影响桡骨远端C型骨折内固定术后疗效的临床相关因素分析

The analysis of prognostic relative factors in patients with type-C fractures of distal radius after internal fixation

目的探讨影响桡骨远端C型骨折行切开复位内固定术后腕关节功能疗效的主要临床相关因素。方法回顾性分析2001年1月至2007年10月行切开复位内固定术的桡骨远端C型骨折患者的临床资料，以腕关节功能评分为结局指标，对术后疗效进行随访评定。采用非条件Logistic回归模型对年龄、性别、待手术时间、C型骨折类型、内固定物等因素与腕关节功能疗效的相关性进行分析。结果本研究共纳入56例患者，随访时间3．1～29．2个月（平均6．3个月）。术后腕关节功能Gartland和Werley评分：优24例，良26例，可3例，差3例，优良率为89．29％。Logistic回归分析结果显示，年龄〈65岁术后疗效优于年龄≥65岁（OR：4．6．4；95％ CI：1，48～14．54；P=0．009）、尽早手术治疗（13d内）利于术后腕关节功能恢复（OR=9．00；95％CI：1．72～46．99；P=0．009）、锁定加压钢板（LCP）内固定术后疗效优于普通“T”型钢板（OR=3．33；95％ CI：1．10—10．12；P=0．034）。结论老龄（≥65岁）及延迟手术（≥13d）是桡骨远端C型骨折内固定术后疗效的影响因素；运用LCP治疗累及关节面的桡骨远端C型骨折，手术疗效优于普通“T”型钢板。

Objective To explore the clinical relative factors on the therapeutic effect of wrist joint function in patients with type-C fractures of distal radius treated with internal fixation. Methods Retrospectively collect consecutive patients of type-C fractures of distal radius treated surgically with open reduction and internal fixation admitted from January 2001 to October 2007. Making Garfland and Werley Score of wrist joint function as the primary outcome variable, the following were assessed ： the postoperative efficacy at the follow-up, and use non-conditional Logistic regression to analysis the correlation of wrist joint function with patients＇ age, gender, time from injury to operation, classifications of type-C fracture, methods of internal fixation and other clinical factors. Results In this study, 56 patients met the inclusion were collected. The follow-up time was 3.1 to 29. 2 months （ mean follow-up 6. 3 months）. The result of Gartland and Werley Score ： 24 patients were excellent, good 26, fair 3, and poor 3 ; the excellent and good rate was 89. 29%. Monovariant and muhivariant Logistic regression analysis demonstrated that postoperative efficacy was significantly associated with elder age, time from injury to operation, methods of internal fixation：age （ OR = 4. 64 ; 95 % CI： 1.48-14. 54 ; P = 0. 009 ）, time from injury to operation （ OR = 9. 00 ; 95 % CI： 1.72- 46. 99 ; P = 0. 009）, methods of internal fixation （ OR = 3.33 ;95 % CI： 1.10-10. 12 ;P = 0. 034）. Conclusions Elder age （ ≥65 years） and delay of surgery（ ≥13 d）are the influential factors of postoperative functional outcome of distal radius fractures. For the treatment of intra-articular type-C fractures of distal radius, locking compression plate is more effective than T-type plate.