桡骨头骨折术后肘关节旋转功能障碍危险因素分析

Risk factors of elbow joint rotation dysfunction afteRradial head surgeries

目的探讨桡骨头术后肘关节旋转功能障碍的相关危险因素。方法回顾性分析首都医科大学附属北京积水潭医院创伤骨科2023年1月—2023年12月因桡骨头骨折行手术治疗的82例患者,其中男性45例,女性37例;年龄20~83岁,平均43.9岁;右侧43例,左侧39例;高能量损伤28例,低能量损伤54例;Mason分型Ⅱ、Ⅲ、Ⅳ型分别为46、21及15例。开放性损伤25例,闭合性损伤57例。根据术后6个月及以上其肘关节活动范围是否>100°分为旋转功能障碍组(20例)和非旋转功能障碍组(62例),分析年龄、性别、BMI、受伤侧别、骨折Mason分型、复位质量、致伤机制、受伤时软组织状态(开放与闭合)、手术方式、受伤至手术时间、术后制动时间及是否使用抗异位骨化药物等影响因素与肘关节旋转功能障碍的相关性。结果单因素分析表明,旋转功能障碍组中复位质量差(35.0%)、高能量损伤(60.0%)、开放性损伤(70.0%)、骨折Mason分型Ⅲ型(30.0%)及Ⅳ型(30.0%)、受伤至手术时间>7 d(70.0%)、术后制动时间>2周(60.0%)、未使用抗异位骨化药物患者比例(50.0%)显著高于非旋转功能障碍组[复位质量差(17.8%)、高能量损伤(25.8%)、开放性损伤(17.7%)、骨折Mason分型Ⅲ型(24.2%)、Ⅳ型(14.5%)、受伤至手术时间>7 d(22.6%)、术后制动时间>2周(32.3%)、未使用抗异位骨化药物患者比例(22.6%)],差异均有统计学意义(P<0.05)。多因素Logistic回归分析表明,骨折Mason分型Ⅲ型及Ⅳ型、复位质量差、高能量损伤、开放损伤、受伤至手术时间>7 d及术后制动时间>2周为桡骨头骨折术后肘关节旋转功能障碍的独立危险因素。结论骨折Mason分型Ⅲ型及Ⅳ型、复位质量差、高能量损伤、开放损伤、受伤至手术时间>7 d及术后制动时间>2周是桡骨头骨折术后肘关节旋转功能障碍的危险因素。

Objective To investigate the risk factors associated with elbow rotation dysfunction afteRradial head surgery.Methods This retrospective analysis was performed on 82 patients admitted to the Department of Traumatic Orthopedics,Beijing Jishuitan Hospital,Capital Medical University,undergoing surgical treatment foRradial head fractures from Jan.2023 to Dec.2023,including 45 males and 37 females.The age ranged from 20 to 83 years,mean 43.9 years.Among them,43 cases involved the right side and 39 the left;28 were high energy injuries and 54 were low energy;46 were of Mason typeⅡ,21 of typeⅢand 15 of typeⅣ;25 were open fractures and 57 were closed.Patients were divided into rotation dysfunction group and non-rotation dysfunction group according to whetheRthe range of motion of the elbow joint was>100°at 6 months afteRsurgery and longer.The correlation of age,gender,body mass index(BMI),injury side,Mason classification,reduction quality,injury mechanism,soft tissue status(open oRclosed)at the time of injury,surgical method,time from injury to surgical treatment,postoperative immobilizaton time,and use of anti-heterotopic ossification drugs were analyzed.Results There were 20 patients in the rotation dysfunction group and 62 in the non-rotation dysfunction group.Univariate analysis showed that the rotation dysfunction group had significantly higheRproportions of patients with unsatisfied reduction(35.0%vs.17.8%),high-energy damage(60.0%vs.25.8%),open fractures(70.0%vs.17.7%),Mason typeⅢ(30.0%vs.24.2%)andⅣ(30.0%vs.14.5%),injury to surgery time>7 d(70.0%vs.22.6%),postoperative immobilizaton time>2 weeks(60.0%vs.32.3%),and no use of anti-heterotopic ossification drugs(70.0%vs.17.7%),all revealing significant difference compared with the non-rotation dysfunction group(all P<0.05).Multiariable logistic regression analysis showed that Mason typeⅢandⅣradial head fractures(OR=3.471,95%CI=1.333-9.037),unsatisfied reduction(OR=3.457,95%CI=1.386-8.622),high-energy injuries(OR=2.223,95%CI=1.435-9.227),open fractures(OR=3.368,95%CI=1.403-8.702),injury to operating time>7 d(OR=3.546,95%CI=1.641-9.032),and postoperative immobilizaton time>2 weeks(OR=3.271,95%CI=1.373-7.746)were independent risk factors foRradial head elbow rotation dysfunctions afteRsurgical management.Conclusion FoRpatients with radial head fractures,those of Mason typeⅢ/ⅣoRwith pooRreduction quality,high-energy injury,open fracture,time from injury to surgery>7 d,oRpostoperative immobilizaton time>2 weeks have a higheRrisk of elbow rotation dysfunction and should be paid more attention to.