摘要
[目的]探讨影响股骨髁间骨折术后膝关节功能恢复的因素。[方法]回顾分析2008年1月～2013年5月收治的89例股骨髁间骨折患者临床资料。男49例,女40例;年龄23～65岁,平均45岁。致伤原因:车祸伤45例,高空坠落伤26例,压砸伤12例,直接暴力击伤6例。Muller分型:C1型50例,C2型28例,C3型11例。术前损伤严重程度计分法(ISS)评分12～29分,平均20.4分;手术据受伤时间为4 h～24 d,平均7 d。内固定采用LISS钢板54例,逆行交锁髓内钉18例,松质骨螺钉、螺栓、克氏针17例。采用非条件logistic回归模型探讨患者年龄、性别、术前ISS评分、手术时机、骨折类型、手术入路、内固定方式、膝关节囊的处理、复位质量、是否CPM功能锻炼与术后膝关节功能恢复的关系。[结果]89例均获随访,随访时间15～26个月,平均18.1个月。术后切口Ⅰ期愈合84例;切口延迟愈合5例,换药1个月内Ⅱ期愈合。术后5例出现下肢深静脉血栓,经溶栓治疗后好转。25例膝关节粘连、关节活动度<90°,17例创伤性关节炎,2例患者膝关节轻度外翻,1例患肢比健肢短缩2cm。骨折愈合时间3～6个月,平均3.9个月。末次随访时依据Merchan标准评价膝关节功能:优49例,良15例,可10例,差15例,优良率为71.91%。单因素分析显示,术前ISS评分、骨折类型、膝关节囊的处理、复位质量、是否CPM功能锻炼与术后膝关节功能相关;多因素Logistic回归分析显示,骨折类型、膝关节囊的处理、复位质量、是否CPM功能锻炼为主要影响因素。[结论]关节面解剖复位,坚强固定,修复膝关节囊,术后早期主动、被动功能锻炼,有利于股骨髁间骨折术后膝关节功能恢复;术前合并损伤越重,骨折越粉碎,预后越差。
[ Objective ] To investigate the factors influencing functional recovery of the knee after surgery for femoral inter- condylar fracture. [ Method] A total of 89 patients （49 males ,40 females） were treated for femoral intercondylar fractures be- tween January 2008 and May 2013. The average age of the patients was 45 years （ range,23 - 65 years）. The causes of the frac- tures were traffic accidents （45 patients）, falling froma height （ 26 patients）, bruising （ 12 patients ）, and tumbling （ 6 patients ）. The cases were classified, based on Mullerg fracture classification, as Type C 1 （50 patients）, Type C2 （28 patients）, and Type C3 （11 patients）. The preoperative injury severity score （ISS） range was 12 -29 （mean,20.4）. The duration from injury to surgery was 4 -24 days （mean, 7 days）. The patients were treated by using the Less invasive stabilization system（LISS） plate （54 patients）, retrograde interlocking intramedullary nail （18patients）, and bone screws, bolts and internal fixation with Kir- schner pins （17 patients）. Unconditional logistic analysis was used to analyze the relationship between age, sex, ISS, opportunity for surgical treatment, classification of the fracture, operative approach, treatment of joint capsule, outcome of reduction, and em- ployment of CPM functional training. [ Result] All 89 patients had a follow -up in 15 -26 months （mean, 18.1 months）. The wound healed by first intention in 84 cases, while delayed healing occurred in the remaining 5 cases. The patients presented with deepvein thrombosis （6 patients）, extensor device adhesions and scope of activities 〈 80% （ 25 patients）, traumatic arthritis （ 17 patients）, mild knee varus （2 patients）, and limb shortening （ 1 patient）. The healing time of fractures was 3 -6 months （mean, 3.9 months）. According to the Merchant knee function scoring system, the results were excellent in 4-5 cases, good in 15 cases ,fair in 10 cases,and poor in 15 cases with an excellent and good results rate of 71.91% at the last follow -up. Single fac- tor analysis showed that the injury severity score, classification of the fracture, treatment of joint capsule, outcome of reduction,and employment of CPM functional training were prognostic factors. Logistic regression analysis showed that classification of the fracture, treatment of joint capsule, outcome of reduc- tion, and employment of CPM functional training were major factors in the recovery of knee function. [ Conclusion ] Ana-tomical reduction of fractures and finn fixation, good condition of the joint capsule following repair, early postoperative active, and passive functional exercises contributed to the restoration of knee function. The prognosis was directly proportional to the ex- tent of the preoperative combined injury and the fracture injury.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第24期2443-2448,共6页
Orthopedic Journal of China
关键词
股骨髁间骨折
膝关节功能
相关因素
femoral intercondylar fracture, knee function, influencing factor
