To Explore The Correlation Between Nonunion And TCM Constitution Based On The Concept Of "Prevention Of Disease"

Objective:To investigate the case characteristics and Traditional Chinese medicine(TCM)constitutions of patients with nonunion,and further explore the risk factors of nonunion and its correlation with TCM constitution.To explore the therapeutic idea of using TCM in predisposed constitution to avoid the occurrence of nonunion in advance according to the results of the study.In order to provide a theoretical basis for the prevention of bone nonunion by traditional Chinese medicine to " prevention the disease".Methods:Patients with nonunion who met the inclusion criteria and visited the orthopedic outpatient clinic and ward of the Affiliated Hospital of Shandong University of Chinese Medicine from September 2020 to September 2022 were selected,and patients with fracture healing with the same sample size were selected as the control group.The database was established by collecting patients’ general information(gender,age,BMI,co-diabetes/hypertension,smoking/alcohol consumption,opioid/NSAIDs use,co-infection,etc.),combined with questionnaire survey to collect and determine the classification of TCM constitution.SPSS26.0 statistical software was used for data processing,and the differences between the nonunion group and the fracture healing group were compared.The distribution rules of TCM constitution and patients’ risk factors were statistically analyzed,and the correlation between the two was explored.Results:1.In this study,there were 167 cases of nonunion,with differences in the gender distribution,with 116 males and 51 females,and significantly more male patients than females.The age of nonunion ranged 20 to 78 years,with the highest proportion in middle age,followed by young age,and the lowest proportion in old age.There were significantly more males than females in the young and middle-aged patients,and no significant difference in the proportion of males and females in the elderly patients.2.The distribution of the affected limbs in the nonunion group was most common in the femur with 61 cases(36.53%)and the tibia with 47 cases(28.14%),followed by the ulnar radius,humerus,clavicle,hand and wrist,foot and ankle.3.In this study,the proportion of TCM constitutional types distributed among the patients with nonunion were in the following order: Phlegm-dampness constitution(31.14%),Yang-deficiency constitution(25.15%),Ping-he constitution(24.55%),Qi-deficiency constitution(15.57%),Yin-deficiency constitution(15.57%),Damp-heat constitution(13.77%),Qi-stagnation constitution(7.78%),Blood-stasis constitution(5.39%)and Inherited-special constitution(4.19%).There was a difference in the distribution of TCM constitutional types in the nonunion group compared to the fracture healing group.4.Overweight or obesity(BMI≥24),diabetes,smoking and TCM constitutional type were correlated with the nonunion(P<0.05),while multifactorial logistic regression analysis showed that BMI≥24(P=0.008,OR=1.903),diabetes(P=0.036,OR=2.672),Phlegm-dampness(P=0.001,OR=3.099)and Yang-deficiency(P=0.009,OR=2.424)as independent risk factors for the development of bone nonunion.5.In this study,the TCM constitutional types of patients with nonunion were correlated with gender.Among the biased constitutions,Phlegm-dampness constitution,Yang-deficiency constitution and Damp-heat constitution were predominant in male patients,and Yang-deficiency constitution,Qi-deficiency constitution and Yin-deficiency constitution were predominant in female patients.There was no significant correlation between TCM constitutional type and age,BMI,diabetes and nonunion type.Conclusion:This study found that there were significantly more males than females with nonunion.The age of the patients was highest in middle age,followed by youth and lowest in old age.The distribution of affected limbs was most common in the femur and tibia.The highest proportion of atrophic discontinuity was found in the type of nonunion.Distribution of TCM constitution: the proportion of patients with nonunion with unbalanced constitution is significantly higher than that of patients with fracture healing,among which the proportion of Phlegm-damp constitution and Yang-deficiency constitution is the highest.Risk factors for the development of nonunion: overweight or obesity,diabetes,smoking and partial TCM constitutional types are associated with the development of osteogenesis,and overweight or obesity,diabetes mellitus,Phlegm-dampness constitution and Yang-deficiency constitution are independent risk factors for the development of osteogenesis.Gender and age were not included in the risk factor analysis in this study.Correlation between nonunion and TCM constitution: Phlegm-dampness constitution,Yang-deficiency constitution and Damp-heat constitution were predominant in male patients,and Yang-deficiency constitution,Qi-deficiency constitution and Yin-deficiency constitution were predominant in female patients.No significant correlation was found between other risk factors and TCM constitutional type.TCM constitutional type can be an important factor in the risk assessment of nonunion and the prevention and treatment of nonunion based on the concept of "prevention of disease" has a sound theoretical basis and wide application prospects.