胫骨平台骨折术后创伤性关节炎危险因素研究

Risk factors of traumatic arthritis after tibial plateau fractures surgery

目的 分析胫骨平台骨折术后创伤性关节炎的危险因素.方法 采用随机平行对照方法纳入2012年10月至2017年10月解放军159医院收治的78例胫骨平台骨折患者为研究对象,开展回顾性分析.所有患者均接受切开复位钢板内固定术治疗,统计患者一般资料及病理学资料.按照术后创伤性关节炎发生状况将其分为创伤性关节炎组与非创伤性关节炎组,采用多因素Logistic回归分析法分析胫骨平台骨折术后创伤性关节炎发生的独立影响因素.结果 78例胫骨平台骨折患者术后随访6个月～5年,30例患者出现创伤性关节炎,发生率为38.46％.单因素分析结果显示,术后创伤性关节炎的发生与性别、年龄、吸烟、手术至负重时间、钢板类型、是否合并侧副韧带损伤、是否合并交叉韧带损伤、内固定是否去除无明显相关性（P〉0.05）,与受伤至手术时间、骨折损伤方式、骨折分型、骨质量、合并半月板损伤、术后Rasmussen解剖学评分有明显相关性（P〈0.05）.多因素Logistic回归分析结果显示,受伤至手术时间、骨折损伤方式、骨折分型、骨质量、术后Rasmussen解剖学评分是胫骨平台骨折患者术后继发创伤性关节炎的独立影响因素（P〈0.05）.结论 胫骨平台骨折术后易发创伤性关节炎,其中受伤至手术时间、骨折损伤方式、骨折分型、骨质量、术后Rasmussen解剖学评分为其独立危险因素,临床应引起足够重视.

Objective To observe the risk factors of traumatic arthritis after tibial plateau fractures surgery .Methods Seventy-eight patients with tibial plateau fractures admitted in Chinese People＇s Liberation Army 159 Hospital from October 2012 to October 2017 were divided into two groups , according to randomized parallel control method , for retrospective analysis .All patients were treated by open reduction and internal fixation , and the general data and pathological data were collected from all enrolled patients .Patients were divided into traumatic arthritis group and non-traumatic arthritis group according to whether having traumatic arthritis or not; the independent factors of the incidence of traumatic arthritis after tibial plateau fracture were analyzed by multivariate Logistic regression analysis . Results Seventy-eight cases of tibial plateau fractures were followed up for 6 months to 5 years, 30 patients had traumatic arthritis , the incidence rate was 38.46%.The results of single factor analysis showed that the incidence of postoperative traumatic arthritis was not related to sex , age, smoking, operation to weight loss , type of steel plate , injury of collateral ligaments , amalgamative ligament injury , or whether internal fixation was removed （ P〉0.05 ） .There was a significant correlation between injury to operation time , fracture mode , fracture classification , bone quality , combined meniscus injury and postoperative Rasmussen anatomical score and development of postoperative traumatic arthritis （ P〈0.05 ） .Multiple factor Logistic regression analysis showed that injury to operation time , fracture mode, fracture type, bone quality, and postoperative Rasmussen anatomical score were independent factors of secondary traumatic arthritis in patients with tibial plateau fractures （ P〈0.05 ） . Conclusions It is easy to develop traumatic arthritis after tibial plateau fracture , and the time from injury to operation , fracture mode , fracture type , bone quality and Rasmussen anatomy score are independent risk factors , which should be given attention in clinical .