目的：对比高原地区与沿海地区股骨粗隆间骨折患者的骨折愈合时间，探讨高原地区特殊地理气候环境对骨折愈合的影响。方法选择高原地区（西藏自治区林芝地区，海拔3000米以上）股骨粗隆间骨折的患者（n＝30）作为研究对象（高原组），以沿海地区（广东省肇庆市，海拔110米）股骨粗隆间骨折的患者（n＝30）作为对照（沿海组），两组患者均采用相同的方法进行治疗，比较两组患者骨折愈合时间。将60例患者的平均骨折愈合时间作为骨折愈合标准时间，从而将60例患者分为愈合时间正常组和愈合时间延长组，对可能影响两组患者骨折愈合的年龄、性别、骨折类型、骨质疏松程度、术前并发症、术后负重活动时间、三酰甘油、血液黏稠度、氧分压、大气压、温度和湿度等因素进行单因素筛选和多元logistic回归分析，统计并分析影响骨折愈合的危险因素。结果高原组的骨折愈合时间明显长于沿海组（ P＜0.001）。单因素分析表明，年龄、骨折Evans分型、骨质疏松程度、负重活动时间、血液黏稠度水平、氧分压、大气压、温度、湿度是影响股骨粗隆间骨折愈合的因素（ P＜0.05）。logistic回归分析结果显示，负重活动时间、氧分压、大气压、温度是影响骨折愈合的主要因素（ P＜0.05）。结论与沿海地区骨折患者比较，高原地区骨折患者的愈合除了受到年龄、负重活动时间等影响外，高原地区氧分压低导致的缺氧、大气压低、寒冷等特殊地理气候环境也是造成骨折愈合时间延长的重要影响因素。%Objective To compare the bone healing time of intertrochanteric fractures between highlands and coastal areas ,so as to investigate influence of special geographical climatein plateau area on fracture healing .Methods Patients with intertrochanteric fracture in plateau region ( Nyingchi area of Tibet autonomous region ,altitude over 3000 me-ters) were enrolled as observation group (n=30),and in coastal areas (City of Zhaoqing, Guangdong province, altitude of 110 meters)were enrolled as control group (n=30).The same treatment was provided toboth groups .The time offrac-ture healing was compared.The clinical data were collected and the influencing factors (including age, gender, fracture type, the degree of osteoporosis , preoperative complications , postoperative weight -bearing activity time, triglyceride, blood viscosity , oxygen points pressure , atmospheric pressure , temperature and humidity ) were analyzed .Results Frac-ture healing time was significantly lengthened in observation group ( P<0.001 ) .Univariate analysis showed that age , fracture type ( Evans type ) , the degree of osteoporosis , weight -bearing activity time , blood viscosity , oxygen partial pressure, atmospheric pressure, temperature, and humidity were the influence factors of fracturehealing (P<0.05).Mo-reover , logistic regression analysis results show that the weight -bearing activity time , oxygen partial pressure , atmospher-ic pressure , and temperature were theprotective factors of fracture healing , while age was the risk factor of fracture heal-ing.Conclusion Compared with patients with fracture in coastal areas , the fracture healing in plateau is affected not only by age and weight -bearing activity time , but also the plateau low oxygen partial pressure , low atmospheric environment , cold and other special geographic and climate factors .
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