桡骨远端骨折术后腕关节功能不良的危险因素分析

Risk factors analysis of wrist joint dysfunction after surgery for distal radius fractures

目的探索桡骨远端骨折内固定术后1年腕关节功能不良的危险因素。方法按照纳入及排除标准回顾性分析自2016年10月至2021年10月因桡骨远端骨折于我科接受掌侧锁定钢板内固定治疗的183例桡骨远端骨折患者资料, 以骨折1年后PRWE评分≥20作为腕关节功能不良标准。首先采用卡方检验对相关因素进行单因素检验, 然后选取差异有统计学意义(P<0.05)的因素进行多因素Logistic回归分析, 确定腕关节功能不良的独立危险因素。结果术后患者获得12~18个月随访, 平均14.6个月, 末次随访时27例存在腕关节功能不良, 约占14.8%。多因素Logistic回归分析结果显示:TFCC损伤、骨折端三维匹配不良、冠状位骨性结构匹配不良是桡骨远端骨折患者术后1年腕关节功能不良的独立危险因素。结论桡骨远端骨折术后腕关节功能不良是多种因素综合作用的结果, 骨科医师在诊疗过程中应全面评估, 科学防治, 提高患者功能预后水平。

Objective To explore the risk factors for wrist dysfunction lyear after internal fixation of distal radius fracture.Methods According to the inclusion and exclusion criteria,a retrospective analysis was conducted on the data of 183 patients with distal radius fractures who received volar locking plate internal fixation treatment in our department from October 2016 to October 2021.The PRWE score≥20 after 1 year of fracture was used as the criterion for wrist joint dysfunction.Firstly,a chi square test was used to conduct a univariate test on relevant factors,and then factors with statistically significant differences(P<0.05)were selected for multivariate logistic regression analysis to determine the independent risk factors for wrist joint dysfunction.Results The postoperative patients were follow-up for 12 to 18 months,with an average of 14.6 months.At the last follow-up,27 patients had wrist joint dysfunction,accounting for approximately 14.8%.The results of multivariate logistic regression analysis showed that TFCC injury,poor three-dimensional matching of the fracture end,and poor matching of the coronal bone structure were independent risk factors for wrist joint dysfunction in patients with distal radius fractures at 1 year after surgery.Conclusion The wrist joint dysfunction after surgery for distal radius fractures is the result of a combination of multiple factors.Orthopedic surgeons should comprehensively evaluate,scientifically prevent and treat,and improve the patient's functional prognosis during the diagnosis and treatment process.