复杂胫骨平台骨折术后并发膝关节僵硬的高危因素分析  

Analysis of high risk factors of postoperative stiffness knee in complex tibial plateau fractures

作　　者：徐云钦[1] 李强[1] 申屠刚[1] 苏佩华[1] 王刚[1] 姚有榕[1] 邓盼[1] 罗正理[1] 魏强强[1] 邱成斌[1] 陈伟[1] 沈海强[1] 

机构地区：[1]解放军第98医院全军创伤骨科中心骨四科,浙江湖州313000

出　　处：《中国骨与关节损伤杂志》2015年第4期364-367,共4页Chinese Journal of Bone and Joint Injury

基　　金：南京军区医学科技创新课题(13ZD03;12WQ01)

摘　　要：目的分析手术治疗复杂胫骨平台骨折术后并发膝关节僵硬的高危因素。方法回顾性分析自2001-01—2013-01诊治的190例SchatzkerⅤ、Ⅵ型复杂胫骨平台骨折,其中40例(21.1%)术后并发膝关节僵硬。采用单因素Logistic回归分析术前、术中、术后共22个临床评估因素,对上述有意义的影响因素(P<0.05)再采用多因素Logistic回归分析确定复杂胫骨平台骨折术后并发膝关节僵硬的高危因素。结果通过单因素Logistic回归分析确定导致复杂胫骨平台骨折术后膝关节僵硬的相关因素包括:合并膝关节周围损伤、高能量损伤、肥胖、关节面复位质量、石膏制动时间、伤口感染、软组织缺损、关节异位骨化、规范康复指导、下肢深静脉血栓形成。通过多因素Logistic回归分析确定导致复杂胫骨平台骨折术后膝关节僵硬的高危因素包括:合并膝关节周围多处损伤、关节面恢复质量差、术后长时间石膏制动、术后缺乏规范化的康复治疗、膝关节周围异常骨化、皮肤软组织广泛缺损。结论关节面恢复质量欠佳、长时间石膏制动、膝关节周围异位骨化及缺乏积极主动功能锻炼将严重影响患者术后关节功能康复质量,并可能导致膝关节僵硬。Objective To analyze high risk clinical factors of postoperative stiffness knee in complex tibial plateau fractures.Methods A retrospective analysis of 190 cases of Schatzker V-VI type fracture from January 2001 to January 2013 was performed, in which 40 cases（21.1%） had postoperative knee stiffness. The univariate logistic regression analysis was adopted to analyze a total of 22 perioperative, intraoperative, and postoperative clinical factors. The indentified significant factors（ P 〈0.05） were analyzed using multivariate logistic regression analysis. Results The clinical factors were identified by univariate logistic regression, and those whose P was below 0.05 included： popliteal injuries around the knee, high-energy injuries,severe obesity, poor quality recovery of the articular surface, gypsum braking time, duration of closed plaster, wound infection,soft tissue defects, joint heterotopic ossification, standardized rehabilitation guidance, and deep venous thrombosis in leg. The indentified significant factors（P 〈0.05） were analyzed using multivariate logistic regression analysis, and those whose P was also below 0.05 included： several popliteal injuries around the knee, poor quality recovery of the articular surface, long duration of closed plaster, lack of standardized rehabilitation guidance, abnormal ossification around joint, a wide range of skin and soft tissue defects. Conclusion The factors including poor quality recovery of the articular surface, postoperative long duration of closed plaster, abnormal ossification around the knee, and lack of active functional exercise, affect the quality of postoperative joint function rehabilitation.

关 键 词：复杂胫骨平台骨折 手术治疗 关节僵硬 高危因素 LOGISTIC回归分析 

分 类 号：R687.3[医药卫生—骨科学]