股骨远端骨折术后膝关节功能恢复影响因素分析

EFFECT FACTORS ANALYSIS OF KNEE FUNCTION RECOVERY AFTER DISTAL FEMORAL FRACTURE OPERATION

目的探讨股骨远端骨折术后膝关节功能恢复的影响因素。方法2001年1月-2007年5月,收治92例股骨远端骨折患者。男50例,女42例,年龄20～77岁,平均46.7岁。致伤原因:交通伤48例,高处坠落伤26例,压砸伤12例,摔伤6例。骨折根据Müller分型:A型29例,B型12例,C型51例。按照美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级,Ⅰ级21例,Ⅱ级39例,Ⅲ级24例,Ⅳ级8例。受伤至手术时间为4h～24d,平均7d。内固定采用解剖钢板43例,逆行交锁髓内钉37例,骨螺钉、螺栓、克氏钉12例。术后膝关节功能采用HSS评分标准评定,并对年龄、性别、术前ASA分级、受伤至手术时间、骨折分型、治疗方式、复位质量、开始功能锻炼时间、是否行CPM功能锻炼、术后并发症10个因素对股骨远端骨折术后膝关节功能恢复的影响进行统计学分析。结果术后88例切口Ⅰ期愈合;术后1周4例切口感染,给予清创换药后愈合。92例均获随访,随访时间16～32个月,平均23.1个月。骨折于术后3～7个月获临床愈合。术后出现伸膝装置粘连、活动度<80°29例,创伤性关节炎25例,骨折移位6例,膝轻度内翻或外翻7例,固定物松动6例。膝关节功能按照HSS评分:优52例,良15例,可10例,差15例,优良率为72.83%。单因素分析结果显示年龄、术前ASA分级、骨折分型、复位质量、是否行CPM功能锻炼、术后并发症6个因素与膝关节功能恢复有统计学意义(P<0.05)。多因素logistic回归分析显示骨折分型、复位质量、是否行CPM功能锻炼、年龄4个因素是影响膝关节功能恢复的主要因素。结论股骨远端骨折术后,年龄、术前ASA分级、骨折分型、复位质量、是否行CPM功能锻炼、术后并发症因素均可明显影响膝关节功能恢复。术前调整患者的身体状态,使骨折解剖复位,并牢固固定,术后早期主动、被动功能锻炼,减少术后并发症,以便最大程度恢复膝关节功能。

Objective To investigate the effect factors of knee function recovery after operation in distal femoral fractures. Methods From January 2001 to May 2007, 92 cases of distal femoral fracture were treated. There were 50 males and 42 females, aged 20-77 years old （average 46.7 years old）. Fracture was caused by traffic accident in 48 cases, by falling from height in 26 cases, by bruise in 12 cases and by tumble in 6 cases. According to Muller＇s Fracture classification, there were 29 cases of type A, 12 cases of type B and 51 cases of type C. According to American Society of Anesthesiologists （ASA） classification, there were 21 cases of grade Ⅰ, 39 cases of grade Ⅱ, 24 cases of grade Ⅲ, and 8 cases of grade Ⅳ. The time from injury to operation was 4 hours to 24 days with an average of 7 days. Anatomical plate was used in 43 cases, retrograde interlocking intramedullary nail in 37 cases, and bone screws, bolts and internal fixation with Kirschner pins in 12 cases. After operation, the HSS knee function score was used to evaluate efficacy. Ten related factors were applied for statistical analysis, to knee function recovery after operation in distal femoral fractures, such as age, sex, preoperative ASA classification, injury to surgery time, fracture type, treatment, reduction quality, functional exercise after operation, whether or not CPM functional training and postoperative complications. Results Wound healed by first intention in 88 cases, infection occurred in 4 cases. All patients followed up 16-32 months with an average of 23.1 months. Clinical union of fracture was achieved within 3-7 months after operation. Extensor device adhesions and the scope of activities of 〈 80° occurred in 29 cases, traumatic arthritis in 25 cases, postoperative fracture displacement in 6 cases, mild knee varus or valgus in 7 cases and implant loosening in 6 cases. According to HSS knee function score, the results were excellent in 52 cases, good in 15 cases, fair in 10 cases and poor in 15 cases with an excellent and good rate of 72.83%. Single factor analysis showed that age, preoperative ASA classification, fracture type, reduction quality, whether or not CPM functional exercise, and postoperative complications were significantly in knee function recovery （P 〈 0.05）. logistic regression analysis showed that the fracture type, quality of reduction, whether or not CPM functional exercise, and age were major factors in the knee joint function recovery. Conclusion Age, preoperative ASA classlncatton, fracture type, reduction quality, and whether or not CPM functional training, postoperative complications factors may affect the knee joint function recovery. Adjustment to the patient＇s preoperative physical status, fractures anatomic reduction and firm fixation, early postoperative active and passive functional exercises, less postoperative complications can maximize the restoration of knee joint function.