桡骨远端骨折掌侧锁定接骨板固定术后并发症的相关因素分析

Analysis of related factors of complications after volar locking plate fixation for distal radius fracture

目的探讨桡骨远端骨折掌侧锁定接骨板术后并发症的相关危险因素。方法收集2013年1月-2017年12月邢台矿业集团总医院创伤骨科收治的桡骨远端骨折患者796例,均行掌侧锁定接骨板治疗,回顾性分析并发症情况(软组织、肌腱、骨愈合、切口等相关并发症),并根据有无并发症将其分为2组。其中有并发症组102例,无并发症组694例,采用单因素分析及多因素Logistic回归分析探讨影响桡骨远端骨折术后发生并发症的相关危险因素。结果 796例桡骨远端骨折患者术后发生并发症102例,总体并发症发生率为12.8%。其中腕管综合征发生率最高为23例,发生率2.9%;其次为切口感染14例(1.8%),复位不良或复位丢失13例(1.6%)。单因素分析结果显示,并发症组与无并发症组患者在年龄、BMI、骨折AO分型、骨折类型、伴有月骨凹明显塌陷、手术时间和术者年资等差异具有统计学意义(P <0.05)。多因素Logistic回归分析显示,桡骨远端骨折术后并发症的独立危险因素为C型骨折(OR=2.14,95%CI1.28~3.08,P=0.004)、开放骨折(OR=3.44,95%CI 1.84~4.77,P<0.001)、伴有明显月骨凹塌陷(OR=3.79,95%CI2.11~4.98,P <0.001)以及术者年资较低(<5年)(OR=1.96,95%CI1.14~2.82,P=0.037)。结论开放骨折、伴有明显月骨凹塌陷、C型骨折以及术者年资较低是桡骨远端骨折术后并发症的危险因素,对于伴多个危险因素的,应采取更优化的方案以预防并发症的发生。

Objective To explore the risk factors of complications after volar locking plate for distal radius fracture.Methods 796 cases of distal radius fractures were collected from January 2013 to December 2017 in the Department of Orthopaedics and traumatology of Xingtai Mining Group General Hospital.All patients were treated with volar locking plate.The complications(soft tissue,tendon,bone healing,incision and other related complications) were analyzed retrospectively and divided into two groups according to the complications.102 cases were in the complication group and 694 cases in the non complication group.Single factor analysis and multi factor Logistic regression analysis were used to explore the risk factors of complications after operation of distal radius fracture.Results There were 102 postoperative complications in 796 patients with distal radius fracture.The overall incidence of complications was 12.8%.The highest incidence of carpal tunnel syndrome was 23 cases(2.9%),followed by incision infection in 14 cases(1.8%),poor reduction or loss of reduction in 13 cases(1.6%).The results of univariate analysis showed that there were significant differences between the complication group and the non complication group in patients’ age,BMI,fracture AO classification,fracture type,significant collapse of the moon bone concave,operation time and the age of the operator(P<0.05).Multivariate logistic regression analysis showed that the independent risk factors for postoperative complications of distal radius fractures were type C fractures(OR=2.14,95% CI 1.28-3.08,P=0.004),open fractures(OR=3.44,95% CI 1.84-4.77,P <0.001),with significant lunar concavity collapse(OR=3.79,95% CI 2.11-4.98,P<0.001),and lower age of the patients(<5 years)(OR=1.96,95% CI 1.14-2.82,P=0.037).Conclusion Open fracture,obvious lunar concavity collapse,type C fracture and low age of the operator are the risk factors of postoperative complications of distal radius fracture.For those with multiple risk factors,a more optimized scheme should be taken to prevent the occurrence of complications.