LISS治疗股骨远端骨折疗效及膝关节功能影响因素分析

Outcome and affecting factors of distal femoral fractures treated by less invasive stabilization system

目的评价股骨远端微创内固定技术（USS）治疗股骨远端骨折的治疗效果并分析影响膝关节功能的影响因素。方法自2009—01-2012—11应用USS—DF钢板内固定治疗股骨远端骨折81例。以临床功能和X线检查结果评价治疗效果。对可能影响膝关节功能的年龄、性别、骨折类型、创伤类型、是否为开放性损伤、是否为多发伤、手术距受伤的时间、是否早期功能锻炼、是否出现并发症作多因素Logistic回归分析。结果81例平均随访18．2（14-21）个月，78例骨折一期愈合。膝关节活动度：A型骨折平均109．1°，C型骨折平均101°。膝关节功能按HSS评分评定：A型骨折优良率91．4％，C型骨折优良率71．7％。多因素Logistic回归分析显示骨折类型、是否早期功能锻炼、是否出现并发症是影响膝关节功能的独立危险因素。结论LISS—DF钢板内固定治疗股骨远端骨折固定牢固，骨折愈合率高，是一种理想的内固定，术后患者应早期加强功能锻炼，减少并发症，提高膝关节功能恢复。

Objective To assess the outcome and affecting factors of distal femoral fractures treated by less invasive stabilization system （LISS）. Methods Between January 2009 and November 2012, 81 patients with distal femoral fractures were treated by LISS. The outcome was evaluated by clinical function and radiographic results. A statistical model was constructed comprising the clinical outcome and the postulated prognostic factors. The association between these factors and outcome was explored by Logistic regression. Results Eighty one patients were followed up for average 18.2 months （14-21 months）. The average knee range motion was 109.1° in type A and 101° in type C. A satisfactory outcome （excellent and good results） was achieved in 32 of 35 type A factures （91.4%）and 33 of 46 type C fracture （71.7%）. Logistic regression analysis showed that the fracture type, whether or not early functional exercise, and whether or not complications happened were major factors in the knee joint function recovery. Conclusion LISS is a useful option for distal femoral fractures. Patients must do early functional exercise and decrease complications to improve the knee function.