中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
3期
208-212
,共5页
股骨髁间骨折%膝关节%功能恢复%危险因素
股骨髁間骨摺%膝關節%功能恢複%危險因素
고골과간골절%슬관절%공능회복%위험인소
femoral intercondylar fracture%knee joint%functional recovery%risk factors
背景：股骨髁间骨折内固定术后常出现膝关节功能受限，但对其功能受限的发生机制及影响因素尚无定论。目的：探究股骨髁间骨折术后膝关节功能恢复的影响因素。方法：选取2009年2月至2014年2月我院收治的股骨髁间骨折患者118例，均行切开复位内固定治疗，术后进行随访。记录并分析患者的年龄、性别、骨折原因、骨折类型、手术时机、ISS评分、固定方式、复位效果、关节囊修复、骨愈合情况和是否进行CPM功能锻炼等。结果：单因素分析显示，骨折类型为C2和C3、创伤严重评分高（ISS评分＞16分）、非解剖复位、关节囊未修复、骨愈合情况为愈合延迟和不愈合、不进行CPM功能锻炼的患者股骨髁间骨折术后膝关节功能恢复较差，有统计学差异（P＜0.05）；多因素分析显示，骨折类型为C2和C3、ISS评分＞16分、非解剖复位、关节囊未修复、骨愈合情况为愈合延迟和不愈合、不进行CPM功能锻炼是患者术后膝关节功能恢复的危险因素（P＜0.05）。结论：膝关节骨折越粉碎，合并损伤越重，预后越差。膝关节坚强固定、解剖复位、膝关节囊修复、术后早期被动及主动进行功能锻炼有利于股骨髁间骨折术后膝关节功能恢复。
揹景：股骨髁間骨摺內固定術後常齣現膝關節功能受限，但對其功能受限的髮生機製及影響因素尚無定論。目的：探究股骨髁間骨摺術後膝關節功能恢複的影響因素。方法：選取2009年2月至2014年2月我院收治的股骨髁間骨摺患者118例，均行切開複位內固定治療，術後進行隨訪。記錄併分析患者的年齡、性彆、骨摺原因、骨摺類型、手術時機、ISS評分、固定方式、複位效果、關節囊脩複、骨愈閤情況和是否進行CPM功能鍛煉等。結果：單因素分析顯示，骨摺類型為C2和C3、創傷嚴重評分高（ISS評分＞16分）、非解剖複位、關節囊未脩複、骨愈閤情況為愈閤延遲和不愈閤、不進行CPM功能鍛煉的患者股骨髁間骨摺術後膝關節功能恢複較差，有統計學差異（P＜0.05）；多因素分析顯示，骨摺類型為C2和C3、ISS評分＞16分、非解剖複位、關節囊未脩複、骨愈閤情況為愈閤延遲和不愈閤、不進行CPM功能鍛煉是患者術後膝關節功能恢複的危險因素（P＜0.05）。結論：膝關節骨摺越粉碎，閤併損傷越重，預後越差。膝關節堅彊固定、解剖複位、膝關節囊脩複、術後早期被動及主動進行功能鍛煉有利于股骨髁間骨摺術後膝關節功能恢複。
배경：고골과간골절내고정술후상출현슬관절공능수한，단대기공능수한적발생궤제급영향인소상무정론。목적：탐구고골과간골절술후슬관절공능회복적영향인소。방법：선취2009년2월지2014년2월아원수치적고골과간골절환자118례，균행절개복위내고정치료，술후진행수방。기록병분석환자적년령、성별、골절원인、골절류형、수술시궤、ISS평분、고정방식、복위효과、관절낭수복、골유합정황화시부진행CPM공능단련등。결과：단인소분석현시，골절류형위C2화C3、창상엄중평분고（ISS평분＞16분）、비해부복위、관절낭미수복、골유합정황위유합연지화불유합、불진행CPM공능단련적환자고골과간골절술후슬관절공능회복교차，유통계학차이（P＜0.05）；다인소분석현시，골절류형위C2화C3、ISS평분＞16분、비해부복위、관절낭미수복、골유합정황위유합연지화불유합、불진행CPM공능단련시환자술후슬관절공능회복적위험인소（P＜0.05）。결론：슬관절골절월분쇄，합병손상월중，예후월차。슬관절견강고정、해부복위、슬관절낭수복、술후조기피동급주동진행공능단련유리우고골과간골절술후슬관절공능회복。
Background: Knee joint function limitation often occurs after internal fixation for femoral intercondylar fracture, but the mechanism of functional limitation and factors affecting the recovery of knee joint function are unclear. Objective:To explore the influencing factors of functional recovery of knee joint after femoral intercondylar fracture. Methods:A total of 118 patients with intercondylar fracture of femur were treated by open reduction and internal fixation be-tween February 2009 and February 2014 in our hospital. Their age, gender, fracture reason, classification of fracture, opera-tion time, ISS score, fixed mode, reduction, capsular repair, bone healing, CPM exercise were recorded during follow up. Results:Single factor analysis showed that patients with C2 and C3 types of fracture, high ISS score (>16), no anatomic re-duction, no capsular repair, delayed healing and disunion and no CPM exercise had worse functional recovery of knee joint after surgery (P<0.005). Multiple factor analysis showed that C2 and C3 types of fracture, high ISS score (>16), no ana-tomic reduction, no capsular repair, delayed healing and disunion, no CPM exercise were risk factors of functional recovery of knee joint after surgery (P<0.05). Conclusions: The more severe crushing injury and the heavier of combined injury, the prognosis is poorer. It is advanta-geous to functional recovery of knee joint after femoral intercondylar fracture if patients have rigid fixation of knee joint, good anatomic reduction and capsular repair, and doing functional exercise passively or actively early after operation.
