基层医院胫骨骨折锁定板内固定失败的logistic分析及对策研究

Logistic Analysis and Countermeasures of Failure of Internal Fixation of Tibial Fracture Locking Plate in Primary Hospitals

目的:采用单因素和多因素logistic分析基层医院胫骨骨折锁定板内固定失败的危险因素,并提出预防措施。方法:回顾性分析本院2014年5月-2018年5月胫骨骨折锁定钢板内固定的116例患者的临床资料,其中内固定失败25例,其中伤口皮肤坏死3例,内固定物松动5例,钢板断裂7例,骨不连4例,骨延迟愈合6例。采用单因素和多因素logistic分析锁定板内固定失败可能的危险因素,包括年龄、性别、骨折类型、感染、钢板长度、螺钉密度、骨断端分离和负重时间。结果:单因素logistic分析发现现感染、钢板长度过短、螺钉密度过密、骨断端分离>5 cm和负重时间≤6周均是锁定板内固定失败的影响因素(P<0.05),年龄、性别、骨折类型均不是锁定板内固定失败的影响因素(P>0.05)。将单因素logistic分析中P<0.05的变量进行多因素logistic分析,结果发现感染、钢板长度过短、螺钉密度过密、骨断端分离>5 cm和负重时间≤6周均是锁骨板内固定失败的危险因素(P<0.05)。结论:感染、螺钉密度过密、钢板长度过短、骨断端分离和负重时间是胫骨骨折锁定板内固定失败的主要危险因素。术后预防感染、选择适当的螺钉数量,减少骨折断端间隙,延迟负重时间是降低内固定失败的关键措施。

Objective:To analyze the risk factors of internal fixation failure of tibial fracture locking plate in primary hospitals using single factor and multivariate logistic,and proposing preventive measures.Method:Clinical data of 116 patients with internal fixation with locking plate for tibial fracture in our hospital from May 2014 to May 2018 were retrospectively analyzed.Among them,there were 25 cases of internal fixation failure,including 3 cases of wound skin necrosis,5 cases of internal fixation loosening,7 cases of plate fracture,4 cases of bone nonunion,and 6 cases of delayed bone healing.Univariate and multivariate logistic analyses were used to analyze possible risk factors for failure of locking plate internal fixation,including age,sex,fracture type,plate length,screw density,fracture end separation,and loading time.Result:Univariate logistic analysis showed that infection,too short plate length,too dense screw density,bone fracture>5 cm and loading time≤6 weeks were all influential factors for failure of internal fixation of the locking plate(P<0.05).Age,sex and fracture type were not the influencing factors for failure of locking plate internal fixation(P>0.05).Multivariate logistic analysis showed that infection,too short plate length,too dense screw density,>5 cm of bone fracture separation and loading time≤6 weeks were all risk factors for failure of clavicular plate internal fixation(P<0.05).Conclusion:Infection,high screw density,short plate length,fracture end separation and loading time are the main risk factors for failure of internal fixation of locking plate for tibial fracture.Postoperative prevention of infection,selection of appropriate number of screws,reduction of fracture gap,delay loading time are the key measures to reduce the failure of internal fixation.