影响桡骨远端骨折治疗效果的多因素分析

Multivariate analysis of treatment effect of distal radius fractures

目的探讨影响桡骨远端骨折治疗效果的相关因素。方法采用单因素筛选和多因素Logistic回归对可能影响桡骨远端骨折治疗后腕关节功能的11个指标进行相关因素分析。结果单因素分析显示,腕关节功能优良率与性别、合并尺骨茎突骨折、合并下尺桡关节脱位、治疗方法、残留掌倾畸形无相关性(P>0.05),而与骨折类型、年龄、合并肌腱皮肤等软组织损伤、残留桡骨短缩、残留尺偏畸形和残留关节面不平整显著相关(P<0.05)。后者进一步经多因素Logistic回归分析,除年龄外,其余均有相关性;按照其作用强度,影响腕关节功能的独立因素依次为:残留关节面不平整、残留桡骨短缩、骨折类型、合并肌腱皮肤等软组织损伤和残留尺偏畸形。结论残留关节面不平整、残留桡骨短缩、骨折类型、合并肌腱皮肤等软组织损伤和残留尺偏畸形为影响桡骨远端骨折治疗效果的独立因素。不稳定桡骨远端骨折应选择手术,尽力恢复腕关节的重要解剖结构,尤其是要恢复桡骨长度、桡骨关节面平整和合并下尺桡关节不稳。

Objective To investigate the influence factors of treatment effect of distal radial fractures. Methods Single factor screening and multivariate logistic regression were used to analyze 11 factors that may affect the treatment effect of distal radial fractures. Results Single factor analysis showed that there were no correlation between the excellent and good rate of wrist function and gender, combined ulnar styloid fracture, combined dislocation of distal radioulnar joint, treatment method, residual deformity of palm deviation （P 〉0.05）, while there were correlation between the excellent and good rate of wrist function and type of fracture, age, combined injury of soft tissue such as tendon and skin, residual deformity of shortening of radial, residual deformity of ulnar deviation, and residual uneven articular surface （P 〈0.05）. Multivariate logistic regression analysis showed that there were correlation except for the age in the latter;, the independent factors affecting wrist function from big to small order were as following： residual uneven articular surface, residual shortening of radial, fracture type, combined injury of soft tissue such as tendon and skin, residual deformity of ulnar deviation. Conclusion Residual uneven articular surface, residual shortening of radial, fracture type, combined injury of soft tissue such as tendon and skin, residual deformity of ulnar deviation are independent factors affecting the treatment effect of distal radius fractures. Unstable distal radius fractures should choose surgery to try to restore the important anatomical structure of the wrist, especially the length and the smoothness of articular surface of the distal radius, as well as the stability of the distal radioulnar joint.