胫骨平台骨折手术疗效影响因素的探讨_胫骨骨折

　　[摘要] 目的 探讨胫骨平台骨折手术疗效的影响因素，为临床提供参考。 方法 采用前瞻性研究的方法对本院2008年4月～2010年4月收治的42例胫骨平台骨折患者的手术后的疗效进行分析；并对影响胫骨平台骨折手术疗效的因素进行多因素非条件Logistic回归分析。 结果 对影响胫骨平台骨折手术疗效的可疑高危因素先进行单因素分析，膝关节周围合并伤、术后并发症、术后康复、骨折类型及手术复位情况等5个方面，差异有统计学意义（P < 0.05）。将单因素分析有显著统计学意义的变量进行多因素非条件Logistic回归分析，结果显示术后康复、术后并发症、骨折类型及手术复位情况差异具有统计学意义（P < 0.05），是影响胫骨平台骨折手术疗效的独立危险因素。 结论 解剖复位、牢靠的内固定是取得满意手术疗效的基础；术后康复、术后并发症、骨折类型及手术复位情况等因素是影响胫骨平台骨折手术疗效的主要因素。
　　[关键词] 胫骨平台骨折；单因素分析；Logistic回归分析；手术
　　[中图分类号] R683.42 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0036-02
　　The study on operative efficacy effect factors of fracture of tibial plateau
　　LI Yonggao MA Jianfan ZHANG Hao TAN Jiajin
　　Taishan People′s Hospital of Jiangmen in Guangdong Province, Taishan 529200, China
　　[Abstract] Objective To explore the influencing factors of the operative efficacy of fracture of tibial plateau, and it provided reference for clinical. Methods The prospective study method was used, 42 patients with fracture of tibial plateau were analyzed in our hospital from April 2008 to April 2010, and the influence factors on the operative efficacy of fracture of tibial plateau had aunconditional Logistic regression was analyzed. Results Suspected risk factors had single factor was analyzed, among them around the knee joint united injury and complications of injury, postoperative rehabilitation, fracture types and surgical reset condition, the difference was statistically significant (P < 0.05). Single factor analysis had statistically significant meaning of variables, which had unconditional Logistic regression analysis, and the results showed that the postoperative rehabilitation, the postoperative complications, fracture types and surgical restoration, the difference was statistically significant (P < 0.05), it was independent risk factors for surgical curative effect. Conclusion Anatomical reattachment, reliable internal fixation with satisfactory curative effect is the foundation of operation; Postoperative rehabilitation, the postoperative complications, fracture types and surgical reduction factors such as the situation is the main factors of curative effect.
　　[Key words] Fracture of tibial plateau; Single factor analysis; Logistic regression analysis; Surgery
　　胫骨平台骨折为关节内骨折，也称为胫骨髁部骨折，可伴有程度不同的关节面移位和压缩。胫骨平台附近解剖结构相对复杂、移位形式也多样化、其复位及内固定难度大，术后并发症多[1]。因此，探讨胫骨平台骨折手术疗效的相关因素对提高疗效有积极的临床意义。本研究采用前瞻性研究的方法对本院2008年4月～2010年4月收治的42例胫骨平台骨折患者的手术疗效影响因素进行分析，现汇报如下：
　　1 资料与方法
　　1.1 一般资料
　　采用前瞻性研究的方法，选择本院2008年4月～2010年4月住院的42例胫骨平台骨折患者作为研究对象进行研究，所有患者均有完备的随访资料，其中，男性22例，女性20例，年龄在16～76岁，平均（46.2±8.2）岁。按Schatzker骨折分型，内侧平台骨折（Ⅳ型）12例；内、外侧平台双髁骨折（Ⅴ型）15例；同时有关节面骨折和干骺端骨折（Ⅵ型）15例。15例患者膝关节周围合并损伤，其中5例前交叉韧带及止点撕裂，4例后交叉韧带损伤，3例内侧半月板损伤，1例外侧半月板损伤，2例内侧副韧带损伤。术后1年内对患者主观症状、临床功能检查及X线检查（膝关节正、侧位X线平片）进行随访。