钢板治疗不稳定骨盆骨折术后关节功能的影响因素分析  

Factors associated with joint function after plate fixation of unstable pelvic fractures

作　　者：黄国伟[1] 殷小军[1] 周正明[1] 汤志军[1] 

机构地区：[1]江苏省江阴市人民医院骨科,214400

出　　处：《中华创伤骨科杂志》2016年第3期257-260,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨钢板治疗不稳定骨盆骨折术后关节功能的影响因素。方法2007年1月至2014年9月间采用钢板固定治疗的168例不稳定骨盆骨折患者，其中109例获得随访，男69例，女40例；年龄23～72岁，平均46．3岁。骨折按Tile分型：Bl型15例，B2型37例，B3型14例，c1型19例，c2型16例，c3型8例。根据随访期间Majeed功能评定标准评价关节功能，并将患者分为优良组（86例，78．9％）和可差组（23例，21．1％）。收集患者的性别、年龄、术前损伤严重程度评分（ISS）、体重指数、手术时机、骨折类型、骨折复位质量、术后并发症情况、骨密度、术后负重时间等。采用logistics回归分析确定影响关节功能的因素。结果所有患者术后随访12～53个月，平均18．7个月。术前ISS（P=0．000）、骨折类型（P=0．008）、骨折复位质量（P=0．009）、术后并发症（P=0．000）是影响钢板治疗不稳定骨盆骨折患者的术后关节功能的危险因素。结论临床应前瞻性使用ISS评估患者病情，明确骨盆骨折类型，尽量对骨折解剖复位，降低骨盆骨折术后并发症的发生率，从而提高不稳定骨盆骨折患者的术后功能恢复。Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures. Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014. They were 69 men and 40 women, 23 to 72 years of age （average, 46.3 years）. By the Tile classification, 15 cases were type B1, 37 type B2, 14 type B3, 19 type C1, 16 type C2, and 8 type C3. Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation. There were 86 cases in the good-to-excellent group （78.9%） and 23 in the fair-to-poor group （21.1%）. Their data were analyzed in terms of gender, age, preoperative injury severity scale （ISS）, body mass index （BMI）, operation time, fracture type, reduction quality, postoperative complications, bone density, and postoperative weight bearing time. The influential factors were determined using Logistic regression analysis. Results All the 109 patients obtained a mean follow-up of 18.7 months （from 12 to 53 months）. Preoperative ISS （ P =0. 000）, fracture type （ P =0. 008）, reduction quality （ P = 0. 009） and postoperative complications （ P = 0. 000） were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures. Conclusion Preoperative assessment by ISS, a clear understanding of the pelvic fracture type, anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.

关 键 词：骨盆 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]