胫骨平台骨折合并髁间棘骨折术后患者膝关节功能恢复的相关因素分析

Factors related to functional recovery of the knee following tibial plateau fracture complicated with intercondylar ridge fracture

目的探讨影响胫骨平台骨折合并髁间棘骨折术后患者膝关节功能恢复的相关因素。方法回顾性分析2019年1月至6月期间河北医科大学第三医院创伤急救中心收治并符合纳入标准的63例胫骨平台骨折合并髁间棘骨折患者资料。男43例,女20例;年龄为18~66岁,平均43.9岁。按胫骨平台骨折综合分型:简单骨折27例(Ⅰ型20例,Ⅱ型7例),复杂骨折36例(Ⅲ型16例,Ⅳ型17例,Ⅴ型1例,Ⅵ型2例)。对可能影响术后膝关节功能恢复的美国特种外科医院膝关节评分(HSS)评分的12个相关因素进行多重线性回归模型分析(患者性别、年龄、职业、骨折类型、医疗付款方式、致伤原因、手术方式、康复起始时间、术后是否安装支具、受伤至手术时间、住院时间、髁间棘骨折块是否游离),筛选出主要的相关因素。结果63例患者术后获6.0~7.1个月(平均6.1个月)随访。末次随访时HSS评分为45~100分,平均92.4分。不同骨折类型患者的HSS评分差异有统计学意义(P<0.05)。与髁间棘骨折块游离的胫骨平台骨折患者相比,非游离患者的HSS评分较高,差异有统计学意义(P<0.05)。将单因素分析中P<0.2的5个变量(年龄、骨折类型、医疗付款方式、住院时间、髁间棘骨折片是否游离)与HSS评分进行多重线性回归分析,只有骨折类型和髁间棘骨折块是否游离对膝关节功能恢复有显著影响。回归方程为:Y=125.591-7.790a-17.277b(Y表示HSS评分,a表示骨折类型,b表示髁间棘骨折块是否游离)。结论胫骨平台骨折综合分型Ⅰ、Ⅱ型(简单骨折)的短期随访预后较好,综合分型Ⅲ、Ⅳ、Ⅴ、Ⅵ型(复杂骨折)预后较差。对于膝关节侧位X线片中髁间棘骨折块游离的患者,建议进行复位固定,骨折块未游离者不予处理。

Objective To explore the factors related to functional recovery of the knee in patients with tibial plateau fracture complicated with intercondylar ridge fracture.Methods Included in this retrospective study were 63 patients who had been treated at Emergency Center of Trauma,The Third Hospital of Hebei Medical University from January to June 2019 for tibial plateau fracture complicated with intercondylar ridge fracture.They were 43 males and 20 females,aged from 18 to 66 years(average,43.9 years).According to our comprehensive classification of tibial plateau fractures,there were 27 simple ones(20 cases of typeⅠand 7 cases of typeⅡ)and 36 complicated ones(16 cases of typeⅢ,17 cases of typeⅣ,one of typeⅤand 2 cases of typeⅥ).To screen out major influencing factors,a multiple linear regression model was used to analyze the 12 factors that might affect functional recovery of the knee by the Hospital for Special Surgery(HSS)scoring:age,gender,occupation,fracture type,way of medical payment,cause of injury,operation method,starting time for rehabilitation,postoperative brace installation,time from injury to operation,length of hospital stay,and presence or absence of a free intercondylar ridge fracture fragment.Results The 63 patients were followed up for 6.0 to 7.1 months(average,6.1 months).The HSS knee scores ranged from 45 to 100 points(average,92.4 points).The HSS knee scores were significantly different between different fracture types(P<0.05).The HSS scores were significantly higher for the patients without a free intercondylar ridge fracture fragment than for those with(P<0.05).Multiple linear regression model analysis of the 5 variables with P<0.02 in the single factor analysis(age,fracture type,way of medical payment,hospital stay and presence or absence of a free intercondylar ridge fracture fragment)and HSS scores showed that only fracture type and presence or absence of a free intercondylar ridge fracture fragment had a significant impact on the knee function.Their regression equation was Y=125.591-7.790a-17.277b(Y indicates HSS score,a indicates fracture type and b indicates presence or absence of a free intercondylar ridge fracture fragment).Conclusions The short-term prognosis for tibial plateau fractures of comprehensive typesⅠ&Ⅱ(simple ones)may be better than that for tibial plateau fractures of comprehensive typesⅢ,Ⅳ,Ⅴ&Ⅵ(complicated ones).For patients with a free intercondylar ridge fracture fragment on their lateral knee X-ray film,effective reduction and fixation is indicated but is not for those without.