老年桡骨远端骨折小夹板治疗后早期腕关节功能恢复的相关因素分析

Analysis of factors associated with early recovery of wrist function after small splint treatment of distal radius fractures in the elderly

目的分析老年桡骨远端骨折小夹板治疗后早期腕关节功能恢复的相关因素。方法回顾性分析2020年1月至2023年1月于河北省唐山市第二医院收治的515例均行小夹板治疗的老年桡骨远端骨折患者临床资料,男286例,女229例,平均年龄(75.82±7.64)岁。根据腕关节恢复情况分为恢复良好组(n=350)、恢复不良组(n=165),随访并比较两组患者一般资料(年龄、性别、体质量指数、优势手、骨质疏松、高血压、糖尿病、高脂血症)、临床资料(粉碎性骨折、掌倾角背伸、短缩畸形、骨折类型、肿胀、僵硬)及治疗相关指标(夹板固定时间、功能锻炼、畸形愈合)、腕关节功能评估量表(Gartland-Werley评分、Cooney评分),采用多因素Logistic回归分析老年桡骨远端骨折小夹板治疗后腕关节功能恢复情况的影响因素。结果515例患者均获得完整随访,随访率100.00%,随访时间6个月~10个月。恢复不良组患者年龄≥75岁、骨质疏松占比明显高于恢复良好组(P<0.05)。恢复不良组患者粉碎性骨折、短缩畸形>5mm、骨折类型CooneyⅢⅣ占比明显高于恢复良好组(P<0.05)。恢复不良组患者夹板固定时间5周、无功能锻炼、畸形愈合占比明显高于恢复良好组(P<0.05)。恢复不良组患者Gartland-Werley评分[(12.36±2.07)分]明显高于恢复良好组[(4.52±1.39)分],Cooney评分[(78.72±4.16)分]明显低于恢复良好组[(90.26±3.45)分,(t=50.673、33.100,P<0.05)]。将单因素分析中差异具有统计学意义的因素进行赋值,同时进行多因素Logistic回归分析显示,年龄≥75岁(OR=7.471)、骨质疏松(OR=5.853)、粉碎性骨折(OR=3.785)、短缩畸形>5mm(OR=6.841)、骨折类型CooneyⅢ(OR=3.904)、Ⅳ(OR=3.904)、夹板固定时间5周(OR=3.540)、无功能锻炼(OR=4.845)、畸形愈合(OR=6.366)、Gartland-Werley评分(OR=5.034)是腕关节功能恢复不良的危险因素,Cooney评分(OR=6.354)是腕关节功能恢复不良的保护因素(P<0.05)。结论老年桡骨远端骨折小夹板治疗后早期腕关节功能恢复不良的概率较高,约占32.04%,其中年龄≥75岁、骨质疏松、粉碎性骨折、短缩畸形>5mm、骨折类型CooneyⅢ、Ⅳ、夹板固定时间5周、无功能锻炼、畸形愈合、Gartland-Werley评分、Cooney评分等均为腕关节功能恢复不良的影响因素,临床可根据患者情况及特点给予针对性治疗方案,有助于改善早期腕关节功能,帮助患者术后快速恢复。

Objective Analyze the related factors of early wrist joint function recovery after small splint treatment for elderly distal radius fractures.Methods A retrospective analysis was conducted on the clinical data of 515 elderly patients with distal radius fractures treated with mini splints at Tangshan Second Hospital in Hebei Province from January 2020 to January 2023.There were 286 males and 229 females with an average age of(75.82±7.64)years.According to the recovery of wrist joint,the patients were divided into good recovery group(n=350)and poor recovery group(n=165).The general data(age,gender,body mass index,dominant hand,osteoporosis,hypertension,diabetes,hyperlipidemia),clinical data(comminuted frac-ture,palmar inclination back extension,shortening deformity,fracture type,swelling,stiffness),treatment related indicators(splint fixation time,functional exercise,malunion),wrist joint function evaluation scale(Gartland Werley score,Cooney score)of the two groups were followed up and compared.Multifactor lo-gistic regression was used to analyze the influencing factors of wrist joint function recovery after the treat-ment of small splint for distal radius fracture in the elderly.Results All 515 patients were fully followed up,with a follow-up rate of 100.00%and a follow-up period of 6 to 10 months.The proportion of patients aged≥75 years and with osteoporosis in the group with poor recovery was significantly higher than that in the group with good recovery(P<0.05).The proportion of patients with comminuted fractures,shortening deformities greater than 5 mm,and fracture types CooneyⅢ-Ⅳin the group with poor recovery was signifi-cantly higher than that in the group with good recovery(P<0.05).The proportion of patients in the poor re-covery group who had a fixation time of 5 weeks,no functional exercise,and abnormal healing was signifi-cantly higher than that in the good recovery group(P<0.05).The Gartland Welley score(12.36±2.07 points)of patients with poor recovery was significantly higher than that of patients with good recovery(4.52±1.39 points),and the Cooney score(78.72±4.16 points)was significantly lower than that of patients with good recovery(90.26±3.45 points)(t=50.673,33.100,P<0.05).The factors with statistically significant differences in univariate analysis were assigned values,and multivariate logistic regression analysis showed that age≥75 years(OR=7.471),osteoporosis(OR=5.853),comminuted fractures(OR=3.785),dwarfism>5 mm(OR=6.841),and fracture type CooneyⅢ(OR=3.904).Ⅳ(OR=3.904),5 weeks of splint fixation time(OR=3.540),no functional exercise(OR=4.845),malunion(OR=6.366),and Gartland Welley score(OR=5.034)are risk factors for poor wrist joint function recovery,The Cooney score(OR=6.354)is a protective fac-tor for poor recovery of wrist joint function(P<0.05).Conclusions The probability of poor early recovery of wrist joint function in elderly patients with distal radius fractures treated with small splints is relatively high,accounting for about 32.04%.Among them,age≥75 years,osteoporosis,comminuted fractures,short-ening deformities>5 mm,fracture types CooneyⅢandⅣ,splint fixation time of 5 weeks,reactive exercise,malunion,Gartland Werley score,Cooney score,etc.are all influencing factors of poor wrist joint function re-covery.Clinically,targeted treatment plans can be given according to the patient's situation and characteris-tics,which can help improve early wrist joint function and help patients recover quickly after surgery.