桡骨远端骨折患者手术后康复效果的影响因素研究

Risk factors affecting the rehabilitation of patients with distal radius fracture after operation

目的探究桡骨远端骨折患者手术后康复效果的影响因素。方法选取2012年7月至2016年7月期间在我院接受治疗的桡骨远端骨折患者90例,记录患者术后3、6、12个月时的腕关节活动度、手的握力及Michigan手功能评分,作为表征患者手术后康复效果的应变量。采用单因素线性回归确定可能的影响因素/自变量和该应变量之间的关系,并将P<0.05的自变量纳入进行多因素Logistic回归分析,确定影响康复效果的危险影响因素。结果在术后的12个月的随访中,2例患者术后出现钉道感染,2例患者术后1个月时出现轻度螺纹松动,1例患者后期发展为腕管综合征。术后3、6、12个月时的腕关节握力、活动度、Michigan得分持续改善。单因素分析结果显示:术后3个月节点:创伤能量、骨折类型、年龄、骨密度、外固定架固定时间与手术后康复效果具有密切关联(P<0.05);术后6个月节点:骨折类型、创伤能量、外固定架固定时间与手术后康复效果具有密切关联(P<0.05);术后12个月节点:年龄、骨密度、骨折类型与手术后康复效果具有密切关联(P<0.05)。多因素Logistic回归显示:严重的骨折类型、高能创伤和较长的外固定架固定时间是影响桡骨远端骨折患者手术3个月后康复效果的危险因素(P<0.05);严重骨折类型、高能量创伤是影响桡骨远端骨折患者手术6个月后康复效果的危险因素(P<0.05);骨密度减少和年龄增加是影响桡骨远端骨折患者手术12个月后康复效果的危险因素(P<0.05)。结论严重的骨折类型、高能创伤和较长的外固定架固定时间是影响桡骨远端骨折患者手术3个月后康复效果的危险影响因素。严重骨折类型、高能量创伤是影响桡骨远端骨折患者手术6个月后康复效果的危险影响因素。骨密度减少和年龄增加是影响桡骨远端骨折患者手术12个月后康复效果的危险影响因素。桡骨远端骨折是否合并尺骨茎突骨折及克氏针的固定时间长短与于桡骨远端骨折患者手术后康复效果关联不密切。

Objective To explore the influencing factors of rehabilitation effect of patients with distal radius fracture after operation. Methods Ninety patients with distal radius fracture treated in our hospital from July 2012 to July 2016 were included in the study. The wrist motion,hand grip strength and Michigan functional score at 3,6 and 12 months after operation were recorded as strain variables to characterize the rehabilitation effect of patients after operation. The wrist motion,hand grip strength and Michigan Hand Outcome Questionnaire(MHQ)at 3,6 and 12 months after operation were recorded as strain variables to characterize the rehabilitation effect of patients after operation. One-way linear regression was used to determine the relationship between the possible influencing factors. The independent variables of P<0.05 were included in the multivariate logistic regression analysis to determine the risk factors of rehabilitation effect. Results During the 12-month follow-up,2 patients had screw infection,2 patients mild screw loosening at 1 month,and 1 patient developed carpal tunnel syndrome at later stage. The grip strength,range of motion and MHQ improved continuously at 3,6 and12 months after operation. Univariate analysis showed that trauma energy,fracture type,age,bone mineral density and fixation time of external fixator were closely related to the rehabilitation effect after operation in 3 months after operation(P<0.05);Fracture type,traumatic energy and fixation time of external fixator were closely related to the rehabilitation effect after operation in 6 months after operation(P<0.05);Age,bone mineral density and fracture type are closely related to the rehabilitation effect after operation in 12 months(P<0.05). Multivariate logistic regression showed that severe fracture type,high energy trauma and long external fixator fixation time were risk factors affecting the recovery of patients with distal radius fracture after 3 months(P<0.05);Severe fracture types and high energy trauma were risk factors affecting the recovery of patients with distal radius fracture after 6 months(P<0.05). Decreased bone mineral density and increased age were risk factors affecting the recovery of patients with distal radius fracture after 12 months(P<0.05). Conclusion In the tresent study,severe fracture types,high-energy trauma and long external fixator fixation time were risk factors affecting the rehabilitation of patients with distal radius fracture after 3 months of operation,and fracture types and high energy trauma were the risk factors at 6 months,while decreased bone mineral density and increased age were risk factors at 12 months. Whether distal radius fracture was complicated with ulnar styloid process fracture and the length of fixation were not closely related to the rehabilitation effect.