髌骨骨折钉线张力带固定与早期功能锻炼的评估

Evaluation of tension band wiring fixation for patellar fracture and early postoperative functional exercise

目的探讨髌骨骨折切开复位钉线张力带内固定与早期功能锻炼的评估。方法回顾性收集2017年1月至2019年12月广东省佛山市暨南大学附属顺德医院骨科髌骨骨折的69例患者资料,纳入患者为入院后3~148 h行髌骨骨折切开复位钉线张力带内固定并早期功能锻炼,患者以年龄中位数51岁分组。采用秩和检验,Spearmen相关,二分类Logistic回归,重复测量方差分析等方法,分析比较术前等候手术时间、合并伤、白细胞计数(WBC)、D-二聚体(DD)水平、术后X光照片、体温等客观评价指标变化与早期功能锻炼的关系。结果以年龄中位数51岁分组,年龄>51岁组的患者等候手术的时间长于年龄≤51岁组患者(Z=2.928,P<0.05)。年龄与术前WBC计数、术后第1、2、3天18点时的体温呈负相关(r=-0.380、-0.300、-0.275、-0.310,均为P<0.05)。年龄与术前DD、术前WBC计数与合并伤、术后第1、2天14点时体温呈正相关(r=0.377、0.244、0.288、0.337,均为P<0.05)。合并伤和第1天18点时的高体温是住院天数增加的危险因素[比值比(OR)=6.531,95%可信区间(CI)(1.672,25.506),P=0.007]和[OR=22.752,95%CI(1.207,428.853),P=0.037],而术前DD是住院时间的保护因素[OR=0.238,95%CI(0.072~0.785),P=0.018]。年龄≤51岁患者体温高于年龄>51岁(F=6.321,P<0.05)。结论髌骨骨折切开复位钉线张力带内固定术后实施早期功能锻炼,可充分利用患者现成的客观资料作为评估指标。

Objective To investigate the evaluation of open reduction and internal fixation by tension band wiring for patellar fracture and early postoperative functional exercise.Methods Data were retrospectively collected from the patients who were admitted to the department of orthopaedics in the Affiliated Shunde Hospital of Jinan University from January 2017 to December 2019.The patients were grouped by median age(51 years).All the patients underwent open reduction and internal fixation by tension band wiring to treat patellar fracture under combined spinal-epidural anesthesia within three hours to 148 h after admission and early postoperative functional exercise.The relationships between the changes in the parameters such as waiting time before surgery,preoperative associated injury,white blood cell count(WBC),D-dimer(DD)level,postoperative X-rays,body temperature,and early postoperative functional exercise were compared and analyzed by Wilcoxon rank-sum test,Spearman’s correlation analysis,binary logistic regression analysis,and repeated measures analysis of variance.Results The patients age>51 years showed longer waiting time before surgery than the patients age≤51 years(Z=2.928,P<0.05).Age was shown to be negatively correlated with preoperative WBC,body temperature at 18:00 on postoperative days one,two and three(r=-0.380,-0.300,-0.275,-0.310,all P<0.05).Positive correlations were observed between age and preoperative DD level,preoperative WBC and presence of associated injury,body temperature at 14:00 on postoperative days one and two(r=0.377,0.244,0.288,0.337,all P<0.05).Presence of associated injury[odds ratio(OR)=6.531,95%confidence interval(CI)(1.672,25.506),P=0.007]and high body temperature at 18:00 on postoperative day one[OR=22.752,95%CI(1.207,428.853),P=0.037]were risk factors for the prolonged hospital stay,while preoperative DD level[OR=0.238,95%CI(0.072,0.785),P=0.018]was a protective factor the length of hospital stay.The body temperature of the patients age≤51 years was higher than that in the patients age>51 years(F=6.321,P<0.05).Conclusion The available objective data should be sufficiently utilized as evaluation indicators for early postoperative functional exercise after open reduction and internal fixation by tension band wiring for patellar fracture.