股骨髁部支撑钢板修复股骨远端骨折效果评价

Effects of femoral condylar buttress plate on repair of distal femoral fractures

背景:股骨远端骨折多为粉碎性、不稳定性骨折,并伴有局部软组织及微循环的严重损伤,骨折愈合较为困难,髁部支撑钢板为临床广泛应用的治疗手段,但影响其预后的相关因素多样,各方报道亦不一。目的:探讨股骨髁部支撑钢板对股骨远端骨折治疗效果的影响因素。方法:回顾性分析股骨髁部支撑钢板置入治疗股骨远端骨折84例患者的临床资料,收集相关数据,应用单因素分析和Logistic回归分析筛查可能的影响因素。结果与结论:84例患者中,Neer评分优良患者63例(75%),单因素分析显示,年龄、骨折类型、损伤类型、手术时机、复位质量、CPM锻炼各组间临床疗效差异存在显著性意义(P<0.05),Logistic回归分析显示,年龄越大,临床疗效越差(OR=0.797),复位满意者、A型骨折和CPM锻炼者临床疗效好,OR分别为2.275,1.756,2.885。结果可见对于股骨远端骨折患者,髁部支撑钢板置入过程中良好的解剖复位和关节嵌合,置入后早期的CPM功能锻炼可有效的促进膝关节功能恢复,对于C型骨折患者,可考虑双钢板强化固定提高疗效。

BACKGROUND：Distal femoral fractures are complex and unstable, and combined with severe injury to local soft tissue and microcirculation. Fracture healing is difficult. Condylar buttress plate is commonly used in the clinic. However, the factors affecting its prognosis are various, and the reports are diverse. OBJECTIVE：To investigate the factors affecting clinical efficacy of femoral condylar buttress plate for distal femoral fractures. METHODS：Clinical data of 84 patients with distal femoral fractures undergoing surgical treatment with femoral condylar buttress plate were retrospectively analyzed. Possible influential factors were screened by univariate analysis and logistic regression analysis. RESULTS AND CONCLUSION：Of the 84 patients, 63 cases （75%） rated as excellent by Neer scores. Univariate analysis of variance showed significant differences in age, fracture category, type of injury, timing of surgery, quality of reduction and CPM exercise among groups （P〈0.05）. Logistic regression analysis showed that older patients had poorer therapeutic effects （OR=0.797）. Patients with satisfactory reduction, type fracture and CPM exercise had good therapeutic effects （OR=2.275, 1.756, 2.885, respectively）. Results exhibited that satisfactory reduction, fitting joints, and early CPM exercises could effectively contribute to functional recovery of knee joint during implantation of condylar buttress plate in patients with distal femoral fractures. For patients with type C fracture, double plates can be used to strengthen fixation and to elevate therapeutic effects.