后外侧支撑固定治疗胫骨平台后外侧髁骨折预后的多元Logistics回归分析  

Multivariate Logistic regression analysis of prognosis of posterolateral condylar fractures of tibial plateau treated with posterolateral buttress fixation

作　　者：于健 徐刚[1] 孙宏[2] 殷照阳[1] 盛路新[1] 厉雷明[1] 孙晓[1] 霍永峰[1] Yu Jian;Xu Gang;Sun Hong;Yin Zhaoyang;Sheng Luxin;Li Leiming;Sun Xiao;Huo Yongfeng(the First People’s Hospital of Lianyungang,Lianyungang 222002,Jiangsu Province,China;Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009,Jiangsu Province,China)

机构地区：[1]连云港市第一人民医院,江苏省连云港市222002 [2]江苏省疾病预防控制中心,江苏省南京市210009

出　　处：《中国组织工程研究》2019年第32期5138-5145,共8页Chinese Journal of Tissue Engineering Research

基　　金：连云港市卫计委面上项目(连卫2016-08),项目负责人:霍永峰~~

摘　　要：背景:累及胫骨平台后外侧髁骨折的治疗一直存在争议,主要集中在后外侧支撑固定的手术指征上,希望此次研究能对该问题的解答提供帮助。目的:探讨胫骨平台后外侧髁骨折患者采用后外侧支撑固定对其骨折预后的影响。方法:对连云港市第一人民医院2011年1月至2016年12月接受手术治疗的胫骨平台后外侧髁骨折患者进行随访调查。以美国特种外科医院膝关节评分作为观察指标,将患者影像学表现上的后外侧骨块前后径、外侧胫骨平台后倾角、后外侧柱皮质是否粉碎、是否合并腓骨近段骨折、是否合并内侧髁骨折等作为混杂因素,采用多元回归方法进行多因素分析,探讨后外侧支撑固定对患者预后的影响。结果与结论:(1)共随访获得200例患者的完整资料,随访时间12-24个月,末次调查时膝关节美国特种外科医院评分62-95分,平均(85.1±5.8)分;(2)单因素分析显示,后外侧骨块前后径、外侧胫骨平台后倾角、合并腓骨近段骨折、合并内侧髁骨折、后外侧支撑固定与累及后外侧髁的胫骨平台骨折术后美国特种外科医院评分均具有相关性(P<0.05);(3)多因素分层分析进一步确认,后外侧支撑固定可以提高后外侧骨块前后径<20 mm、合并腓骨近段骨折、胫骨外侧平台后倾角≥15°的患者术后1年随访的膝关节美国特种外科医院评分(P<0.01),但对后外侧骨块前后径≥20 mm患者的膝关节美国特种外科医院评分和满意度的提高无明显影响;(4)相对于前外侧排筏钢板固定,采用后外侧支撑固定可以大幅提升后外侧骨块前后径<20 mm患者的1年随访美国特种外科医院评分,建议对此类患者采用后外侧支撑固定。对于合并腓骨近端骨折、胫骨外侧平台后倾角≥15°的胫骨平台后外侧髁骨折患者,进行后外侧支撑固定也可以提高术后1年的美国特种外科医院评分优良率,建议作为参考指标。BACKGROUND:The treatment of the posterolateral condyle fracture involving the tibial plateau has always been controversial,mainly focusing on the surgical indications of the posterolateral support fixation.It is hoped that this study can provide help for the solution of this problem.OBJECTIVE:To study the effect of posterolateral buttress fixation on prognosis of patients with posterolateral condyle fracture of tibial plateau.METHODS:Follow-up survey was conducted in patients with posterolateral condylar fracture of tibial plateau treated surgically in the First People’s Hospital of Lianyungang from January 2011 to December 2016.The Hospital for Special Surgery score of knee joint was used as the observational index.The imaging differences of anteroposterior diameter of posterolateral bone mass,posterolateral tibial plateau obliquity,posterolateral cortex comminution,proximal fibula fracture and medial condyle fracture were taken as mixed factors.Multivariate regression analysis was used to study the effect of posterolateral buttress fixation on the prognosis of patients.RESULTS AND CONCLUSION:(1)The data of 200 patients were obtained with a follow-up time of 12-24 months.The Hospital for Special Surgery score of the knee joint at the last survey was from 62 to 95,mean 85.1±5.8.(2)Univariate analysis showed that anteroposterior diameter of posterolateral bone mass,posterior tilt angle of lateral tibial plateau,proximal fibular fracture,medial condylar fracture,and posterolateral buttress fixation were correlated with Hospital for Special Surgery score after operation for tibial plateau fracture involving posterolateral condyle(P<0.05).(3)Multivariate stratified analysis further confirmed that posterolateral buttress fixation could improve the Hospital for Special Surgery score of knee joint in patients with anterolateral bone mass diameter<20 mm,proximal fibular fracture,and the posterolateral tibial plateau inclination angle≥15°in one-year follow-up(P<0.01).However,no significant difference was found in th

关 键 词：胫骨平台骨折 后外侧 后倾角 支撑固定 LOGISTIC模型 预后分析 美国特种外科医院评分 

分 类 号：R459.9[医药卫生—治疗学] R687.32[医药卫生—临床医学]