股骨干骨折后戒烟能减少骨不连

目的了解长期吸烟的股骨干骨折患者戒烟与否与发生骨不连之间的联系。 方法回顾性分析近2年在上海市奉贤区中心医院就诊的股骨干骨折患者病例资料。纳入标准为采用髓内钉治疗的男性单侧股骨干骨折、吸烟者的吸烟史≥5年；排除标准为开放性骨折、长期卧床、严重骨质疏松症、合并其他部位骨折、感染性骨不连。根据患者吸烟、戒烟情况，将受伤前无吸烟史的患者纳入为非吸烟组、受伤后戒烟的患者纳入为戒烟组、受伤后未戒烟的患者纳入为未戒烟组。记录3组患者达到骨折临床愈合的时间，进行卡方检验，了解3组患者骨不连发生情况的差异；并对骨折达到临床愈合的中位时间用Kaplan-Meier法进行预估及比较。 结果非吸烟组有12.5%(4例)、戒烟组有20.4%(11例)、未戒烟组有52.9%(9例)出现骨不连，差异具有统计学意义(χ²＝10.705，P<0.05)，成对比较提示未戒烟组的骨不连发生情况明显高于非吸烟组(χ²＝9.315，P<0.0167)、及戒烟组(χ²＝6.779，P<0.0167)。3组患者骨折达到骨折临床愈合的中位时间估计值分别为15.1周95%置信区间(14.9，15.3)周]、22.0周95%置信区间(21.7，22.4)周]和51.1周，3组患者达到骨折临床愈合时间的差异有统计学意义(P <0.05)。 结论长期吸烟的股骨干骨折患者伤后及时戒烟能减少骨不连发生，但骨折临床愈合时间比未吸烟患者稍有延长。

Smoking cessation after fracture of femoral shaft can reduce nonunion

Objective To explore the relationship between smoking cessation and nonunion in femoral shaft fracture patients with long-term smoking. Methods Retrospective analysis of patients with femoral shaft fractures treated or reviewed in People’ s Hospital of Fenxian District in Shanghai from 2016 to2017. Inclusion criteria: unilateral femoral shaft fractures treated with intramedullary nails,smoking history≥5 years;exclusion criteria: open fractures,long-term bedridden,severe osteoporosis,fractures with other parts,infectious nonunion. According to whether the patient smoked before injury or quit smoking after injury,the patients who had no smoking history before injury were included in the non-smoking group,the patients who successfully quit smoking after injury were included in the smoking cessation group,and patients who did not quit smoking after injury were included in the non-quit smoking group. The time to achieve clinical healing of fractures was recorded in the three groups. Chi-square test was used to identify the differences in the incidence of nonunion in the three groups of patients. The Kaplan-Meier method was used to estimate and compare the median time to clinical healing of fractures. Results Bone nonunion occurred in12. 5%( four cases) of the non-smoking group,20. 4%( 11 cases) of the smoking cessation group,and52. 9%( nine cases) of the non-quit smoking group,the difference was statistically significant( χ^2=10. 705,P < 0. 05). Pairwise comparison showed that the incidence of nonunion in the non-quit smoking group was significantly higher than in the non-smoking group( χ^2= 9. 315,P < 0. 0167) and the smoking cessation group( χ^2= 6. 779,P < 0. 0167). The median time to fracture healing in the three groups was estimated to be 15. 1 weeks 95% confidence interval( CI)( 14. 9,15. 3) weeks],22. 0 weeks 95% CI( 21. 7,22. 4) weeks],and 51. 1 weeks. There were differences in the timing of fracture healing among the three groups of patients( P < 0. 05). Conclusion Long-term smoking of patients with femoral shaft fractures who can quit smoking in time after injury will reduce the incidence of nonunion,but the clinical healing time of fractures is slightly longer than that of non-smokers.