood transfusion,and the difference was statistically significant(P<0.05);the nonunion group(9.0%)was higher than the bone healing group(3.4%)in the aspect whether there is a history of drug allergy,and the difference was statistically significant(P<0.05).However,the difference between the groups generated by whether antidiuretic drugs were used,whether anti-cardiovascular drugs were used,whether hypoglycemic drugs were used and whether osteoporosis drugs were used has no statistical significance.The result of blood routine tests showed that the neutrophil count in the nonunion group(4.10±1.933)was higher than that in the bone healing group(3.77±3.232),and the difference was statistically significant(P<0.05);the percentage of neutrophils in the nonunion group(63%±12.4%)was higher than bone healing group(60%±10.8%),and the difference was statistically significant(P<0.05);basophilic granulocyte count of bone nonunion group(0.02±0.039)was lower than bone healing group(0.03±0.048),and the difference was statistically significant(P<0.05);but there was no statistical difference in white blood cell count,hemoglobin count,platelet count,monocyte count and the percentage,eosinophil count and the percentage.The result of blood biochemical tests showed that the combined bilirubin of the bone nonunion group(3.51±3.407)was lower than the bone healing group(10.07±8.206),and the difference was statistically significant(P<0.05);the total bilirubin of the bone nonunion group(10.75 ±5.588)was higher than the bone healing group(3.49±3.297),and the difference was statistically significant(P<0.05);the white egg of the nonunion group(43.23±4.217)was lower than the bone healing group(45.04±19.346),and the difference was statistically significant(P<0.05);the globular of the nonunion group(28.17±4.910)was higher than the bone healing group(26.99±4.972),and the difference was statistically significant(P<0.05);while in the aspects of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,creatinine,urea nitrogen,uric acid,admission glucose,glycosylated hemoglobin,total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,the difference was not statistically significant.The results of coagulation function showed that the content of fibrinogen in bone nonunion group(3.04±0.950)was higher than that in bone healing group(2.56±0.698)and the difference has statistical significance(P<0.05);while the aspect of prothrombin,the activation part and thromboplastin time counts in the time of admission,there was no statistically significant difference.Blood type results showed that the difference in bone nonunion group and bone healing group(A type: 29.1% V27.7%;B type 19.3% V26.7%;O type 43.5% V38.5%;AB type 8.1% V7.1%)has no statistical significance.The multivariate logistic regression equation for fracture nonunion was used to analyze the risk of nonunion with conjugated bilirubin>15 group,group 10-15,and group 5-10 was 236.415 times that of that <=5 group(OR=236.415 95% CI: 31.604 1768.514 P=0.00),221.699-fold(OR=221.699 95%CI: 52.803 930.833 P=0.00),35.307-fold(OR=,35.307 95%CI: 20.743 60.096 P=0.00).Total bilirubin>15 groups,10-In group 15 and group 5-10,the risk of nonunion was 0.001 times(<0.001 95% CI: 0.000 0.011 P=0.00)and 0.001 times of that <=5 group(OR=0.001 95% CI: 0.000 0.007 P,respectively)= 0.003,0.033 times(OR = 0.033 95% CI: 0.019 0.057 P = 0.00).The risk of nonunion of triglyceride 1.5-2 was 0.401 times lower than that of the < = 1 group(OR = 0.401 95% CI: 0.176 0.918 P=0.031).The percentage of neutrophils in the 60%-65% and >65% groups were 0.567 times of the risk of nonunion respectively(OR=0.567 95%CI: 0.337 0.954 P=0.033),0.522 times(OR=0.522 95%CI: 0.346 0.787 P=0.002),which has statistical significance.The percentage of Fibrinogen in the and >65% groups were 1.150 times of the risk of nonunion respectively(OR=1.150 95%CI: 1.065 1.349 P=0.000)The two groups of patients were divided into four types using single Logistics regression equation according to the fracture site and the clinical data of the appeal were counted as follows:Femur: the differences in gender,open injury,hyperarticular fixation,postoperative functional advancement,smoking,alcohol consumption,hypertension,anti-cardiovascular drugs,and whether there was a history of blood transfusion(P < 0.05)were statistically significant.In the bone nonunion group,the age,weight,BMI,total bilirubin,creatinine,uric acid,neutrophil and its percentage,and hospitalized fibrin were higher than those in the fracture healing group and the difference was statistically significant(P < 0.05).The levels of conjugated bilirubin,albumin and triglyceride were significantly lower than those in the healing group(P<0.05).Tibia & Fibula: whether there is hyperarticular fixation,open injury,whether to advance functional exercise,whether there is a history of blood transfusion or history of drug allergy(P <0.05)are statistically significant.The total gall bladder,the content of fibrin,globulin,neutrophils,and fibrinogen of the nonunion group in admission were higher than those in fracture healing group(P<0.05)and it's statistically significant.The conjugated bilirubin,albumin were lower than that in fracture healing group and has statistical significance(P<0.05).Humerus: There was a statistically significant difference in whether there is hyperarticular fixation(P<0.05),and the difference in the total bilirubin in the non-union group compared with the fracture healing group was statistically significant(P<0.05),and the combined bilirubin was lower than the fracture healing group and the difference was statistically significant(P<0.05).The statistical results of radius and ulnar bone: There was a statistical difference in whether there was an open injury(P<0.05).In the non-union group,basophils were admitted to total bilirubin and fibrinogen was higher than that in the fracture healing group(P<0.05).In conjugated bilirubin,the mononuclear cell count was lower than that in fracture healing group with statistical significance(P<0.05).Conclusions:There are numerous risk factors for fracture nonunion,such as age,total bilirubin,globulin,neutrophil count and the percentage.Patients with high fibrinogen levels and relatively low conjugated bilirubin,albumin,triglyceride and basic alveolar count in admission should be alert to the occurrence of fracture nonunion. |
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