摘要
目的探讨不同Schatzker分型胫骨平台骨折疗效及预后影响因素。方法选取2016年1月到2021年10月青岛市胶州中心医院收治的70例符合Schatzker分型胫骨平台骨折患者作为研究对象进行回顾性分析,依照Schatzker分型进行分组,分为Ⅰ型组(n=5)、Ⅱ型组(n=16)、Ⅲ型组(n=23)、Ⅳ型组(n=8)、Ⅴ型组(n=12)和Ⅵ型组(n=6),所有患者均采取手术治疗。对比不同Schatzker分型患者的临床疗效与术后并发症发生率。随后将术后评价为优和良的患者分为预后良好组(n=55),将可和差的患者分为预后不良组(n=15)。对比两组患者临床一般资料,手术及术后情况,并应用Logistic回归分析分析影响不同Schatzker分型胫骨平台骨折疗效的独立因素。结果70例患者术后总优良率为78.57%(55/70),其中Ⅰ型组为100.00%,Ⅱ型组为87.50%,Ⅲ型组为86.91%,Ⅳ型组为75.00%,Ⅴ型组为58.33%,Ⅵ型组为50.00%,虽然Ⅰ型组优良率高于其他分型,但组间比较,差异无统计学意义(P>0.05);70例患者术后并发症发生率为18.57%(13/70),其中畸形愈合2例,创伤性关节炎2例,膝关节僵硬2例,关节面塌陷1例,皮肤坏死3例,切口感染2例,复位不良2例,但不同Schatzker分型胫骨平台骨折患者术后并发症发生率比较比差异无统计学意义(P>0.05),预后良好组与预后不良组性别、年龄、体重指数、合并高血压、合并糖尿病、受伤原因比较,差异无统计学意义(P>0.05),合并骨质疏松、骨折类型、膝关节周围合并伤情况,差异均有统计学意义(P<0.05);预后良好组与预后不良组手术时间、术中出血量、手术时机比较,差异无统计学意义(P>0.05),术后并发症、复位情况、早期术后康复情况比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果表明:骨折类型、膝关节周围合并伤、术后并发症、早期术后康复为胫骨平台骨折预后的独立影响因素(P<0.05)。结论不同Schatzker分型之间的优良率与并发症发生率对比并无明显差异。另外,骨折类型、膝关节周围合并伤、术后并发症、早期术后康复为影响胫骨平台骨折的独立因素。
Objective To investigate the curative effect and prognostic factors of tibial plateau fractures with different Schatzker classifications.Methods Seventy patients with tibial plateau fracture who met the Schatzker classification from January 2016 to October 2021 in Qingdao Jiaozhou Central Hospital were selected for retrospective analysis.They were divided into typeⅠgroup(n=5),typeⅡgroup(n=16),typeⅢgroup(n=23),typeⅣgroup(n=8),type V group(n=12)and typeⅥgroup(n=6)according to the Schatzker classification.All patients were treated with surgery,The clinical efficacy and postoperative complication rate of patients with different Schatzker classification were compared.Subsequently,the patients evaluated as excellent and good after surgery were divided into good prognosis group(n=55)and poor prognosis group(n=15).The general clinical data,surgery and postoperative conditions of the two groups were compared,and the independent factors affecting the efficacy of different Schatzker classification tibial plateau fractures were analyzed by logistic regression analysis.Results The overall excellent and good rate of 70 patients was 78.57%(55/70),including 100.00%in type I group,87.50%in typeⅡgroup,86.91%in typeⅢgroup,75.00%in typeⅣgroup,58.33%in type V group,and 50.00%in typeⅥ.Although the excellent and good rate of type I group was higher than that of other types,there was no significant difference in comparison(P>0.05).The incidence of postoperative complications in 70 patients was 18.57%(13/70),including 2 cases of malunion,2 cases of traumatic arthritis,2 cases of knee stiffness,1 case of articular surface collapse,3 cases of skin necrosis,2 cases of incision infection,and 2 cases of poor reduction.However,there was no significant difference in the incidence of postoperative complications among patients with tibial plateau fractures of different Schatzker classifications(P>0.05);there was no significant difference in gender,age,body mass index,hypertension,diabetes,and injury cause between the good prognosis group and the poor prognosis group(P>0.05),but there was significant difference in osteoporosis,fracture type,and combined injuries around the knee joint(P<0.05);there was no significant difference between the group with good prognosis and the group with poor prognosis in terms of operation time,intraoperative bleeding and operation time(P>0.05),but there was significant difference in postoperative complications,reduction and early postoperative rehabilitation(P<0.05).The results of logistic regression analysis showed that the type of fracture,combined injuries around the knee joint,postoperative complications,and early postoperative rehabilitation were independent prognostic factors of tibial plateau fracture(P<0.05).Conclusion The overall excellent and good rate of patients with tibial plateau fracture is 78.57%,and the complication rate is 18.57%.There is no significant difference between the excellent and good rate and the complication rate among different Schatzker classifications.In addition,the type of fracture,combined injuries around the knee joint,postoperative complications,and early postoperative rehabilitation are independent factors affecting tibial plateau fracture.
作者
姚大伟
况倩倩
高绪敏
YAO Da-wei;KUANG Qian-qian;GAO Xu-min(Department of Spinal Trauma,Qingdao Jiaozhou Central Hospital,Qingdao Shandong 266300,China;Department of Anesthesiology,Qingdao Jiaozhou Central Hospital,Qingdao Shandong 266300,China)
出处
《临床和实验医学杂志》
2023年第5期503-506,共4页
Journal of Clinical and Experimental Medicine
基金
山东省医药卫生科技发展计划项目(编号:202104070268)。
