女性骨质疏松性桡骨远端骨折锁定钢板内固定术后腕关节功能恢复的影响因素分析

Analysis of factors influencing wrist function recovery after locking plate internal fixation for treatment of osteoporotic distal radius fractures in female

目的:探讨女性骨质疏松性桡骨远端骨折锁定钢板内固定术后腕关节功能恢复的影响因素。方法:收集68例因骨质疏松性桡骨远端骨折接受切开复位掌侧锁定钢板内固定术治疗的女性患者的病例资料。均为单侧闭合性骨折,所有骨折均波及关节面,A2型28例、A3型12例、C2型18例、C3型10例。通过查阅患者的病例资料,提取年龄、体质量指数、腰椎骨密度、掌倾角、尺偏角、桡骨高度及Cooney腕关节评分(所有数据均选择行内固定拆除术时的数据)。在X线片上测定双侧掌倾角、尺偏角、桡骨高度,以健侧值减去患侧值后取绝对值,分别记为掌倾角差值、尺偏角差值及桡骨高度差值。依据Cooney腕关节评分将患者分为恢复组(评分≥80分)和未恢复组(评分<80分)。结果:恢复组40例,未恢复组28例。单因素Logistic回归分析结果显示,掌倾角差值、尺偏角差值及桡骨高度差值与术后腕关节功能恢复有关联[OR=2.045,P=0.043;OR=2.238,P=0.019;OR=1.722,P=0.005],年龄、体质量指数及腰椎骨密度与术后腕关节功能恢复无明显关联[OR=0.998,P=0.975;OR=0.999,P=0.999;OR=4.927,P=0.155]。多因素Logistic回归分析结果显示,掌倾角差值、尺偏角差值及桡骨高度差值是术后腕关节功能恢复的影响因素[OR=2.190,P=0.023;OR=2.296,P=0.012;OR=1.623,P=0.005]。结论:对于采用锁定钢板内固定术治疗的女性骨质疏松性桡骨远端骨折患者,患侧与健侧掌倾角、尺偏角及桡骨高度的差值是腕关节功能恢复的影响因素。

Objective： To explore the factors influencing wrist function recovery after locking plate internal fixation for treatment of os- teoporotic distal radius fractures in female. Methods：The medical records of female patients with osteoporotic distal radius fractures who were treated with open reduction and volar locking plate internal fixation were collected. All of the fractures belonged to unilateral closed fractures and spreaded to joint surfaces. According to classification of fracture, the fractures belonged to types A2 （ 28 ）, A3 （ 12 ）, C2 （ 18 ） and C3 （10）. The data, including ages, body mass indexes, lumbar vertebra bone densities, volar tilt angles, radial inclination angles, radial heights and Cooney wrist scores when the internal fixation system was removed,were extracted from patient＇s medical records. Bilateral vo- lar tilt angles, radial inclination angles and radial heights were measured on the X-ray films, and the absolute values of difference between injured side and uninjured side were recorded as volar tilt angle difference, radial inclination angle difference and radial height difference respectively. The patients were divided into recovery group（ score of ~〉80 points）and un-recovery group（ score of 〈 80 points）according to the Cooney wrist scores. Results： Forty patients were in recovery group and 28 patients were in un-recovery group. The result of single - fac- tor logistic regression - analysis demonstrated that volar tilt angle difference, radial inclination angle difference and radial height difference had association with postoperative wrist function recovery（ OR = 2. 045, P = 0. 043 ; OR = 2. 238, P = 0. 019 ; OR = 1. 722, P = 0. 005 ） ; and age, body mass index and lumbar vertebra bone density had no apparent association with postoperative wrist function recovery（ OR = 0. 998, P= 0. 975 ; OR = 0. 999 ,P = 0. 999 ; OR = 4. 927 ,P = 0. 155 ）. The result of multiple - factor logistic regression - analysis demonstrated that volar tilt angle difference, radial inclination angle difference and radial height difference influenced postoperative wrist function recovery（ OR = 2. 190,P = 0. 023 ; OR = 2. 296, P = 0. 012; OR = 1. 623, P = 0. 005）. Conclusion：The difference between injured side and uninjured side in volar tilt angles, radial inclination angles and radial heights were the influencing factors of wrist function recovery in female patients with osteoporotic distal radius fractures who are treated with locking plate internal fixation.