股骨远端C3型骨折行对侧髂骨取骨有利于膝关节早期康复训练

Contralateral ilium harvesting for C3 fracture of distal femur is beneficial to early rehabilitation of knee joint

目的研究对侧髂骨取骨与同侧取骨相比是否会对股骨远端C3型骨折术后膝关节功能康复产生影响。方法按照纳入、排除标准,前瞻性纳入自2013年4月至2015年7月手术治疗股骨远端C3型骨折的病例,按照手术侧与髂骨取骨侧是否相同,分为同侧取骨组、对侧取骨组。分析两组患者的手术耗时;术后患侧膝关节主动伸直达到10°、屈曲达到120°的时间间隔;术后3个月末髂骨取骨区的疼痛视觉模拟评分(VAS);记录随访期内取骨区出现切口红肿、切口延迟愈合、血肿、感染、髂嵴撕脱骨折等情况。计量资料采用t检验或秩和检验,计数资料采用卡方检验,术后患侧膝关节主动伸直达到10°、屈曲达到120°的时间间隔采用Kaplan-Meier法进行生存分析,行Breslow检验。结果共纳入同侧取骨组12例、对侧取骨组11例,同侧取骨组随访中位时间18(14,21)个月,对侧取骨组随访中位时间15(13,20)个月。对侧取骨组手术耗时(t=2.169,P<0.05)、术后膝关节主动伸直达到10°、屈曲达到120°的预期时间(Х^2=7.999,P<0.05;Х^2=9.325,P<0.05)、取骨区疼痛减轻程度(t=8.910,P<0.01)都优于同侧取骨组。术后同侧、对侧取骨组分别出现1例、2例取骨处切口红肿,予以对症治疗后好转、痊愈;所有患者随访期内均未发生取骨区血肿、感染、髂嵴撕脱骨折。结论股骨远端C3型骨折行对侧髂骨取骨有利于膝关节早期康复训练。

Objective To investigate the influence to knee joint rehabilitation with the ipsilateral or contralateral ilium harvesting in the distal femur C3 fracture surgery.Methods According to the inclusion and exclusion criteria,patients who underwent surgical treatment of distal femoral C3 fractures from April2013 to July 2015 were prospectively selected.According to the donor site,the patients underwent ipsilateral or contralateral iliac harvesting alternately,were then grouped in ipsilateral harvesting group and contralateral harvesting group.Theatre time,time interval of knee joint active extension to 10°and flexion to 120°,visual analog score(VAS)of the donor site at three months post-operatively were compared respectively.Complications such as incision redness,delayed incision healing,hematoma,infection,iliac crest avulsion fracture were recorded.The t-test or rank sum test was used for the measurement data.The chi-square test was used for the count data.The Kaplan-Meier method was used for survival analysis of the knee joint with active extension to 10°and flexion to 120°,and the Breslow test was performed.Results A total of 12 patients in the ipsilateral harvesting group and 11 patients in the contralateral harvesting group were included.The time of follow-up were 18(14,21)months for the ipsilateral harvesting group and 15(13,20)months for thecontralateral harvesting group.Compared to the ipsilateral harvesting group,the theatre time of the contralateral harvesting group was significantly less(t=2.169,P<0.05),the median survival time of knee active extension to 10°and flexion to 120°were less(Х^2=7.999,P<0.05;Х^2=9.325,P<0.05 respectively).The pain relief in the donor area were better in contralateral harvesting group than that in the ipsilateral harvesting group(t=8.910,P<0.01).There were three cases of red incision,with one in the ipsilateral harvesting group and two in the other one.All the incisions healed after treatment.During the follow-up period,no hematoma,infection or iliac crest avulsion fracture of the donor area happened.Conclusion Harvesting of the contralateral ilium for the C3 fracture of distal femur is beneficial to the early rehabilitation of knee joint.