LISS钢板治疗股骨远端骨折术后膝关节功能及其影响因素

Function and influencing factors of LISS plate in the treatment of distal femoral fractures

目的探讨微创内固定系统(less invasive stabilization system,LISS)钢板治疗股骨远端骨折术后膝关节功能及其影响因素。方法回顾性分析2014年9月—2017年2月惠州市中心人民医院骨科治疗的66例股骨远端骨折患者的临床资料,包括年龄、性别、致伤原因、骨折分型、手术时机、手术时间、内科合并疾病、是否合并骨质疏松、复位质量、术中是否植骨、是否行石膏制动、是否行CPM功能锻炼等。其中男性44例,女性22例;年龄23~64岁,平均35.86岁;道路交通伤40例,高处坠落伤14例,摔伤7例,其他伤5例。依据膝关节HSS评分将患者分为优良组和非优良组,采用单因素χ2检验和多因素Logistic回归分析探究股骨远端骨折LISS术后膝关节功能的影响因素。结果术后平均随访(12.26±7.14)个月;截止末次随访,62例患者骨折愈合,平均愈合时间(3.8±0.7)个月;术后膝关节功能优32例,良17例,可12例,差5例,优良率为74.24%。单因素分析结果显示年龄(P=0.018)、骨折AO分型(P=0.000)、手术时机(P=0.000)、复位质量(P=0.000)、是否行CPM功能锻炼(P=0.011)为术后膝关节功能的影响因素;多因素Logistic回归分析显示年龄(OR=13.443,95%CI:1.736~37.546,P=0.027)、骨折AO分型(OR=20.665,95%CI:3.884~57.365,P=0.009)、手术时机(OR=9.882,95%CI:1.557~30.754,P=0.043)、复位质量(OR=15.667,95%CI:3.206~49.758,P=0.015)、CPM功能锻炼(OR=10.646,95%CI:1.652~34.376,P=0.036)为术后膝关节功能的独立影响因素。结论 LISS治疗股骨远端骨折术后膝关节功能影响因素较多,包括年龄、骨折AO分型、手术时机、复位质量、CPM功能锻炼等。

Objective To explore postoperative knee joint function of LISS in the treatment of distal femoral fractures and related factors. Methods A total of 66 patients （44 males and 22 females aged 23-64 （35.86 on average） years） diagnosed as distal femoral fracture were collected from Sep. 2014 to Feb. 2017 in our hospital. Age,gender,cause of injury,type,operation opportunity,operation time,complication,osteoporosis,reduction quality,bone graft,plaster immobilization,and CPM functional exercise of all the patients were collected and recorded. According to the HSS score of the knee,the patients were divided into excellent and good group and fair group.Univariate χ 2 test and multivariate logistic regression analysis were used to explore risk factors of knee joint function after LISS fixation. Results The patients were followed up for （12.26±7.14） months. At the last follow-up,fracture healing occurred in 62 cases,and average healing time was （3.8±0.7） months. Postoperative knee function was excellent in 32 cases,good in 17 cases,fair in 12 cases,and poor in 5 cases. The excellent and good rate was 74.24%. Univariate χ2 test revealed that age （ P =0.018）,AO fracture type （ P =0.000）,operation opportunity （ P =0.000）,the quality of reduction （ P =0.000）,and CPM functional exercise （ P =0.011） were factors related to knee joint function. Multivariate logistic regression analysis revealed that age （OR=13.443,95%CI： 1.736~37.546, P =0.027）,AO fracture type （OR=20.665,95%CI： 3.884~57.365, P =0.009）,operation opportunity （OR=9.882,95%CI： 1.557~30.754,P=0.043）,the quality of reduction （OR=15.667,95%CI： 3.206~49.758, P =0.015） and CPM functional exercise （OR=10.646,95%CI： 1.652~34.376,P=0.036） were independent influencing factors related to knee joint function. Conclusion There are many influencing factors of knee joint function after LISS for patients with distal femoral fractures. The age,fracture type,operation opportunity,the quality of reduction and CPM functional exercise are factors related to knee joint function.