桡骨远端骨折夹板外固定治疗对腕关节功能恢复的影响因素分析  

Influence factor analysis of wrist joint function recovery in splint external fixation of distal radius fractures

作　　者：赵奇[1] 刘世清[1] 明江华[1] 周炎[1] 廖琦[1] 张春[1] 杨越[1] 

机构地区：[1]武汉大学人民医院骨科

出　　处：《临床外科杂志》2015年第5期343-346,共4页Journal of Clinical Surgery

摘　　要：目的：探讨桡骨远端骨折夹板外固定治疗腕关节功能恢复的影响因素，为提高临床疗效提供依据。方法150例桡骨远端骨折的患者，行手法复位夹板外固定后，随访9～12个月，首先进行单因素分析，采用χ2检验对年龄、性别、掌倾角背伸是否＜10°、尺倾角是否＞15°、短缩畸形是否＞5 mm、骨折类型、有无骨质疏松、是否为严重粉碎性骨折、是否肿胀、固定后1周内是否复查、有无进行功能锻炼共11个因素与桡骨远端骨折夹板外固定治疗腕关节功能恢复相关关系进行单因素分析，逐一剔除无统计学意义的变量。在单因素分析的基础上，采用多因素 Logistic 回归分析影响桡骨远端骨折夹板外固定治疗腕关节功能恢复的因素。结果Gartland 及 Werley 腕关节评分89例患者评定为优，32例患者评定为良，21例患者评定为可，8例患者评定为差，优良率80．67％。年龄＞60岁组与年龄≤60岁组优良率分别为75．73％、91．49％；56例男患者与94例女患者优良率分别为71．42％、86．17％；短缩畸形＞5 mm 组与≤5 mm 组优良率分别为46．81％、96．11％；CooneyⅠ、Ⅱ组（关节外骨折组）与 CooneyⅢ、Ⅳ（关节外骨折组）优良率分别为96．26％、41．86％；骨质疏松组和无骨质疏松组优良率分别为78．72％、83．93％；粉碎性骨折组与非粉碎性骨折组优良率分别为25．00％、93．44％；1周内复查组和1周无复查组优良率分别为98．31％、12．90％，以上差异均有统计学意义。结论骨折类型、严重粉碎、复查3个因素是影响桡骨远端骨折夹板外固定治疗腕关节功能恢复的主要因素。桡骨远端骨折夹板外固定治疗腕关节功能恢复除了与骨折本身的特点和受伤的程度有关外，人为可控因素应受到重视，门诊一定要向患者交代病情及相关注意事项，尤其是第一周的来院复查显得尤为重要。Objective To investigate influence factors of wrist joint function recovery in splint external fixation of distal radius fractures and provide references for improving the clinical curative effect. Methods One hundred and fifty cases of distal radius fractures treated by splint external fixation from August 2012 to August 2013 in our department were analyzed retrospectively.All patients were followed up for 9 to 12 months.Univariate analysis was performed byχ2 based on age,gender,palm tilt,ulnar inclina-tion,shortening deformation,fracture type,osteoporosis,severe comminuted fracture,swelling,review,func-tional exercise and so on.Multivariate logistic regression analysis was also applied for further analysis of influence factors.Results One hundred and fifty cases of distal radius fractures were followed up for 9 to 12 months,with an average of 11 months.Gartland and Werley Score showed excellent in 89 cases,good in 32 cases,fair in 21 cases,and poor in 8 cases.The over-all excellent and good rate was 80.67%.Among of them,the excellent and good rates were 75.73% in patients over 60 years and 91.49% in patients less than or equal to 60 years;71.42% in 56 male cases and 86.17% in 94 female cases;96.11% in patients with deformation less than 5 mm and 46.81% in patients with deformation greater than 5 mm;96.26% in CooneyⅠandⅡgroup and 41.86% in Cooney Ⅲ and Ⅳ group;78.72% in non-osteoporosis group and 83.93% in osteoporosis group;25.00% in non-comminuted fracture group and 93.44% in comminuted fractures group;98.31% in review group（within a week）and 12.90% in control group（over a week）,re-spectively.The above differences were all significant between groups（P 〈0.05）.Conclusion Fracture type,severe comminuted fracture,and review are the main factors related to wrist joint function recovery in＆amp;nbsp;splint external fixation of distal radius fractures.Beside the fracture characteristic of and injury extent,arti-ficial controllable factors should be taken seriously in wrist joint function recov

关 键 词：桡骨远端骨折 夹板固定 功能恢复 LOGISTIC 回归 

分 类 号：R687.3[医药卫生—骨科学]