股骨远端骨折术后膝内翻的原因分析
摘要
目的探讨股骨远端骨折术后并发膝内翻的原因。方法对收治的656例股骨远端骨折术后患者进行随访,观察膝内翻的发生情况,采用单因素分析及二分类logistic回归模型分析膝内翻发生的相关因素。结果643例股骨远端骨折术后患者获得随访,随访(37±1.8)个月,33例患者发生膝内翻畸形,发生于术后9~30个月,平均(16±0.6)个月。单因素分析结果显示:年龄、术前ASA分级、骨折分型、术后是否进行规范的康复训练、复位质量、术中植骨与否、是否合并韧带损伤、术后是否发生并发症及下床活动时间9个因素对膝内翻发生的影响有统计学意义(P<0.05)。二分类logistic回归分析显示:复杂的骨折类型、未行规范的康复训练、未达到解剖复位、术中不植骨是导致膝内翻的危险因素(P<0.05);而无韧带损伤、无发生术后并发症、下床活动时间晚是膝内翻发生的保护因素(P<0.05)。结论重视膝关节周围软组织的修复、术中充分的植骨、围手术期处理及制定术后康复训练计划,可减少术后膝内翻的发生。
引文
[1]李强一,王以进,张秋琴.股骨髁间骨折三种内固定方法生物力学实验研究与临床应用[J].骨与关节损伤杂志,2000,15(1):19-21.
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[3]American Society of Anesthesiologists.ASA physical status classification system[EB/OL].(2011-10-19)[2013-05-01].http:∥www.asahq.org/clinical/physicalstatus.htm.
[4]BUCHOLZ R W,HECKMAN J D,COURT BROWN C,等.洛克伍德-格林成人骨折[M].6版.裴国献,译.北京:人民军医出版社,2009:1619.
[5]ENGH G A,HOLT B T,PARKS N L.A midvastus musclesplitting approach for total knee arthroplasty[J].Arthroplasty,1997,12(3):322-331.
[6]KUSUMA S K,PURI N,LOTKE P A.Lateral retinacular releaseduring primary total knee arthroplasty:effect on outcomes and complications[J].Arthroplasty,2009,24(3):383-390.
[7]LACHIEWICZ P F,SOILEAU E S.Patella maltracking in posteri or stabilized total knee arthroplasty[J].Clin Orthop Relat Res,2006,452:155-158.
[8]WHITE R E Jr,ALLMAN J K,TRAUGER J A,et al.Clinical comparison of the midvastus and medial parapatellar surgical approaches[J].Clin Orthop Relat Res,1999(367):117-122.
[9]李雄杰,蒋家正,李立东,等.32例股骨远端严重粉碎性骨折解剖钢板内固定的治疗探讨[J].中国矫形外科杂志,2007,15(6):474-475.
[10]蓝旭,刘雪梅,葛宝丰,等.持续被动活动促进下肢骨折愈合的微循环研究[J].微循环学杂志,2001,11(3):16-17.
[11]郝振海,周东生,张进禄.GSH交锁髓内钉治疗股骨远端骨折术后早期康复[J].中国康复,2004,19(2):106-108.
[12]SALEH K J,NOVICOFF W M.Starting rehabilitation within 24hours after total knee arthroplasty was better than delaying to within48 to 72 hours[J].J Bone Joint Surg Am,2012,94(4):366.
[13]周殿阁,吕厚山.膝内翻全膝关节置换术软组织平衡方法探讨[J].中国修复重建外科杂志,2006,20(6):602-606.
[14]周游,李新志,卢国强,等.膝关节周围骨折术后膝内翻原因分析[J].中国矫形外科杂志,2010,18(4):336-338.
[15]KAMMERLANDER C,RIEDMLLER P,GOSCH M,et al.Functional outcome and mortality in geriatric distal femoral fractures[J].Injury,2012,43(7):1096-1101.
[16]贝朝涌,王锐英,唐际存,等.股骨远端骨折术后膝关节功能恢复影响因素分析[J].中国修复重建外科杂志,2009,23(9):1053-1057.
[2]MARTINET O,CORDEY J,HARDER Y,et al.The epidemiology of fractures of the distal femur[J].Injury,2000,31 Suppl 3:C62-C63.
[3]American Society of Anesthesiologists.ASA physical status classification system[EB/OL].(2011-10-19)[2013-05-01].http:∥www.asahq.org/clinical/physicalstatus.htm.
[4]BUCHOLZ R W,HECKMAN J D,COURT BROWN C,等.洛克伍德-格林成人骨折[M].6版.裴国献,译.北京:人民军医出版社,2009:1619.
[5]ENGH G A,HOLT B T,PARKS N L.A midvastus musclesplitting approach for total knee arthroplasty[J].Arthroplasty,1997,12(3):322-331.
[6]KUSUMA S K,PURI N,LOTKE P A.Lateral retinacular releaseduring primary total knee arthroplasty:effect on outcomes and complications[J].Arthroplasty,2009,24(3):383-390.
[7]LACHIEWICZ P F,SOILEAU E S.Patella maltracking in posteri or stabilized total knee arthroplasty[J].Clin Orthop Relat Res,2006,452:155-158.
[8]WHITE R E Jr,ALLMAN J K,TRAUGER J A,et al.Clinical comparison of the midvastus and medial parapatellar surgical approaches[J].Clin Orthop Relat Res,1999(367):117-122.
[9]李雄杰,蒋家正,李立东,等.32例股骨远端严重粉碎性骨折解剖钢板内固定的治疗探讨[J].中国矫形外科杂志,2007,15(6):474-475.
[10]蓝旭,刘雪梅,葛宝丰,等.持续被动活动促进下肢骨折愈合的微循环研究[J].微循环学杂志,2001,11(3):16-17.
[11]郝振海,周东生,张进禄.GSH交锁髓内钉治疗股骨远端骨折术后早期康复[J].中国康复,2004,19(2):106-108.
[12]SALEH K J,NOVICOFF W M.Starting rehabilitation within 24hours after total knee arthroplasty was better than delaying to within48 to 72 hours[J].J Bone Joint Surg Am,2012,94(4):366.
[13]周殿阁,吕厚山.膝内翻全膝关节置换术软组织平衡方法探讨[J].中国修复重建外科杂志,2006,20(6):602-606.
[14]周游,李新志,卢国强,等.膝关节周围骨折术后膝内翻原因分析[J].中国矫形外科杂志,2010,18(4):336-338.
[15]KAMMERLANDER C,RIEDMLLER P,GOSCH M,et al.Functional outcome and mortality in geriatric distal femoral fractures[J].Injury,2012,43(7):1096-1101.
[16]贝朝涌,王锐英,唐际存,等.股骨远端骨折术后膝关节功能恢复影响因素分析[J].中国修复重建外科杂志,2009,23(9):1053-1057.