手术治疗复杂胫骨平台骨折术后并发膝关节僵硬的高危因素分析

Analysis of high risk factors of postoperative knee joint stiffness after complex tibial plateau fracture surgery

目的探讨手术治疗复杂胫骨平台骨折术后并发膝关节僵硬的高危因素。方法将2013年3月～2017年3月我院接诊的54例胫骨平台骨折患者纳入本研究。采取Logistic回归分析观察复杂胫骨平台骨折术后并发膝关节僵硬的高危因素。结果经多因素Logistic回归分析,合并膝关节周围损伤、关节面复位质量欠佳、术后镇痛、需要植皮或肌瓣/皮瓣修复的软组织缺损、关节周围异位骨化、功能锻炼和规范的康复指导是复杂胫骨平台骨折术后并发膝关节僵硬的独立危险因素[Exp(B)=2.174,18.751,17.333,283162,30247,25.301;P <0.05]。结论手术治疗复杂胫骨平台骨折术后并发膝关节僵硬的高危因素主要包括合并膝关节周围损伤、关节面复位质量欠佳、术后镇痛、需要植皮或肌瓣/皮瓣修复的软组织缺损、关节周围异位骨化、功能锻炼和规范的康复指导,临床需引起足够的重视。

Objective To explore the high risk factors of postoperative knee joint stiffness after complex tibial plateau fractures surgery. Methods Filly-four patients with complex tibial plateau fractures were researched in our hospital from March 2013 to March 2017, the high risk factors of postoperative knee joint stiffness after complex tibial plateau fracture surgery were analyzed by Logistic regression analysis. Results Multivariate Logistic regression analysis showed that： The combined around the knee joint injury, articular surface reduction in poor quality, postoperative analgesia, needed skin grafts or muscle flap/skin flap to repair soft tissue defect, heterotopie ossification around joints, functional exercise and standardized rehabilitation guidance were independent risk factor for postoperative knee joint stiffness after complex tibial plateau fraeture surgery[Exp（B）=2.174, 18.751, 17.333, 283162, 30247, 25.301, P 〈 0.05]. Conclusion The high risk factors of postoperative knee joint stiffness after complex tibial plateau fracture surgery include combined around the knee joint injury, articular surface reduction in poor quality, postoperative analgesia, needed skin grafts or muscle flap/skin flap to repair solt tissue defect, heterotopic ossification around joints, functional exercise and standardized rehabilitation guidance, which should be paid enough attention in clinic.