AO可塑形双钢板置入内固定修复老年肱骨远端骨折:效果的影响因素分析

Influential factors for AO plastic double plate fixation in repair of senile distal humeral fractures

背景:老年肱骨远端骨折的临床治疗包括保守治疗、外展支架和切开复位植入物内固定治疗,切开复位内固定方法繁多,效果评价不一,给临床治疗带来较大困难。目的:探讨切开复位AO可塑形双钢板置入内固定修复老年肱骨远端骨折的疗效及影响因素,旨在提供最佳修复模式。方法:纳入2009年6月至2013年6月陕西省中医学院附属医院收治的老年肱骨远端骨折切开复位内固定患者114例,采用AO可塑形双钢板置入内固定。应用自行设计的调查问卷对患者肘关节恢复效果和可能影响因素进行调查,以卡方检验和多因素Logistic回归分析对可能影响因素进行分析。结果与结论:在114例患者中肘关节功能恢复优良85例,优良率为75%。单因素分析显示,患者在不同骨折类型、AO分型、是否合并神经损伤、血管损伤和并发症时的差异有显著性意义(P<0.05)。多因素Logistic回归分析显示,骨折类型、AO分型和神经损伤是影响修复效果的主要因素(P<0.05),即骨折类型为开放型、AO分型为C型、并且合并神经损伤者肘关节功能恢复更差。提示骨折类型、AO分型和神经损伤是影响切开复位AO可塑形双钢板置入内固定修复老年肱骨远端骨折效果的主要因素,应针对其影响因素进行相应干预。

BACKGROUND：Clinical treatment for elderly patients with distal humeral fractures includes conservative treatment, abduction, and open reduction and internal fixation. The methods for open reduction and internal fixation are various, and the effects are not unified, which brings great difficulties for clinical treatment. OBJECTIVE：To explore therapeutic effects and influential factors for open reduction and AO plastic double plate fixation for treating senile distal humeral fracture so as to provide the best treatment mode. METHODS：114 patients with senile distal humeral fracture, who received open reduction and internal fixation in the Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2009 to June 2013, were enroled in this study. AO plastic double plate fixation was used. Self-designed questionnaire was utilized to investigate elbow recovery effect and influential factors. The possible influential factors were analyzed by chi square test and multiple Logistic regression analysis. RESULTS AND CONCLUSION： Among 114 patients, elbow joint function recovery was excelent in 85 cases and the excelent and good rate was 75%. Single factor analysis showed that significant differences were detected in different fracture types, AO type, with or without nerve injury, vascular injury and complications （P 〈 0.05）. Multivariate Logistic regression analysis showed that fracture type, AO type and nerve injury were the mainnbsp;factors that influence the treatment effect （P 〈 0.05）. That was, elbow joint function recovery was worse because of open type fracture, C type fracture, fracture combined with nerve injury. Above results confirmed that fracture type, AO type and nerve injury are the main factors influencing the effect of open reduction and internal fixation with AO plastic double plate for treating elderly patients with distal humeral fracture, and intervention should be done according to its influential factors.